|
i
<br /> JOB ADDRESS: PERMIT 4:
<br /> LICENSED CONTRACTORS DECLARATION
<br /> I hereby affirm that i am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business
<br /> and Professions Code and my license is in full force and effect.
<br /> License N_ Expiration Date
<br /> Date Contractor
<br /> OWNER-BUILDER DECLARATION
<br /> I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and
<br /> Professions Code: Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to
<br /> its issuance,also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the
<br /> Contractor's License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he
<br /> is exempt bereftom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
<br /> the applicant to a civil penalty of not more than five hundred dollars($500)):
<br /> 0 1,as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not
<br /> intended or offered for sale(Section 7044,Business and Professions Code:The contractor's License Law does not apply to an owner
<br /> of property who builds or improves thereon, and who does such work himself or through his own employees,provided that such
<br /> improvements are not intended or offered for sale. If,however,the building or improvement is sold within one year of completion,
<br /> the owner-builder will have the burden cf proving that he did not build or improve for the purpose of sale.)
<br /> 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
<br /> and Professions Code(B&PC): The Contractor's License law does not apply to an owner of property who builds or improves hereon,
<br /> and who constructs for such projects with a contractor(s)licensed pursuant to the Contractor's License Law.)
<br /> 0 1 am exempt under Section , B&PC for this reason
<br /> Date: Owner
<br /> WORKERS'COMPENSATION DECLARATION
<br /> 1 hereby affirm that I have a certificate of consent to self-insure,or a certificate of Workers'Compensation Insurance,or a certified
<br /> copy thereof(Section 3800,Labor Code).
<br /> Expiration Date Company .
<br /> 0 Certified copy is hereby famished
<br /> 0 Certified copy is filed with the Environmental Health Department
<br /> CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE
<br /> (This section need not be completed if the permit is for one hundred dollars($100)or less)
<br /> I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to
<br /> become subject to the Workers'Compensation Laws of California.
<br /> Date: Applicant
<br /> N0TICE,,TO,APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
<br /> Compelf�aljgnp'ovisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked.
<br /> r
<br /> CONSTRUCTION LENDING AGENCY
<br /> I hettkiy..aff firm that there is a construction lending agency for the performance of the work for which this permit is issued(Section
<br /> 3097X,tool Cade).
<br /> LendeA.:4
<br /> r's Name
<br /> Lender'Address
<br /> 'DIVISION OF INDUSTRIAL SAFETY PERMIT CERTICATION
<br /> ❑ 1 hereby certify that no excavation five(5) or more feet in depth into which a person is required to descend,will be made in
<br /> connection with work authorized by the permit,and that no building structure, scaffolding,falsework,or demolition or dismantling
<br /> thereof,will be more than thirty-six(36)feet high. (Chapter 3.2,Group 2,Article 2,Section 341,Title 8,California Administrative
<br /> Code).
<br /> 0 As owncr-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as
<br /> noted above,unless such person has a permit to do such work from the division.
<br /> 0 Division of Industnal Safety Permil N
<br /> I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
<br /> ordinances and state laws relating to well construction and or sewage system construction,and hereby authorize representatives of this
<br /> county to enter upon the above-mentioned property for inspection purposes.
<br /> Date Applicant
<br /> ERD 43-0]-007 LICENSED CONTRACTORS DECLARATION
<br /> 12'11P2D02
<br />
|