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FPE11kt1r t! LICENSED CONTRACTORS DECLARATION m licensed under.the prM%imy of Chapter g(cont nanoi coir$agivr 7000)of Division 3 of fl9.asnesrrtl d my license is in full fore and effect. Explratlon Date Contractor OWNER-BUILDER DECLARATION hereby afRrm met I am exempt from the Conlrectoa'a License Law for the fdtowing reason I5eman 7031.6,Buskreae end p roreaSions sdso r Aires Bre ap Mica fw ch"' h pehmA tO to WrlsrnrG alter, mprove,tlemoAslr.ar repair any structure.prior to ifs Issuance, e9u slgnad ataterrrenl Ihe[he Is Roenasd hamfsa Lew(Cfraptev 8(connhsncing wNh t3ertiorl 7000)d Dirlslon 3 of the Bwineas and prof10 the prasisbns of dre CeMraetara harsher and the heels for the alleged plias. pry ylolation of Seytion 7037.5 Cpl alone pCode)of Mat he the s e3emN ro e rti r t penaity M nq more then five hundred dollars(as0o)): by any a IraM for a Q I.>H owner of erepropadis or my afrgfoyaes wlBf wages as tusk sok DDmpensatlon,cots do the work.and Bre etna:here is rho( iMefMad or offered for sate(Section 7t)/4,Bustrfass end Professions Code:The cenhactofa Classes Law poet not appy to an orvrteriW. not of property who bolds or mrproves Brsrsan.and who does such work herhsetf ar 1Motrgtf his ohm employees,t appled that con rod own rher-bkdlder Ishave the burdenfo � if h�ww.the twildrrrg or&nPmvwrwd is sold within one year of + pravtng that he dd not build or inprove forthe purpose of sale.) 0 tPmkasbnOwnera Code B&PM am arclasWey contracting with lioer>sed contractors to cansvuet the project Sectio 7044.Business and and who ( M*Contracpors Lloanse Law does not apply to an owner of property who builds or Improves hereon, . cartetnrcb forsuch omthactor(e)Scenasd pursuant to the Contractors license Law.). O t am ekempl under Section , B&PC for thio reason Date: Owner. WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a cerg=ta of Consent to seimnsurs or a certircete of Workers'Compensatlpn Insurance,or a certified Copy thereof(Section 3600,(,abor Cade). Expiration Date (spam a Certified copy Is hereby furnished i 0 Certified copy is filed with the Environments?Health Department 4 CERTIFICATE OF EXEMPTION FROM WORKERS.COMPENSATION INSURANCE MIS "on need n r one h02M dollars f certify that In the performance of the work for which this permit is issued.I shag not employ any person in any manner so as to became subject to the Workers'Campensaeon Laws of Cwftrnia Dat: Applicaa! NOTICE TO APPLICANT:If,aftr maidng this Certificate of Ecempllan,you should become MbJeet to the Workers'Compensation prod51ons of the Labor Code,you must twOw tfh comply with web provisions or this permit shay be deemed revoked. ' lk CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a eonstruCifon lending agency for the performance of the work for which this permit is issued (Section 3097,Civil Code), Landers Name Lender Address DMSION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION O 1 hereby oenify that no excevaWn five(a)or more feet In depth Into which person is a persis required to descend,coil be made in connection wth work authorized by the permit end that ma building stncture,am kflnp,falaewvrk,or demoNtion or dtsma" thamor,will be mere than etdrty-six(36)fest NO.(Chapter a2.Group 2,ArticJs 2,Section 341, title E,CaNtomfa Admhhi t ffvs tea)._er-b_ _ O As ownuilder,1 win not r p' •` Mi'" Industrial 0 anyone ID.de work from would isIon,e a permit from the Division of Industrial 9 above,unless attar person hes a permit to de such work from Ina NvLslat. � �'��etl 0 Division of Industrial safety PermR N i !oenry that l have read this appliceaon and state that the above inu. tion is coml:d.I agree to mmpy with el city end countyl ordinances and state haws relating to well eonstrudlon and or sewage system eonehuction,and hereby auatartre representatives of"s J county to enter upon Bre above-mentioned property for chspsdiwr ptepows. Dat N Applicant END43-07 101SW - LICEN5W00NTRACTMDECIARATM J