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<br /> THORNTON - -
<br /> JosADDREss: 8855 RNMRZNN RD , PERMIT #: -
<br /> - STOCKTON -
<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
<br /> and Professions Code and my license is in full force and effect.
<br /> License # 290813 - ExpirationDate. 5 -31 -08
<br /> Date 742-07 F . Contractor HENNINGS BROS , DRILLING CO . , INCL
<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 /> ❑ 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-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): 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 /> ❑ I am exempt under Section , B&PC for this reason
<br /> Date: Owner
<br /> WORKERS' .COMPENSATION DECLARATION
<br /> I hereby affirm that I have a certif:cate'of consent to self-insure, or a certificate of Workers' Compensation Insurance, or a certified
<br /> copy thereof (Section 3800, Labor Code).
<br /> ( Expiration Date 1 - 1 -08 Company STATE COMPENSATION INS . FUND
<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 /> (This section need not be completed if the permit is for one hundred dollars ($100) or less)
<br /> Jeertify that in the performance of the work for which this permit is issued, I shall not emp ioy any person in my manner so as to
<br /> become subject to the Workers' Compensation Laws of California: - -
<br /> Date: Applicant
<br /> NOTICE TO APPLICANT: If, ager making this Certificate. of Exemption, ,you should become subject to the Workers'
<br /> Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit 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 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 descend, will be made in
<br /> connection with work authorized by the permit, and that no building structure, scaff_olding, ,falsework, or demolition or dismantling_
<br /> reof,
<br /> the . will be more than thirty-six (36) feet high. (Chapter 3.2, Group 2, Aiticle 2, Section 341 , Title 8, California Administrative
<br /> Code). 1 - -
<br /> I ❑ As. owner-buildeq 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 permitto'do such work from the division • - ' .0 - ,
<br /> ❑ Division of Industrial Safety Permit # s S
<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 towell construction and or sewage system construction, and hereby authorize representatives of this
<br /> county to enter upon the above-mentioned property for inspection purposes.
<br /> C
<br /> Date - Applicant -
<br /> EIID 43-02-007 ,LICENSED CONTRACTORS DECLARATION
<br /> /2// 112002
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