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FACTOR PSF ADJ.AREANALUATION � OWNER-BUIL�ER DECLARATION SFR/ADD/REM � O p I HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT I AM EXElAPT FROM THE CONTflACiORS LI- � Garage/Carport 17J CENSELAWFOf1THEFOLLOWING3IEASON(SEC.7031.SBUSINESSANDPPOFESSIONSCODE:ANYCITYOq Z' COUNTYWHICHR'cOUIRESAPERMITTOCONSTRUCT,ALTER.IMPROVE,DEMOLISH,ORflEPAIRANYSTRUC- W patio/Deck � " W TURE,PRIOR'�TO ITS I59UANCE,qL50 RE�UIRES THE APPLICANT FOR SUCH PERMITTO FILEA SIGNE� W � STATEMENT THAT HE OR SHE IS LICENSE�PURSUANT TO iHE PAOVISIONS OF THE CONTRACTORS LI� � CENSE LAW(CHAPTEFi 9(COMMENCING WITH SECTION 7Co0)OF DIVISION 3 OF THE BUSINESS ANO PRO� � POOVSpe FESSIONS CODE)OR THAT HE OR SHE IS IXEMPT TNEREFROM AND THE BASIS FOR THEALLEGED EXEMP- � TION.ANYVIOLATIONOFSECTION7031.SBVANYAPPLICpNTFORAPERMITSUBJECTSTHEAPPLICANiTO Z pe-Roof ACIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).�: ❑I.ASOWNEROFTHEPROP RiV,OAMVEMPLOVEESWIiHYJAGESASiHEIRSOLECOMPENSATION, Q Z � Commerclal - WIIL DO THE WORK,AND THE 5T UCTURE IS NOT INTEN�ED OP OFFEfiED FOfi SALE(SEC.7044,BUSI� J � �NESSAN�PROFESSIONS CDOE:THE WNTflACTORS LICENSE LAW DOES fJOT APPLV TO AN OWNER OF � � PROPERNWHOBUILDSORIMPRbVESTHEREON,ANDWY,O�0E55UCHWORKHIMSELFORHERSELFOR �� THROUGH HIS OR HEfi OWN EMPLOYEES,PROVI�ED THAT SUCH IMPROVEMENTS ARE NOT IN7ENDED OR m Q�. 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PLUMBIN� Z �CERTiPY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I .M� - ` C�} SHALL.NOTEMPLOYANY��PERSONINANVMANNERSOASTOBECOMESUBJECTiOTHE � WORKERS'COMPENSA710NLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDBECOh7E INSPECTIONFEE SUBJECT TO THE WORKEFS'COMPENSATION PROVISIONS OF SECTION 370o OFTHE LABOR SCODE,ISHALLFORTHWITHCAMPLYWITHTHOSEPROVISIONS. ISSUANCE � � SMIP I! i°3 j p DATE: APPLICANT: ___________ �� � ENERGY P/C �.if WARN W G FAILUFE TO SECURE WORKE(i5'COMPENSATION COVERAGE IS UNLAWFU4 ANO SHALL BE � SUBJECTANElAPLDYERTOCFtIMINALPENALTIESANDCIViLFINESUPTOONEHUN�REDTHOUSAN� ENERGYPERMIT �OLLARS(5100.000),IN ADDITION TO TNE COST OF COMPENSHTION,DAMAGES AS PROVIDED FOR IN � SECTION 37oe OF THE LPBOR CODE,IN7ERE5T,AND ATTORNEY'S PEES. RETENTION FEE: a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � IHEREBYAFfIRMUNDEflPENALTYOFPERJUFVTHATTHEREISACONSTRUCTIONLENDINGAGENCY FOR THE PERFORMANCE OF THE WORk FOR WHICH THIS PERMIT IS ISSUED(SEC.30 W,CIV.C.). . . 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