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0E/2E%2019 13:50 Canepa & Sons {FAX", P.0031"004
<br /> Jos ADORESS�,D�`192 -5. y -I TYW* PERMIT#:
<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 buslness and
<br /> Professions Code and my Ilcenae Is In full force and effect.
<br /> License# 425749 Expiration Date 7/31/2020
<br /> Date Contractor CANEPA AND SONS,INC.
<br /> OWNER-BUILDER DECLARATION
<br /> I hereby affirm that I am exempt from the Contractor's License Lew for the following reason(Section 7031.5,9USIness and Professions
<br /> Code; Any City or County which requires a permit to construct, alter.improve, demolish,or repair any structure, prior to its issuance,
<br /> also requires the applicant for such permit to file a signed statement that he Is llcensed pursuant to the provisions of the Contractor's
<br /> License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Susiness and Professions Code)or that he is exempt
<br /> herefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant
<br /> to s civil penalty of not more than five hundred dollars($500)):
<br /> ❑ I, se owner of the property, or my amployces with wages as their sole compensation,will do the work, and the structure is not
<br /> intcndod or offered for sale (Section 7044, Business and Professions Code: The contractor's License Law does not apply to an
<br /> owner of property who builds or Improves thereon,and who does such work himself or through his own employees, provided that
<br /> such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of
<br /> completion,the owner.builder will have the burden of proving that he did not build or Improve for the purpose of sale,)
<br /> p I,as owner or the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and
<br /> Professions Code(B&PC); The Contractors 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 /> ❑1 am exempt under Section , B&PG for this reason
<br /> Date: Owner
<br /> WORKERS'COMPLN5ATION DECLARATION
<br /> I hereby affirm that I have a certificate of consent to self nsure or a certificate of Workers'Compensation Insurance,or a certified copy
<br /> thereof(Section 3800,Labor Coda),
<br /> Expiration Date 7/16/2019 Company CALII'OPN1A INSUILINCE COMPANY
<br /> ❑Certified copy is hereby furnished
<br /> ❑Certified copy i9 filed with the Environmental Health Department
<br /> CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE
<br /> iThia section need not be completed if the permit is for 901a hundred dollars($100)or lessi
<br /> I certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to
<br /> become subject to the Workers'Compensation Laws of California,
<br /> Data: Applicant
<br /> NOTICE TO APPLICANT; If, after maKing this Certificate of Exemption, you should become subject to the Workers' Compensation
<br /> provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked.
<br /> CONSTRUCTION LENDING AGENCY
<br /> I hereby affirm:hat there is a construction lending agency for the performance of the work for ivhloh this permit Is Issued(Section 3097,
<br /> Civil Cod¢).
<br /> Lender's Name
<br /> Lender's Address
<br /> DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
<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,fslsework, or demolition or dismantling
<br /> thereof, will be more than thirty-Six 00)feet high. (Chapter 3.2, Group 2, Article 2, Section 341, Title 8. California Administrative
<br /> Code),
<br /> ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted
<br /> above,unless such person has a permit to do such work from the division.
<br /> ❑0lvlslon of Industrial Safety Permit 4
<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-mentloned property for inspection purposes,
<br /> Date Applicant
<br /> EMD 43-02-007 LICENSED CONTRACTORS DECLARAT:oN
<br /> 6-26-09
<br /> Received Time Jun, 26, 2019 1 :46PM No. 5207
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