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I JOB AODRE6a:17 PERMITfl:_ 'LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code and my license to In full force and effect. Liconso 11 C 964224 _c 7 Expiration Date 08/31/2021 Date___ .?O Contractorf ��1 C� 7�2✓C77bt�` 2✓/�S OWNER-BUILDER DECLARATION I hereby strait Ihsl I am exempt from[he Contractor's License Law for Iho follmving reason(Section 7031.6,Business and Professions Code: Any city or county which requires a permit to consbucl,alter,Improve,domollsh,or repair tiny structure,pilot to Its Issuance, also requires the applicant for such permll to file a slgnod statement that he Is licensed pursuant to the provisions of the Conlroclora License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or the(tie is exempt horofrom and the basis for the alleged exemption. Any violation of Section 7031.6 by any applicant for o permit subjects Ilia applicant to o civil penalty of not mora then five Hundred dollars($60D)): ❑1,as owner of Die property,or my employees with wages as their sole compensation,will do Ilia work,and the abucluro Is not Intended or Offered for sale(Section 7044,Business and Professions Code:The conlraclofe License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or through his own employees,provided that such Improvements are not Intended or offered for solo. 11,however,the building or improvement Is sold within one year of completion,Ilia owner-builder will have the burden of proving that he did not build or improve for Ilio purpose of sale.) i L7 I,as owner of the property,am exclusively contracting with Ilcensed contraclors to construct the project(Section 7044,Business and P(OfOSilans Code(B&PC): The Contractor's License Law does not apply to an owner of properly who builds or Improves hereon, and who constructs for such projects with o conlraclof(s)licensed pursuant to[tic Contractor's License Lew.) ❑I ani exempt under Section , B&PC for this reason Data: Owner WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent(o sel6lnsuro or a ceutificato of Workers'Compensolion Insurance,or a certified copy thereof(Section 3800,Labor Code). Expiration Dale 08/02/2020 Company State Workman's Comp Fund 9066578 O Catiaad copy is hereby furnished to Cert holder Crawford &ASSC. ❑Certified copy Is riled with the Environmental Health Department CLSB CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE (this section need not be Completed If the oermll Is for one hundred dollars(5100)or essl I codify Ilial In Ilia performance of Ilse work for which this permit Is Issued,I chall not employ any poison In any manner so as to become subject to the Workers'Compensallon Laws of California. Date: Applicant NOTICE TO APPLICANT:If,alter making this Certificate of Exemption,you should become subject to the Workers Conipensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for winch this permit Is Issued(Section 3097, Civil Codo). Lender's Name Lender's Address DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION ❑1 Hereby certify that no excavation five(6)or more foot in depth Into which a person Is required to descend,will be made in connection with work authorized by the permit,and that no building slmrluro,scaffolding,falsework,or demolition or dismantling (hereof,will be more than thirty-six(38)feel high.(Chapter 3.2,Group 2,Article 2,Section 341,Title D,California Administrative Code). ❑As ownor-buildor,I will not employ anyone(0 do work which would require o permit from the Division of Industrial Safety,as noted above,unless such parson has a permit to do such work from the division. ❑Division of Industrial Safety Perailt 9 I certify that I have read this application and stele that the above inroanolion it con 1 agree to comply with all city and county ordinances and slate laws relating to well construction and or sewage system censlru o,and h9feby authorize re rationalities of Ihls county to enter upon Ilia abovo-menlioned properly for Inspection purposes. Dale -_-_- CZ.- Z� - 19 Applicant Fits 4302001 LICENSEO CONTRAOTORS OECIAMTION 648.011