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JoeADOW56: L` Rs�Z ) ecu Y.. 1 Z� �S(�At,�A� CP] l._J�o Pt fsialT r: LICENSED CONTRACTORS DECLARATION t heroby aeim Ofae 1 asr Mesrtea0 uixls+:na cx i0tts d Chapw (�`"a^ ':SeccrOn 700Q)d Divlsloet 3 of fe BUaeur end Professions Coda and my lasnee k In kA kxcs and Lfo10lns fi R F 7/ - Dela OWNER-OWLDER DECLARATION I lwsby ankrn ewt I am exanp hon+the C.Onsra+`t`hr 6 i. rhrart Law for It*foaowwv ressw(Sechan?031 S.Busvv"and Professions Codw Any dry or county wfwch►epcsree a proal:O arxasu t, wirer,nwove.demdiah.Or reps+any structure.pricy to its asuance, ado re*rss the sopacant for such peerrPd 10 Me a sognect roatarrera haat reu is 6w-d purawo b rie pravwons of the Contraclurs Lowtea Ls*;Ch Wer 9(00,nm ano V w.1!+ swt�n 7010?d Dmwcn 3 of true Bkmrass and Pnotae«ons Code)a thea he a azo' am aws6on p the be"for the attegea e:empw Any v on 7031 5✓1 any whcam for a ps"rA subtects the WO-cant to a dvM P&Vft d rat more than"hundred doM M(SNOC I: O 1.se owner of oe property.or mhy�s wnh>MOM r thaw sob comps*usdeOn we pro t o work. and ee strudsae s not ell6a4 'or orated fpr sate(Sechon 71)44, t'uas'rNs and Pmd"*kW*Cods The OonVaMes Lroanse law pop not apply b an owner of props"who txrelds of wyclotiees vw mn,and who does with work hwr aav Or show hos own employees.povfdsd Otat such snprov wft are hat wAwx*d or 00&md for 1616 If, hOwft r tM^ txrfdwtp +x mxnrovemen'. w add "I"" wo year of 00rn011e6on.the owrw-bud wrt here OIs boroon of W74"hast he dwi not WW')r Anptrne V"purpo"o1 ears) O I.as ownw of In poverty.ion asdprvdy coAredlif WO koeraed wn"dors b ow%tuct the protect(Secton 7044.Buskeae and Profeserae Cods(B&pq The Cor*OdWs Lfowtea Law does not appy to an owner of prop"w tv brads Or rrV-A*'No and who Const wft fcr such profsds*IV:s oxantraclor(s)jxw6 xf pwsuent to Rte Contractors I.sc.wr+se Law) D 1 an emmo Under 30cwn BBPC W ter Mason Dula: ,!___. C)htrfter WORKERS*COMPENSATION DECLARATION I hereby affirm OW I have a cert@fcM of consent 10 eaff.xtsure Or a peMfrate,-0 WV*e Co*'�xr Sa. ;n��xa� cr a Cartr9ed Copy hereof(Secyoon 3WO.Labor Code) Ettpirstkm Dale Company O CettAed Dopy 06 hereby hrtroahed 13 Certdhed copy as ffied wt,the Envhron+rharttal►teskh PA4w r"Twv CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE Ma astAgn Cud not be oornrdel d'L'y t owt/y RAR b the pe+br*svnc e d tfle v�A won r:•.h s pronto It s¢M»d.I sho not emp+oy&W P—xv-any mhwhn w 60 M 10 be='*99110ct to tne'Irtxks+*r Corr+pe t<� lawn» r Caoom* -_ ------- NOTICE TO APP(-ICJINT t1, MWtrtakir+p d"Certthcasr Of Exert+pan. you should bevy' sub)Oc tO "Workers'Car+Aawabon pmvwiom of Thr Labor Code.you must brOt"th cc'-"weh went P of*"psnnrt%Wbe 6m-,ed tevokad CONSTRUCTION LENDING AGENCY I hwobt MIN—,P,1w here is aG4r`-1UUi!-i4!i Nd:tu'�s.:'�+'gwnc. y for rNe Cl8�N�4r'��1`C�tf'�Q MItDh'k�Cd M�'t t`�h h::S;.�E•.••,;:t-.S-PSURj i�.�On 3(.��, CRY$CC40) Lend#e%Nerve lenders Address _ DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION p 3 hereby cor-1y 11hat nO ax::avabo n oke (5) or more few. rr: ;feVh �rlc, +v'"& a �Wu:-�, :3 requ.re.: t-:) desoand.IMM be I, in c"wcbo+n wain work sAhontad by the parrot.and" no WON lr-KI rre seaffoWN fa wwort� or do gN mnor dWnNWV mereof.wo ten mors Oen orrty-ism(36)toot h9h (Chap*, 3:: Group 2, Art-Ae 2. Sectrn 34, TWO a.CaMOrw Ad""n'5V4&6 Com) 13 As 0warer•bv#4Q, i*0 not'afrVoy an -� do work wtvcP*mad ^r,L rr d p8n"dh tird-9*DN(Aont d VWL WW Satety,as nosed above,aueas wd,pwaem has a Per"6,vas such wroth from the del O Dwwon cl Industrna-Satiety Pw",,a I tnsrllfty rt et t Haug ^ears tl+Ps apq&slur+ sort wroth ft at tfNt ett vs trtfOttTtat►orh f6 pofraGt l apse b oon+py rslOt N dry and CCU" Cry &too saws rewty to wee wnritr;t^On and or savage system ow4vucb-.and imp"au torlie reprsawMs"Vee of Otis oouMy to er w Llp-r p-,e above-n►snara pfor"kx hnspKbon Purposes Ute Appeeerrf _— ttCEMIED COMTRACTORS DEC-"ATM E�f.Tt12-0D7 ( A-76Ce I _