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BCPs 410199
<br /> JOBADDRESS: 1630 HAST HAMMER LANE, STOCKTON, CA 95210 PERMIT#:
<br /> LICENSED CONTRACTORS DECLARATION
<br /> I hereby affirm that I am licensed under the provisions of Chapter a(commencing with Section 7000)of CMelon 3 of the Business and
<br /> Professions Code and my ficense 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 /> I her ffirm that I am exempt from the Contractors License Law for the following reason(Section 7031.5,Business and Professlons
<br /> Code: Any or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to Its Issuance,
<br /> also requlres the nt for such permit to file a signed statement4hat he Is Iicenssd pursuant to the provisions of the Contractors
<br /> License Law(Chapter mencing with Section 7000)of Division 3 of the Business and Professions Code)or that he Is exempt
<br /> herefrom and the basis for the ed exemptlon. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant
<br /> to a ciNl penalty of not more than five red dollare(0500)):
<br /> D I,as owner of the property,or my employe Yh wages as their able compensation,will do the work, and the structure Is not
<br /> Intended or offered for sale(Section 7044,Buslne nd Professions Code:The contractors License Law does not appy to an
<br /> owner of property who builds or Improves thereon,and w ces such work himself or through his own employees,provided that
<br /> such Improvements are not Intended or offered for cele. If, ver, the buldfng or Improvement is sold within one year of
<br /> completion,the owner-builderw ill have the burden of proving chat he d build or improve for the purpose of sale.)
<br /> O I,as owner of the property,em exclusively contracting with licensed contractors to fruct the project(Section 7044,Business and
<br /> Professions Code(B&PC): The Contractors License Law does not apply to an Avner ONDWerty,who builds or Improves hereon,
<br /> and who constructs for such projects with a contractor(s)licensed pursuant to the Contractors se Law.)
<br /> O l em 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 STATS INC. CO.
<br /> ,Certified copy is hereby furnished
<br /> 13 Certified copy is filed with the Environmental Health Department
<br /> CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE
<br /> h tfon nee n leted If the Demnit Is for one Imindned dollars 100 r
<br /> I certify that in the performance of tfre ion this permit is issued,I shall not employ any person in any manner so
<br /> as to become subject to the Workers'Compensa on California.
<br /> Date: Applicant
<br /> NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject rkers'Compensation
<br /> provisions of the Labor Code,you must fortirMth compy with such provisions or this permit shall be deemed revoked
<br /> CONSTRUCTION LENDING AGENCY
<br /> 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 /> Lender's Name
<br /> Lender'Address
<br /> DMSION OF,INDU$.TRIAL SAFETY PERMIT CERTIFICATION
<br /> O 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 than thirty-six(36)feet high.(Chapter 3.2,Group 2,Ankle 2,Section 341,Tige 8,California Administrative
<br /> Code).
<br /> 0 As Amer-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.>'Ph'Mcm of Industrial Safety Permit# 2012-908414
<br /> 1 certify that I have read this application and state that the above Information Is correct. I agree to comply with all city and county
<br /> ordinaries and state laws relating to well construction and or sewage system conlion,and he eb authorize representatives of this
<br /> county to enter upon the above-mentioned property for Inspection purposes.
<br /> 'phyData 1/21/2013 Appl(ca
<br /> EI043-07 LWMSEDCQNIRACTOR DECLARATION
<br /> MV7
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