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09/25/2019 07:58 Canepa & Sons (FAX) P,005/008
<br /> JOt3 ADDRESS: BO'S v b�� PERMITft:
<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 and
<br /> Professions Coda and my license Is In full force and effect.
<br /> License* 425749 Expiration Date 7/31/2020
<br /> Data Contractor CANEPA AND SONS,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 Professions
<br /> Code: Any city or county which requires a permit to construct alter, improve,demolish,or repair any structure,prior to Its issuance,
<br /> also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's
<br /> License Law(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code)or that he is exempt
<br /> herefrom and the basis for the.alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant
<br /> to a civil penalty of not more than five hundred dollars($500)):
<br /> 17 I, as owner of the properly, 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 7D44, Business and Professions Code; The contractor's License Law does not apply to an
<br /> owner of property who bulids 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 /> Q 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and
<br /> Professions Code(B&PC): The 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 contractor(s)licensed pursuant to the Contractor's License Law,)
<br /> ❑lam exempt under Section , B&PC for this reason
<br /> Data: Owner
<br /> WORKERS'COMPENSATION DECLARATION
<br /> I hereby affirm that I have a certificate of consent to&elf-insure or a certificate of Workers'Compensation Insurance,or a certified copy
<br /> thereof(Sectlon 3900,jLpbor�C]ode),
<br /> Expiration Date r 1114/�li�G Company CALIFORNIA INSURANCE COMPANY
<br /> ❑Certified copy is hereby furnished
<br /> ACertified 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 oerrttjgkLLg one hundred dollars(1100)or less)
<br /> I certify that in the performance of the work for which this permit is Issued,I$1111 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' Compensation
<br /> provisions of the 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 thcrc is a construction lending agency for the performance of the work for which this permit is issued(Section 3097,
<br /> Civil Code).
<br /> Lendor's Namo
<br /> Lender's Address
<br /> DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
<br /> ❑ I 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, fslsework, or demolition or dismantling
<br /> thereof,will bo more than thirty-six(36) feel high. (Chapter 3.2,Group 2,Article 2, Section 341,Title 5, Calltomla 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 noted
<br /> above,unless such person has a permit to do such work from the division.
<br /> CI Division of Industrial Safety Permit#
<br /> I 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 /> ordinances and state laws relating to well constriction and or sewage system eonstructlon,and hereby authorize representatives of this
<br /> county to enter upon the above-mentioned property for inspection purposes.
<br /> Date Applicant
<br /> END 03-OZ-007 LICENSED CONTRACTORS oEctAkAT)0N
<br /> 5-26--os
<br /> Received Time Sep. 25. 2019 7: 53AM No. 5528
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