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JoeAooReaa 4000 Aplicella Ct. PenrlrtY: <br /> LICENSED CONTRACTORS DECLARATION <br /> I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section,7000)of D-sion 3 of the Business and <br /> Professions Code and my license is in full force and effect. f <br /> Licenser_ �15`­i Up'l - - . Expiration Date <br /> Date �I 2� Contractor GeD_F_�( <br /> — r OWNER-BUILDER DECLARATION <br /> I hereby affirm that am exempt from the Contractor's License Law for the following reason(Section 7031.5,Business and Professions <br /> Code: Any city or�ounty which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance, <br /> also requires the applicant for such parrot to file a signed statement that he is licensed pursuant to the provisions of the Contractor's <br /> License Law(Chap6r 9(commencing with Section 7000)of Division 3 of the Business 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 a civil penalty of rot more than five hundred dollars(S500)): <br /> ❑I,as owner of It a property,or my employees with wages as their sole compensation,will do the work,and the structure is not <br /> intended or offisied for sale(Section 7044,Business and Professions Code:The contractor's License Law does not apply to an <br /> owner of properly 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. H, however, the building or improvement is sold within one year of <br /> completion,the nen-builder will have the burden of proving that he did not build or improve fru the purpose of sale.) <br /> ❑I,as owner of the property,am exclusively mntracting with licensed contractors to construct the project(Section 7044,Business and <br /> Professions Cod (B8.PC): The Contractors License Law does not apply to an owner of property who builds or improves hereon. <br /> and who constru s for such projects with a contractor(s)licensed pursuant to the Contractors License Law.) <br /> j ❑1 am exempt and r Section BBPC for this reason _ <br /> i <br /> Date: Owner <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 copy <br /> thereof(Section 380),Labor Code). 1 <br /> Expiration Date !I^ — Companya�t? ZnS-0(cinc <br /> 0 Certified copy is hereby furnished <br /> ❑Certified copy is filed with the Environmental Health Department <br /> CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE <br /> I if h r i for n hundred dollars 1 r l <br /> I certify Nat in the Aormanoe 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 /> Date:_ _. 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 that there is a construction lending agency for the performance of the work for which this permit is issued(Section 3097, <br /> Civil Code). <br /> Lenders 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,falsework,or demolition or dismantling <br /> thereof,will be more than thirty-six(36)feet high.(Chapter 3.2,Group 2,Article 2,Section 341,Title 8,California Administrative <br /> Code). <br /> E3 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 /> ❑Division of Industrial Safety Permit# <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-rmantioned property for inspection purposes. <br /> Date ---- ---- Applicant <br /> EHo 43 e2 007 LICENSED CONTRACTORS DECLARATION <br /> fl 28 e0 <br /> i <br /> L— <br />