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.Joa ADDRFSS
<br />PFRMIT i'
<br />LICENSr D CONTRACTORS DEC LAKA TION
<br />I hereby aftlrn that I urn licensed under the pronsorth of Chafaw 0 (c:ornmarw,,ng with Socl,u j 7000) of Dws,on 3 of Me Businwrs and
<br />P(rAossons Code
<br />��and
<br />��my "cense, h, in fol frt re are .Hirci
<br />L.kense s ��l -1 Expiration Data
<br />Date IDIZLI iIh Contractor [ ! L %X sub$tTr�- I_ (j
<br />OWN[ R.BUILDER DECLARATION
<br />1 Iwreby al5nn that I am exempt from file C:cr�draria's l,acme Law r .. 1 Twv,0 reasuil (Sailor 7031.5. flus,tw5a and Plotes3io is
<br />Code: Any city or county which requires a permd to construct, &lite : , -, n, demotsh, n nifwrr any structure. prix to its asuanoa.
<br />also requires lee applicant for such permit In file a signed statement that he, ai licensed Pursuard M the lxov,.—s d til« Ccxdrwinrs
<br />L rcenso I aw (Chopper 9 (convinernong voln Section 7000) of DdvWnn 3 (A the Busv,ess and Pmfessxfrn: Credo) or that ho m Rtempl
<br />f,eretrom and Me Iwais fnr ee alkrgnd a—pilon. Any ,ic laflun or Saion 7031.5 by any apphrant tot a purred subjects Il,e apFkcant
<br />In 0 civil penalty of not mune than five hundred dnllars (SWU)).
<br />13 1, as ovwher of ewe property of my wrgrkrya,ers with wayrrs as Thar sole comperuatron, will do tiro wtxk. and the stricture is not
<br />vviande d or tiered for sale ISaiwn 7044. 8LW1t= and Profession Code. The Contrartrxs License 1 axe does not apply to an
<br />owner of property who builds m improves thereon, and woo does such work heneelf or Dhrowh firs awn employees, PrrwwW that
<br />auris heVWsrWft larva rat rrrlwloed o rass
<br />offered fix sab C harasser, to Melding or knprrxertxvq a sold within ono yoar of
<br />Complabi the cooler -builder unit have Ifo burden of prwalp"he did nil b dd or improve for the purpcne of sahr. )
<br />O 1, as ower of Itis PrcPwV. am em iosnely mntracling wth YmrusO mrtagont to constnrri the prged (Secbw 7(144, 8u5inesl and
<br />Prokh66iprte Cafe (BWCk The Cmtracdfors 1 rrtnse, Law does nil apply No an planter, of propeft who builds or tnlpnrves hereo::
<br />and who consflLcls ler such prajacts with a oswracfor(a) honsed plssuare to M CaArador's License Law )
<br />O dm exempt under Seafon . eBPC for this resew
<br />I Date' - Owner:
<br />WORKERS' COMPENSATION DECLARATION
<br />I hemt/v a'!am that 1 have a certfialle of cnrtsent to self insure or a ccrloca(e of W-10jes' Comperecat"i Insurance tx a
<br />Certified copy ttwCwf (Section 3900. Labor Cods) 1
<br />Expiration Date X02 G f jg Comp+ty C �tIG 2 Co (T mQ2l"3n
<br />hi Cern'sad Copy is hereby!unshed
<br />O Cortilied Copy in Wd with the. Environmental Ncralth Deparimcnl
<br />CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE
<br />(TI 1W lgQs11k11 fin CAn11)tP► d'tht milt r for run od_dollaru i$JgQj.sT1tY 15
<br />1 certify tfd.rl n the pemcxn1inCe of file: w n* For which this permit is issr»xi. I shall ncl omploy any person in any manner xo
<br />as W bocortre sitlrltict to cul WottcCx:; Ccimpr;nsahonlaws r1f C,lifortua
<br />Date: - -- AppUcwvt__ _
<br />NOTICE TO APPLICANT It, after nuking this Cwtrkalu ril Fternplwn, you should bwcerno sr3ynct to tri Wakes' Compensanon
<br />pennons d trio l abnr Code, ytnu mist fnrr—tr. dimity witri sur n pry—inns or T,s dxefn" rhall be deemed nrveked.
<br />CONSTRUCTION LENDING AGENCY
<br />I hereby affirm that Uxtru is a cowtrrxtxt, Innrllnq ajmcN dor Ifve perdnnranfx- (,l thin w(wk'or which Out. Ixalnit is ism".
<br />(Section 3097. Civil (;odn)
<br />Lenders Name
<br />Lender Address
<br />DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
<br />O 1 nereuy tee irfy trial no excavatexr fin: (5) Cc more Wel in Depth lrttu whin it pwsrxd Is required k1 dict rand, will be made in
<br />Conation rot^ work ouhonzed by Me Parma and that no buidrng tbucure. sung, talsework. ry donw!i,un or c>:srrartling
<br />itnered, welt be n�,n! than flatly set (, 6) fwwt hryh. (C har4er 3.2. Gaup :. Article 2. Sours, u1, lac a Calrk,r^sa Admv mbaave
<br />Code)
<br />0 As ovmer bonder, . will "d mp" anyone to do work whir world ryquee a permit from the Dimon of industna' d moi, as noted
<br />above. unless such person has a pnmst W do surb wrrk from the drinson
<br />0 Drtrisein of Industrial Safety Pentel a _
<br />I certify that I have read Mrs appkrasien and state that file atvrvo irdormabod a rxxmct I agree In "vinpfy w,a) yl city and pouty
<br />ordinances and stato Uv^, relating to well construction and or sewage syslern construolsxr, arnd tvveby aulnorrre repres+nfairm of this
<br />Cannily to mfW Won the aMrve rnadiawd mop" for inspection Purposes.
<br />Daft Applicant
<br />EH(J 4.1 (r7
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