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Aug-15-06 01 :50P P.08 JoiB ADDRESS: LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code and my license is in full furce and effect.License# -:553 gaiI Expiration Date 0 Date Axkw5t Contractor hnn OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ProfLssions Code: Any city or county which requires a permit to construct,after,improve,demolish,or repair any structure,prior to its issuance, also rcquir�,-,,- the applicant for such permit to file a signed statement that he k licensed pursuant to the provisions ofthe Contractor's License Law(Chapter 9(norrimencing with Section 7000)of Division 3 of the Business and Professions Code)or that lie is exempt herefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subject-, the applicant to a civil penalty of not more than five hundred dollars($500)): C3 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or OffbTed For sale (Section 7044, Business and Professions Code; The contraclor7% License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such iinprovLments are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale.) 0 1,as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Professions Code (B&PC): The Contractor's License Law does not apply to an owner of property Who builds or improves hereon,and who constructs for such projects with a contractor(s)licensed pursuant to the Contractor's License Law,) M 1 am exempt under Section B&PC for this reason Date: Owner WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self-insure,or a certificate of Worker,-,'Compensation Insurance,or a certified copy thereof(Section 3800,Labor Code), I - �Expi ation Date /0/9//" Company �U[,-10 007?S�TUCt707k� Zaeified copy is hereby furnished 13 Certified copy is filed with the Environmental Health Department CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE (This section need ngt.be completed if the permit is for one hundred doLarsffi11DOLorlesJs — --- 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 become subject to the Workers- Compensation Laws,of California. .1 1 Date:. 1J — Applicant No,rICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work,for which this permit is issued(Section 3097,Civil Code), Lender's Name, Lender'Address