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12/21/2018 10: 17 Canepa 8 Sons (FAX) P.003/004
<br /> Joi3 ADDRESS- /3 A5 C... YJ&K `40',- PERMIT#:
<br /> LICENSED CONTRACTORS DECLARATION
<br /> I hereby affirm that I am licensed under the provisions of Chapter 9(commancing with Section 7000)of Division 3 of the Business and
<br /> Professions Code.arld my license I In full farce end effect. L'Z620
<br /> License# � xpi ti Date � ;U
<br /> Data 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 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 exemptlon. Any violation of Section 7031.5 by any applicant for a permit aubjects the applicant
<br /> to a civil penally of not more than five hundred dollars($500)):
<br /> O 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 (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 /> completion,The owner-bullder will have the burden of proving that he did not build or Improve for the purpose of sale,)
<br /> O I,as owner of the property,em 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 /> ❑1 em 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 copy
<br /> thereof(Section 3800,Labor Code),
<br /> Expiration Date Company
<br /> ❑Certified copy Is hereby furnished
<br /> Certified copy is filed with the Environmental Health,Department
<br /> CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE
<br /> (Lie section need not be completed If the permit is for one hundrod dollars 0140)or lessl
<br /> I 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 California,
<br /> Date: Applicant
<br /> NOTICE TO APPLICANT; If, after making this Certlflcste 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 permlt shall be deemed revoked,
<br /> CONSTRUCTION LENDING AGENCY
<br /> I hereby affirm that there is a construction lending agency for the performance of the work for which this peril Is issued(Section 3097,
<br /> Civil Code).
<br /> Lender's Name
<br /> Lender's Address
<br /> DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
<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 tho permit, and that no building structure,scaffolding,falsework,or demolition or dismantling
<br /> thereof,will be more than thlrtyslx(36)feet high.'(Chapter 3.2,Group 2,Article 2,Section 341,Title 8,California Administrative
<br /> Code).
<br /> ❑ As owner-builder,1 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 /> Q DlvIsIon 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 Construction and or sewage system construction,and hareby authorize representatives of this
<br /> county to enter upon the abOve•menUOned property for Inspection purposes.
<br /> Data Applicant
<br /> IND 43-02-007 LICENSED CONTRACTORS DCCLARATION
<br /> 6.26.09
<br /> Received Time Dec. 21. 2018 10 : 16AM No, 4501
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