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Jos AOOREss: PES 0:�___ -- i i LFCEMM CONTRACTORS DECLARATION t i twroby atann twat i am boansad under ow Dura of CPMWW fa�r!rrrertarg7 Secaron?fDt�lj d Drat+3 d Via Buse s aM Pro06s*cm Coda and my Somme a in hAl lor0e and afbct_ �Expiration Deft Centr wft QwNER.SUFLDER DECLARATION 4 4*mtyf Asian that 1 am ewro from me CorwacW&Lioerae Lew for C»bt>ow.rtg reason f.5e!tsar?rat S.&%mesa and Profe"04- Coda Arty cOy or crxanty wh+dr rvgwws a parrnit b Come:OL afssr,rte.dentt/ah. or tapa+mpi atria".prior t0 ft m&JinW: &ISO repkWes the appl+cant br Such parmt to fla a elWwd awdlarnr4 that he ve 4censad PUMU&q t.0 the Pry of the Corl"Ooes j LAxa6e Law(CrrapMr 9;oortxnenor y wHh Secbn?006)of DivMw 3 of tree Busnml and PmftWWs Code)or t*'M he n ttxernpi tgrehom and the ws*s fix the 0"06 esanipaen. Any vidstion of Section 7rJ37.5 by arty apaacarK o'•parrM subfst is Ow applcant to a av4 penally of not mwe Mw flue Nv4red 0011-s(SW')' O 1. as owrw of the prop".or eery smpwysaa w4h vra4aa as 7sair 6010 aamvaraation. we do 5+e work. and tee 40%PCOx0 s not 1 1 tntaradett or of)ww br Saba(Sect on 7044. Husinets and PrtfaasiOM COd6 The owVactor's Laoeaae LAW does not apply to an owner of proparrty who bLm d Or wr9roy"fl+anon.and who does succi work has"or` (Ough ha awr•ei>7Woyeen•?rmided"l i svUi �rtpr -mensa are not iManded or alilMttd for brie it, 4aosrever. E+e bsrldtnp of erprovemer` a Sold rMthm one laar of 4 owrtpieboa,go Owner-budder wd have to burOan of provwV that he dto not buil or inVrovo far the purpose Of%a*) O I.as Owner of ku property,am ataduew*corAnww p W*roweed corttracs"to r„onsvuct the Prolact(Section 7064.Buwww"and ;i { P-*ss+om Code(B&PC) The C&Araalot's LiOmaa Law dcas riot apply to an owrner of pogertj wtro buids Or rnprovm heroes, f{ and-hocx�rsstn,da kr suds projects,entre a oonttscsor!y i�x sed 5urat+an'.'o t`,a Contrsc f s l c+msa Law) r O 1 am emm,wt under Swa on Bd.PC row tris reason � Dill. ONnar WORKERS'COMPENSATION DECLARATION i 1 hefeb/afFrm thm f kava a aervicate of omwl to salt-natxe Or a oarofcft c>'Worker Com+ sr t inwrarxea e oor"w copy thereof(Section 3860:Labor Code) j Expiration Dais Company _�------- ! (a CrtAed ooay is hereby hers!—ad, 0.eftA*d ropy is iced wk-,the Enwro rw"Fiea?t'+Deprifnent I I ' CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE i M&M need d Cta 0aane n bt one hr_+triM dalars A10010[isssl 1 I CmVy OW in to perlomwice of Ire work for white+Stas Pwnwl n aauad.t snare not anpsotr Orel varactr ua any rnart++er so as to bs00aia subsea to Eta Workers'ConVereaw Law^of Cakktrrxa Dols: _ ---- Applicant NOTICE TO APKICAUT: if, aAw makM this C0nftsta of ErerrVbOn. Y=x%should beaorns subect to tr+e tMxtam' Comp."bore prpnbtpm n labor Code.you must!o*moth mmp+y wth such provisions or than Px WW ba deetrted ravraked V St i CpNSTRUCTION LENDING AGENCY t i j M Vbj Mlkm that tltae fe•xaftwCOOn*xkV&9wroy for the pwf0rmanoe ref u''a trek Or whcoh Sha Oar"^t,�xsa»d i �3C97. AIA Cods) L.eadea'ts Nessa Lasdars Address t I DMMN OF INDUSTRIAL SAFETY PERMIT CEFMFICATtON 2 >Mt t10 fare ;5)9r mora feat n depth inter vvh h a Person s mQu_wd i-o descend. wn1 be made 'n 1' lw*W Carty rAbld�rp falsewortc err dwr*won or darrmstirnp or1 ! t7OnnaCiOn vm wk mewrbwd by the panni.and and MSM no bust M strtxa-fay ecr pdrr>resfaative i VW$d,va be.mon Van#w"(30)feat tiiph (Chapter 3 2, Groaw 2. Artida 2. $eyylon i4 t. T'te 8, akk!rnia code) j Satey As ow -dwA&er.I vA not M►OW wvx a to dD trod[*V& reQu`rc a petr^A►rorr ttte Dtvwc ,f tr d cstrta .a,note a w%*unlaa w&Pafnoh has a Pa I I to do Such work horn the drna+or' !�DrMW m Of kXkXV d SaVy PVT M2 4 i 1 comy d+rt f have read this appic>6kerf Orb 0614"Sat!tri MOW 1rtfr'atw .6 wrra� t�10-n"v�as�Y and county f drtwsena and SUN taws wbinp b wail nonabucwn and or aawte.7e system r OR aid hereby rrr�onze Tprese*ra'•'+r 6 cf=`r s cm cna.,t;r b easier upon Q+a abor►ewrroaa i M"wty ler inapacbm purA Dab Applicant :.CEWAD CCmTRaCTrAkS AEC.UWATV0% OMD 4442Get a-2i17a