WP0042734 - Laserfiche WebLink

Home Browse Search

JonAI>Dpms: � z 3 67 n (-p►g�Qd'e(L PERIM 9 - LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under the provisions of Chapter 9 (minrrienang with Section 7000) of Division 3 of the Business and Professions Code and my ficense is in full force and effect t l 1 License S t f i l9– !A :1 ED Exptfation Date 'G ` 00 ` Date %- y ZQZ/ Contractor PT n, OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the ContracWs License Law for the following reason (Section 7031.5, Business and Profesiorts Code: Any city or county which requires a permit to constrmc, after. tmpro vee demolish, or repair any sbuchae, prior to its issuance, afro requires tate appdrant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (Comttencmq with Section 7000) of Division 3 of the Buseress and Professions Code) or that he is exempt herefrom and ifm basis for the alleged excmpGr n Any v� of S -6..r 7031.5 by —y A rot u pemit the appiitani to a civil penalty of not more than five hundred dollars ($600)x E3 I. 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 Offered for Sale (Section 7044, Business and Professions Code: The cons License Law does not appy to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale_ If. however. the budder or improvement is sold within one year of completion, the owner -budder will have the burden of pm mhg that he did not buil or irrhprove for the purpose of sale_) D 1. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 704-4, Bws mess and Professions Code (BaPC)_ The Contractors License Lawn does not apply to an owner of property who builds or improves hereon, and who constructs for such projects wdtn a contactor(s) licensed pursuant to the Contractors License Law.) El 1 am exempt under .section BBPC for this reason Date- Owner — - WORKERS' COMPENSATION DECLARATION 1 hereby affirm that 1 have a certificate of consent to selfirtsure or a certificate of Workers* Compensation insurance, or a certified copy thereof (Section 3800. Labor Code)_ Expiration Date Company____ 13 Certified copy is hereby humished 13 Certified copy is fled with the Environmental Health Department CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (this section treed not be completed if the permit is for one hundred dollars (Si 00) or less) I certify that in the perfomrarim of the work for which this permit is issued. 1 shad not employ any person in any manner so as to became subject to the Workers' Compensation Lars of California. Datta. Applicant NOTICE TO APPLICANT: If, after snaking 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 shad be deemed revoked_ CONSTRUCTION LENDING AGENCY I hereby affirm that thele is a construction lending agency for the performance, of the work for which this permit is issued (Section 3097, Civil Code). Lenders Name Lenders Address DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION ❑ I hereby testify that no excavation five (5) or more feet in depth No which a person is reQuued to descend, will be made in confection with work at dxwiwd by the permit, and that no building structirre, scaffolding. falsewworkt, or dernolron or dismanlbng thereofwill be more than thirty-sa (36) feet high- (Chapter 32, Group 2, Article 2, Section 341, Title 8, Caflfornia Admmhkiiianve Code)_ 0 As owner -builder, t will not employ anyone to do work Which would regime a permit from the Division of Industrial Safety, as rioted above, unless such person has a permit to do such work from the division - 0 Division of Industrial Safety Permit It 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 ordinances and slate laws reiatirng to well construction and or sewage system construction. and hereby authorize representatives of this county to enter upon the above-mentioned properly for inspection purposes. Date Apprrrant ERD ctm,007 LBCE?� cohrraAcrons DECLARATION G29M