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Jos ADDRESS: PERMIT <br /> 0 <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 0 <br /> and Professions Code and my license is in full force and effect. <br /> License# Expiration Date <br /> Date Contractor <br /> OWNER-BUILDER DECLARATION 0 <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 herefrom 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)): 0 <br /> ❑ I, 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 0 <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 of proving that he did not build or improve for the purpose of sale.) <br /> ❑ I, 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, E.J <br /> and who constructs for such projects with a contractor(s)licensed pursuant to the Contractor's License Law.) <br /> ❑ I am exempt under Section , B&PC for this reason 0 <br /> Date: Owner 0 <br /> WORKERS' COMPENSATION DECLARATION <br /> I hereby affirm that I have a certificate of consent to self-insure,or a certificate of Workers' Compensation Insurance,or a certified J <br /> copy thereof(Section 3$00, Labor Code). <br /> Expiration Date Company <br /> ❑ Certified copy is hereby furnished <br /> ❑Certified copy is filed with the Environmental Health Department <br /> CERTIFICATE OF.EXEMPTION FROM WORKERS' COMPENSATION INSURANCE <br /> r (This certinn need not ha rmmnlrte.ri if the nermit is fnr nnr himrirPrl rinllnre(TI nm nr heel <br /> � ZOOZIUS <br /> 1IWN9d WS3 <br /> o-Zo"E7 aHH <br /> i <br /> /V OUO �Z ) 0-5#lsan au aau�aSeg Pall!u�ajl#Q!!!aM #aa!onul als{i lunoutd <br /> �,dbci i?N i9Ao o-zz-�, Sr.N3"Noo o <br /> if indaQ Ilam palanjlsuoa alpq Cg uo�laadsu!uotlatulsad <br /> pan[aaag a3AlvM ❑ ?v-� 2-� ale(] +C8 uonaadsu!dulnd <br /> ;�luaad [Ia,N'IVlJ3d$ 13alep C8 uonaadsuE mo�� 0 <br /> f L #C!!aadoldu�d easy algia ' 1 fl� 49 palaaaay uopealldav <br />