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JOB PERMIT #-- LICENSED CONTRACTORS DECLARATION I hereby affmm that' am kenr-ed under the Provsions of Chapter 9 (oxmnencing with Section 7000) of Division 3 of the Business and Professions Code and my iconse is in full force and effect Lice rsse##�� 4 Expiration Date Contractor n (l OWNER43UILDER DECLARATION I hereby affirm that 1 am exempt from tho Conbactds License Law for the following reason (Section 7031.5, Business and professions requiresCode:AyCity the �ry � ich �— a �t to ��. �' Improve, dernolsh, or repair any struchae, Prior to its issuarrA License taw (heap mg (( for such permit to file a signed statement that tie is licensed pursuant to the provisions of the Contractor's e and oro pierbac( with Semon 7000) of Division 3 of the Business and Professions Code) or that tie is exempt exwnpfiorL Any violation of Section 7031.5 by aril' aPPf�ht lou a to a civil penalty of not more than five hundrod dooms ($500))_ Pce suhjers8 the app6mrd O I. as owner of the property. or my employees with wages as their sole compensation, will do the work and the skudure is not intended or offered for sale (Section 7044. Business and Professions Code_ The conbacWs License taw does not apply to an owner of property who builds a improves thereon, and who does succi work himself or through his own enyloyeez,. provided that such 6rlPravernents are not intended or offered for Sete_ it, however. the btrrldmg or improvement is sold within one year of comPlebon, the owner-buddef will have ttte burden Of VWM Dia( he did not buDd or improve for the purpose of sere,) 13 1. as owner of the property, am exclusively contracting with licensed contractors to eonssbW the prajett (Section 7094. Business and Professions Code (B&PCj= The ConhaGoes License Lew does not apply to an owner of property who minds or improves hereon. and who cOnStnicts; for such projects with a conhactur(s) ficensed pursuant to the Contractor's License Law.) O I am exempt under Section , BSPC for this reason WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to sel%insrae or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, labor Code). Expiration Date 13 Certified copy is hereby fumshed Company 0 Certified Copy is filed with the Environmental Health Deparbnent CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE CO-- —bon need not be cwndemd if the Permit is for one hurKh ad dollars ($100) or less) 1 e>w* that in the per(pmrance of the work for which this permit is sSued. I shall not em become Subject to the Workers' Compensation Laws of California_ Piot any Pg in arty manner So as to Date' Appiirant NOTICE TO APPLICANT_ IL after making this Certificate of Exemption, you should become subject to the Wakens' Convensalion Provg%Gm Of the labor Code, you must forthwith comply with such Provsiors or this permit shoe be deemed revoked_ CONSTRUCTION LENDING AGENCY I hereby affirm that theme is a construction k "Ti g agency for the pedormanee of the work for which this permit is Civissued (Section 3097, Civil Code). -dice{s Name Lender's Address DfMION OF INDUSTRIAL SAFETY PERW CERTIFICATION 0 1 hereby cerly that no excav3(Ioh five (5) or more foat in depth into which a pennon m required to descend, will be made in connection with work authorized by the permit, and that no buidirig shichm, sca$othng l k or demofhon or dismantling thereof, will be more than flinty -sloe M) feet high- (Chapter 3-7- Group 2. Article 2, sec8wh 341, Tine 8, Caltromia ndmi nismamve Code)_ 0 AS owner-bwlder. 1 will not employ anyone to do work which would mquia a Permit from the Division of Industrial Safely. as noted above, unless such person has a pemtit to do SUCK work from the division - Ci Division of Industrtal Safety Permit # fondiertify that and slate taws hisais and state that the above information is commt 1 agree to oDmply with OR city and county relating well construction and or std SySIM G0h6UUCtion, and hereby auguNtM representatives of Ibis a)#J y to ernter upon the above-rrren6oried property fix inspection pu poses_ Date EMIMUz-our slaw Applicant