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Joe ADDRESS: 7 11 !J V4 /(.If 1(o ' PBMT LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code and my license is in fun force and effect_ License 1 t 5 7A Expiratiorh Datta Date & ` Z— zo Z l Contractor IJ (,%,A C 3 V I I V,-, OMER43UILDER DECLARATION 1 hereby affirm that I am exempt from the Contras License Law for the following reason (Section 7031.5, Buairhess and Professims Code: Any city or county which requires a permit to construct, alter, improve, demgish, of repair any strtrchue, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is lhrarised pursuant to the provisions of the Contractor's License taw (Chapter 9 (cothx mming with Semon 71]00) of Division 3 of the Business and Professions Coda) or that he is exempt hernfnxn and the b*cfc for the alleged eherrrpk6n_ Any v66fion of Section 7031.5 by any aPPtkwd for a prmnrf suhjecis the applicant to a civil Panatty of not more than five hundred dollars ($5W)� 0 I. as owner of the property, or my employees with wages as their sole compensation. whTl do the work and tha structure is not Intended or offered for sale (Section 7044, Business and Professions Code. The eontradoes License Law does not apply to an owner of Property who builds or improves thereon, and who does such work thlmselr or through his own employees. provided that such improvements are not intended or offered for sale If, however, the bu ikling or improvement is said withm one year of c QM*b0n, the trwner-b(Jader will have the burden of ptnvahg that he did not build or improve for the purpose of sale.) ❑ 1, as owner of the Property, am exclusively contracting with licensed contractors to construrr the project (Section 7044, Business and Professions Code (B&PC): The Contractcles License Law does not apply to an owner of property who bums or improves hereon, and who constructs for such prnjeds with a cmtraciar(s) licensed pursuant to the Contracfmls License Law_) ❑ 1 am exempt under Section , BBPC for this reason WORKERS' COMPENSATION DECLARATION 1 thereby affirm that I have a certificate of Consent to self -insure or a cerffimte of Workers' Compensation Insurance, or a certified copy thereof (Sectim 3800, Labor Code). Expiration Date __ Company O Certified copy is hereby fumished 13 Certified copy is foiled with the Envuurnmental Health Department CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be cumhdeted If the permit s feu one ItuIIdred dollars f$l00? Ot Iess) I cwtity that in the performMce of the work for which this permit is issued. I span not employ any person in any manner so as to become subject to the dodoes' Compensation Laws of California_ Date: Applicant NOTICE TO APPLICANT If, after making this Certificate of Exemption. you should become subject to the Workers' Compensation Provisions of the tabor Code. you must forthwith comPly with such Provisions of this Permit shall be deemed revoked_ CONSTRUCTION LENDING AGENCY 1 thereby affirm that there G a cotstruclion lending agency for The performance of the work for which this permit m issued (Section 3097, Civil Code). gender's Nares Lender's Address DIMION OF INDUSTRIAL SAFETY PERMfT CERTIFICATION ❑ I hereby off" that no excavation we (5) or more feet in depth into which a person is required m descend. win the rr>ade in Connection with work ahrfhorized by the permit and that no building structrua, scaffolding. lalsewoflt, or demolition or desmon thereof, will be more Ulan thirty-spc (36) fent high- (Chapter 3-2Group 2, Artide Z Section 341, Ttfle 8, California Adminlstratme Code)_ E] AS owner`bun r. 1 VA not employ anyone to do work which, would m,quire a permit from the Division of Indra safety. as need above, unig- such person has a permit to do such work from the divisim O Division of Indusbial Safety pemtit # I terry [that I have read this application and state that the above information is cared_ I agree to Comply with all city and county ordinances o e and state taws rebating to well CautructiOn and or sewage System torhshwfion, and hereby aulhWw reprmentalr s of "his cotrrhy, to enter upon the above Property for inspection pwp�_ Applicant LM 43-0e-001