|
I hereby affirm that 1 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#_ Expiration Date
<br /> Date Contractor
<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 penalty of not more than five hundred dollars ($500)):
<br /> 0 I, 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 (Scctiot: 7044, Business and Professions Code: T'he contractor's License Law does not apply to an owner
<br /> of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such
<br /> improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion,
<br /> the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale_)
<br /> ❑ 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): 'rite Contractor's License Law does not apply to an owner of property who builds or improves hereon,
<br /> and who constructs for such projects with a cowractor(s)licensed pursuant to the Contactor's License Law.)
<br /> 0 I am exempt under Section P&PC for this reason _
<br /> Date: Owner
<br /> WORKERS'COA•iPENSATION DECLARATION
<br /> I hereby affirm that I have a certificate of consent to self-insure,or a ce:titicate of Workers' Compensation Insurance,or a certified
<br /> copy thereof(Section 3800,Labor Code).
<br /> Expiration Date Company _
<br /> 0 Certified copy is hereby fumished
<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 permit is for one hundred dollars 100 or less
<br /> I certify that in the performance of the work for which this permit is issued, 1 shali 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 Cod,-,you must forthwith comply with such provisions or this pert-lit shall be deemed revoked.
<br /> CONSTRUCTION LENDING AGENCY
<br /> I hereby affirm that there is a constriction 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 desrend, will be made in
<br /> connection with wo:k 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 8, California Administrative
<br /> Code).
<br /> 17 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 /> ❑Divisien of Industrial Safety Pcrmit#
<br /> T -+;A, ti—t r 1....,. .....7 .L:, o....l:..tee:.... -A .h- .J.....- ;-4r--.#.-. r .........1., ..,:rt. .,11 ..:r.......P ..n..«r.,
<br />
|