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BCE #10D50
<br /> JOBADDRESS: 3250 W. GRANT LINE ROAD, TRACY, CA 95377 PERMITM
<br /> LICENSED CONTRACTORS DECLARATION
<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# 804431 Expiration Date 8/31/2013
<br /> Date 1/21/2013 Contractor JONES COVEY GROUP, INC.
<br /> OWNER-BUILDER DECLARATION
<br /> (here ffinn that I am exempt from the Contractor's License Law for the following reason(Section 7031.5,Business and Professions
<br /> Code: Any or county which requires a permit to Construct,atter,Improve,demolish,or repair any structure,prior to Its Issuance,
<br /> also requires the ' nt for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors
<br /> License Law(Chapter ncing with Section 7000)of Divlslon 3 of the Business and Professions Code)or that he Is exempt
<br /> herefrom and the basis for the ed exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant
<br /> to a civil penalty of not more than five red dollars($500)):
<br /> 17 1, as owner of the property, or my employe 'th wages as their sole compensation,will do the work,and the structure is not
<br /> Intended or offered for sale(Section 7044, busine Professions Code:The contractors License Law does not appy to an
<br /> Owner of property who builds or improves thereon,and oes such work himself a through his own employees,provided that
<br /> such improvements are not Intended or offered for sale. If, ver,the building or Improvement Is sold within one year of
<br /> Completion,the owner-builder will have the burden of proving that he d build or Improve for the purpose of sale.)
<br /> 0 I,as Omer of the property,sm exclusively contrac5ng with licensed contractors truct the project(Section 7044,Business and
<br /> Professions Code(B&PC): The Contractors License Law does not appy to an Owner rty who builds or Improves hereon,
<br /> and who constructs for such projects with a contractor(s)licensed pursuant to the Contractors se Law.)
<br /> 01 am exempt under Section , B&PC for this reason
<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
<br /> certified copy thereof(Section 3800,Labor Code).
<br /> Expiration Date 2/1/2013 Company GRANITE STATE INC. CO.
<br /> Certified copy Is hereby furnished
<br /> 0 Cer ifted copy is filed with the Environmental Health Department
<br /> CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE
<br /> Ml�s�sec Ion�neeis sec Ion nee n leted If he permit Is for Ong hundred dollars 1 or less
<br /> certifythat In the performance of the Ich this permit Is Issued,I shall not employ any person in any manner so
<br /> as to become subject to the Workers'Compensation alifomta.
<br /> Date: Applicant
<br /> NOTICE TO APPLICANT: If,after making this Certificate of Exempton,you should become subjec ars'Compensation
<br /> provisions of the Labor Code,you must forthwith complywith such provisions or this permit shall be deemed revoke .
<br /> CONSTRUCTION LENDING AGENCY
<br /> I hereby affirm that there s 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 CERTiPICATION
<br /> 17 1 hereby cant'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 6,Celifornla Administrative
<br /> Code).
<br /> U As Omer-bullder,I W11 not employ anyone to do work which would require a permit from the Dlvislon of Industrial Safety,as noted
<br /> \,above,unless such person has a permit to do such work from the division.
<br /> >&I Division of Industrial Salary Permit# 2012-908414
<br /> l certiy 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 con ction,and he by authorize representatives of this
<br /> county to enter upon the above-mentioned property for Inspection purposes.
<br /> Dale 1/21/2013 Applicant
<br /> END43o7 IrCENSED CONTRACTOR DECLARATION
<br /> IVM17
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