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HI_lia-E6-E1711121 02:L i F' FRIC-11:E1,1PRI]El15'E1 ^'�Lc?%1 T0: 1E1=1'�^44 i 1=11=1 F'.E Joe ADDRESS:— PERMIT M LICENSED CONTRACTORS DECLARATION I herahv nrffrm that I am licensed under Via provisions of Chapter 9(commencing with Sectlon 7000)of Dlvislon 3 of the Buslnrrss and Professions Cade and my license is In full force and effect. t) J q /'i 0 h o 1 L Lfcense ttt "7Z'"t—to C 7 Expiration Data V_ Date. " J0 Contractor �h N�`1✓aod O0 r(� OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's Llcenee Lew for ate follorMno reason(6ortlon 7031.5,business and Proresslona Cade: Any city or county which requires o permit to conatruct,alter,Improve,demolish, or repair any slrumuia,prior to Its Issuance, Bleu tequIIen ale applicant for such porrrin to life a signed statement that hn in bcnnnrd punsuanl to thn provteluns of tho Contractor's License Law(Chapter B(commencing with Section 7000)of Division 3 of the Business and P(oresslons Code)or that he Is exempt horofrom and the basis for the ellegao exemption. Any vlolabun of$cAiorl 7031.5 by any applicant for a pertrilt euufoCle the applicant to a uivl Welty of not more than five hundred dollars(3500))' d I,as owner of the property, or MY employees with wages na then sole compensation, will do the wnrtr, onA the slruc[ure Is not Intended nr otfarad for Rale(Section 7044, Business and Professions Code: The contractors License Lew does net apply to an owr)er or pmpetty who builds or Improves thereon,and who coat ouch work himself or throvgh his own rxnployeos,provided that such Improvomonit aro not mtond.ld or offered for Salo If, however the bulldhhg or Improvement Is shirt within one year of cnmplelfon,the ownor•builder will have the Wrden of proving ami he did not build or Improve for the purpose of Sale) Q I,as own6f of the property,nm oxcluslvey contracting with licensed contrartont to con®hruct the project(Soctlon 7044,Rutlnoss and Protossfons Code(B$PC): The Cantraelore License Law does not apply to an owner of property who builds or improves hereon, and who constructs for such projects vAh a eontrector(a)Iiccnset7 pursuant t:)the Coniractor'a Liconae Lav+.) ❑1 amexempl under 6e4c;aon _ 68PC for thts rKasan Data: Owner. WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self-Insure or a certiricale of Workers'Compensatlon Insurance,rae' certified copy thereof(Section 3800, Labor Code). 1_� /o M �y Expiration Date-0/ ZJI v Company 7V 1.. CI Ce IAod copy Is hnroby fumished Certlfled copy is filed with the Environmental Health Deparhnent CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE Thls sertlnn need nal be completed If the_p9rrnft 1N for one hundred dollnrm($100)or less). I crlrtlfy 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 become subject to the Workers'Compensation Laws of California, Date: Applicant - NOTICE TO APPLICANT: If, slier making this Certillcate of Exemption,you should hecoms subject to the Workers' Cn,nP"'nsetlon prnvislons of the Labor Code,You must forthwith oompy with such provisions or thio pemhii shall be deemed ravokud. CONSTRUCTION LENDING AGENCY 1 hereby atlam that there Is a construction londiny agency for the performance of the work for wniCll this permit 15 Issued (Secfion 3097,Civil Code). Lender's NAm1 Londoe Address I DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION ❑ 1 hereby certify that no excavation nve (5) or more foot In depth Into which a potsun Is required to descend, will be made In cunuucliun wilh work authorized by the permit,and that n0 hulldln0 etrueturo. Rcaflolding,falsewofk. or rlr,molltinn or dismantling thereof,will be more than thirty-six (35) feet high, (Chapter 3.2, Group 2,Article 2,Section 341,Tide 8,California Adminlstralive C ode). ❑As owner-hulldar,I will not employ anyone to du work which would require a permh from the Division of industrial Safety,as uote0 000va,unloss such parson has a permit to do such work from the division. 0 plvislon of Industrial Safely Permit 4 I certify that I have road this application and state (flat the above information is correct I ugrao to cvmpy with al!city and county ordinances and allte.laws relating to wall construction and Or 8ewa00 system construction,and herchy authorize representatives of thls county to onfor upon the obove-n-Allooed property for inspenann purposes Date Applicant ENU 3J-07 UCENeED CONTRACTnR DCCI.AnATION 1 WSW