|
JOB ADDRESS: 31600 KOSTER RD. PERMIT#:
<br /> TRACY
<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
<br /> and Professions Code and my license is in full force and effect.
<br /> License#^ 290813 Expiration Date 5-81-08
<br /> Date 9-26-07 Contractor HENNINGS OROS. DRILLING.00., INC.
<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, Business and
<br /> Professions Code: Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to
<br /> its issuance,also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the
<br /> Contractor's License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he
<br /> is exempt herefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
<br /> the applicant to a civil penally of not more than five hundred dollars(5500)):
<br /> ❑ 1,as owner of the property,cr 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 /> 4 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 /> I ❑ 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
<br /> and Professions Code(B&PC): The Contractor's License Law does not apply to an owner of property who builds or improves
<br /> hereon,and who constructs for such projects with a contractor(s)licensed pursuant to the Contractor's License Law.)
<br /> ❑1 am exempt under Section— _, 8&-PC for this reason
<br /> Date: Owner
<br /> WORKERS'COMPENSATION DECLARATION
<br /> 1 herebv affirm that I have a certificate of consent to self-insure,or a certificate of Workers'Compensation insurance,or a certified
<br /> copy thereof(Section 3800,Labor Code).
<br /> Expiration Date 1-1-08 Company STATE Ct)MPENSATION TNS. FUND
<br /> 4 ❑Certified copy is hereby furnished
<br /> 4(Cettified copy is filed with the Environmental Health Deparment
<br /> CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE
<br /> (This section need not be comnleted if the permit is for ine hundred dollars($100)or less
<br /> I certify that in the performance of the work for which this permit is issued,I sha?l not employ any person in any manner so as to
<br /> become subject to the Workers'Compensation Laws of California_
<br /> Date: Applicant
<br /> NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
<br /> Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked.
<br /> CONSTRUCTION LENDING AGENCY
<br /> (hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Section
<br /> 3097,Civil Code).
<br /> Lender's Name
<br /> Lender'Address
<br /> DIVISION OF INDUSTRIAL SAFETY PERMIT CERTICATION
<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,fatsework,or demolition or dismantling
<br /> thereof,will be more than thirty-six(36)tett high.(Chapter 3.2,Group 2,Article 2,Section 341,Title 8,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
<br /> noted above,unless such person has a permit to do such work from the division.
<br /> ❑Division of Industrial Safely Permit
<br /> 1 certify that 1 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 construction,and hereby authorize representative,,of this
<br /> county to enter upon the above-mentioned property for inspection purposes.
<br /> D%te Applicant _
<br /> EHD43-02.007 LICENSFDCONTRACTORS DECLARATION
<br /> 12r 11/200-
<br />
|