|
m
<br /> JOB ADDREM: PERMT#•
<br /> 7 LICENSED CONTRACTORS DECL1. ARATION i -J (1 r
<br /> j
<br /> 1 hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business
<br /> arid Professions Code and my Wense is in full force and effect. a - > I , ,
<br /> I 1
<br /> License# Expiration Dale -
<br /> �- Date'. - r , •. ' •.Contractor
<br /> .l
<br /> OWNER-BUILDER DECLARATION
<br /> 1-hereby affirm thatll*am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business anA
<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 penalty of not more than five hundred dollars($500)):
<br /> ❑ 1,as owner of the property,or 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 /> 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 /> �w completion,the owner-builder will have the burden of proving that be did not build or improve for the purpose of sale.)
<br /> O 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 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 certified
<br /> copy thereof(Seg ion 3800,Labor Code).
<br /> Expiration Date Company
<br /> O Certified copy is hereby famished
<br /> ❑Certified copy is filed with the Environmental Health Department
<br /> CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE
<br /> (This section need not be completed if the vermit is for one hundred dollars(S 100)or less)
<br /> 1 certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to
<br /> become subject to the Workers'Compensation Laws of Califomia.
<br /> Date: Applicant
<br /> NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
<br /> Compensation provisions ofthe labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked.
<br /> CONSTRUCTION LENDING AGENCY
<br /> 1 hereby affirm that there is a concoction 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 /> ❑ I hereby certify that no excavation five(5)or rare 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)feel high.(Chapter 3.2,Group 2,Article 2,Section 341,Title 8,California Administrative
<br /> ❑As owner-builder,I will not employ anyone to do work which.would requima'permit from,lhe Division of Industrial Safety,as
<br /> noted above,unless such person has a permit to do such work fiom the division. ± --
<br /> ❑Division of Industrial Safety Permit# -
<br /> 1 certify thal I have read this_application and'state that the above information is correct I agree a comply with all city and county
<br /> ordinances end stair laws relating to wellconatiuction and or sewage system tonstmiciion,and hereby authorize representatives of this
<br /> county to enter upon the above-mentioned property for inspection purpdse's.' - -
<br /> Date Applicant -
<br /> EHD 43-02-07 � ' , .�- ` .pa.-'` ' LICENSED CONTRACTORSpECLARATIDN.-
<br /> tvllaos2
<br />
|