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.IDB AOOeu: 00 8West Mossdale,Lathrop,CA 95330 PU.an K: LICENSED CONTRACTORS DECLARATION I hereby athan that I an ficensod under 0.povivms of CwPW 9(commaaJng with Se b'm17000)of Division 3 of tiro Basi ss am Professions Cade and my license Is In for force and vff a L.kamet 710079 Expiration Dara 7(31115 Date �- --T Contractor t � OWNER-BUILDER DECLARATION I hereby atom that 1 an exempt from tha Cd+t es license Law ton the fosawi g mason(Seahon 70315,Suet.am!PMessions Code: Any city or county,which reoukes a pen b construct.sitar,owrow.demol sh.or repair any sTctme.prior to Its bsuance. also raduires the eppir for sudh permit to No a e4red sbtetnam that na Is Irnrcod prynnt to trn powions of Ma Gonhacbls Lkeme Law(Choptar 9 Scomnencay WM Semon 7000)of Division 3 d.the Busna,..ad Professions Code)or thlf he is anent htlef m ad tlro basis far she alhi e.c p6c i. Amy vbt.idon of Section 7031.5 by any sppkpartt for a pent subje s Mr applchnt m a cil penally of not rode than Mo hundred dollars($.500)): 0 I,as oweor of the propory.or nw employees with wapas w their bole pmpmsanon,will do the work.and aro stfucbnr-Is ret hdadni or offered for sale(Soden 704x,BW- w and Profesabrs Coda The,mlb s Lirvi Law does not apply n afro owner at property who bards of Mlppras thereon.and who does such work Innsa Or VvDLO Ns awe a 00)`M3.pOYIdim 9Wl YJCh mpewmenb are rot"ended or offered for Lae. If, howewn,Me buddrg of Ynprownrer4 Is Sold with'o cna year of cdnpenon,the ow,pr Wildon will haw ere buldon of Poring Mat he old ret Wald or inprow for the Prpoyi of sate.) o,as owner of the property.or,mdusivoly con"ca g with Iloensed rorhbadds m comb,,,the Mat(Section Mm.Business all Professions Code(UPC): The Con"CWea LIWma law does ret apply b an ownor of propenY wfe WV43 Or Improsas heroin, and who constructs for such Projects with a amftaSG r(a)licensed puryant b the Contracws lkeose Law.) 131 am exemptoder Saabs r BdPC for the reason WORKERS'COMPENSATION DECLARATION I hereby off nn that I have a uaNficate of hareem to seN-,,,h,m a eaffficaho of Workers'Canperm!�Irourante,or a certified ropy t hemd('Section 3800,LabwCode). /� C2 Expiration Dale 1LI11 RED'-) CompanyOV0A ( i 6 ❑Cemhod ovy Is hateby hirnished O Certified copy is Nod with the Emironmenl Health DepaMnenl CERTIFICATE OF E)IEMPTION FROM WORKERS'COMPENSATION INSURANCE (Thus sec0 m reed not be cvntolated if the pemkt Is for one h•rued dopa ($100)a ess1 I croft that in the perforrturce of Ma work for which"a pent is Issued.I shrill not enp$oy all Person in any manner so es to botorre subject to the Workers'Compensation Lows of Cali Gn Date: Applicant — NOTICE To APPLICAKT:e.aear—un t ConOkae of Eaemptlan,you stead oomrna abjed to the Wadmrs'Gampor¢ o prevabns of the Labor Code.you moat fcnhwiM comply with sial provisions a the parma shall to deemed RMed. CONSTRUCTION LENDING AGENCY I hereby afitfm that there Is a wnsbX6041 lendfiM agWICY for the Wfamance of thd work for which INS perntH is issued (Section 3097,Civil Code) Lender's Nem- -- --- Londer'Address _ DMSION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION 0 I hereby oaraty sat ro eoo;wason fiw (5) or mere feet In depth Imo wl w a Parson Is required b descend.roll W made in carsroabn wT b/the pon^i.and that ro bu"N struaum.sr�llol&n9.hen r knvit"or ohroarrillm in6Va9ve ch.,i will W mory Man Minta (m)foot high.(Chapter 3 2.Group 2.Article 2.Section 351,Troe Code). 0 As owrer.hebar,I wet not empoy eraser m CO work whkh would mquim a pdmn hen esu Glrlacn u.`Indusbiwl Safety.os road ob-we,unas,yah Dorson has a tams to do yrs work from the dMsbn. 0 Dhision of In histrlei Slaty Perron s -- I cenhly,Mak 1 haw read this appieuaan is,jeer'.Mel the above kaonnabon a rarhoct 1 a3rwn la mmPly with at city all rowdy erdnan®s and myo taws nil&e to"I d n euddon and or sewage system mn5ntdbn,and hereby auan¢e rapamnmtlws Of th s county to enrtor upas-ha adN-Inornbwd property for Lnwoc-on WrPoras' Dato _ Applicant 1�rsco cerci trwcrrn u orwn..ran Eloaya7 tarsal