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JOB ADDRESS: PERMIT M: LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under the ptevisiom ofChapon q(commencing with Section 7")of Divisim 3 of the Business am Professions Code, and my dicers is in full farce and effect. License i ExM1 Date 1)sse_ Cmtneta OWNER-BUILDER DECLARATION 1 herchy affirm than I am exempt from the C.ntriveur's License law far the following reason(Sec.7031.5.Business it Rofeasions Code: Any city err county which responses•permit to consumer,alter,improvc.demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed interview that Is is licensed pursuant to she provisions of the CmvunrrR License Law(Chapter!)c.cm,wilt Section 7").f Division 3 of the Business end Profusions Cale)or that he is exenpt herefrom and the basis for the alleged eaemptien. Any violation of Section 7031.5 by eny applicant for a permit subjats the eppiicent to a civil penaby of not more than five hundred Dollars (15500)): O 1,as owner of the property,or my employees with wages as their sole compensation,will do the work,-oil IM structure is not intended or offered for axle (Sec.7094,Business and Pm(essians Cede:The Cono-utoi s License Law does not apply m an owner of property who builds"' impro ,a importer thereonnd who rore ta does such work himself or through his own employees,provided that such improvements aut intended or offered for sale.IL however.the building us improvement is told within one year of completion,the owner builder will have the burden of Proving that he did ata build or improve for the propos of sale.) 01.as came,of the property,am exclusively contracting with licensed esometes to crnsmmt the Project(Sec.7094,Business and Profen ot Code:The Convaemr's Lic<nsc law does nut apply to an owner of propertyµho builds.r ilt�raves thereon,and whq convects for such projects with a o m icmr(s) licensed pursuxm m the Cmtrannr's Littnu IawJ "- ' I D l am exempt under Sec. ,B&P.C.for this m}von Dere Owner WORKERS'COMPENSATION DECLARATION 1 hereby affirm that 1 have a canifaesse of convent on self-insum,or•certificate of Warkcri Compensation lormance,e Is notified imply thereof(Sec.3800. Lab.C). Exp-Doe Company ❑Certified copy is hereby[mniahed 0 Certified copy is filed with the County Building Inspection Division CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE Clbis section n d ed b,completed,if the permit is Ior one hundred dollars(15100)or less) -- I certify that in the performance of the work for which this permit is Issued,I shat)cot employ any peau.in any manner u.1 1.become subject to he Workers'Compensation Laws of California. Diane Applicant NOTICE TO APPLICANT:If,aftor mating this Cartificsse of Exemption.you should become subjano the Workers'Compensation provisions of the Labor Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 herMy affirm that there is a construction lending agency for the Performance of the work for which do,Permit is issued(Sec.3097.Civ.Q. Londsr'a Name 1<Mer s Address DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: D 1 hereby certify that no excavation rive(5)or mom feet in depth into which s Person required in descend,will be make in connection with work amhmized by the permit,and that no building swcture,scaffolding,falsework,ordemolition or dismantling thereof,will be more den thirty-six(36)feet high. (Chap.3.2,Grp 2,Pat 2,Sec 341,Title S.C.A.C.). 0 As owner-builder.l will not employ anyone to do work which to require a permit from the Division of lissmo rial Safety,es mond shove,unless imeb .on has a permit to do such work fmm dm&vision. 0 Division of Ins'usvial Permit No. 1 certify mar 1 have read this aPPliwion and ante thu the above information is const. I agree m comply with all city and eronty adituaes and roue laws missing to well construction and or sewage system construction,and hereby authorize representatives of this city to enter upon the above-nnontio ed property onno cele purposes. pate ApPlieam