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Apr.26, 2018 9:11AM Canepa & Sons <br />JOBADDRESS: Lz011 E. 12o. PERMIT#: <br />LICENSED CONTRACTORS DECLARATION <br />No.1355 P, 3/4 <br />I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and <br />Professions Code and my license is in full force and effect. <br />License# 425799 Expiration Date 7/31/18 <br />2 <br />Data. Contractor CANF2A AND SONS, rNC. <br />OWNER -BUILDER DECLARATION <br />I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Bysiness and Professions <br />Code: Any city of 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 licensed pursuant to the provisions of the Contractors <br />License Law (Chapter 9 (commencing with Section 7000) of Dlvislon 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 penally of not more than five hundred dollars ($500)): <br />❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure Is not <br />Intended 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 />CJ 1, az owner of the property, em exclusively contracting with licensed contractors to construct the project (Section 7044, Buslness and <br />Professions Code (B&PC): The Contractor's 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 />LI I am exempt under Section , B&PC for this reason <br />Date: <br />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 <br />certified copy thereof (Section 3800, Labor Code). <br />Expiration Date 7/16/18 Company CALIFORNIA INSURANCE CO. <br />❑ Certified copy is hereby furnished <br />M Certified copy Is filed with the Environmental Health Department <br />CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE <br />TI hls section need not be completed if the permit is for one hundred dollars ($100) or less) <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 <br />as to become subject to the Workers' Compensation Laws of California. <br />Date: <br />Applica <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 <br />(Section 3097, Civil Code). <br />Lenders Name <br />Lender' 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 then thirty-six (3e) feet high. (Chapter 3.2, Group 2, Article 2, Section 341, Title a, 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 />M Division of Industrial Safety Permit # <br />I certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county <br />ordinances and state laws retailing to wall construction and or sewage system construction, and hereby authorize representatives of this <br />county to enter upon the above-mentioned properly for Inspection purposes. <br />Date <br />EHD 43-A7 <br />101&07 <br />Received Time Apr,26. 2018 9:21AM No -3423 <br />Applicant <br />UCENSEO CONTRACTOR DECLARATION <br />