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PACTOR PSF ADJ.AREANALUATION � - - � OWNER-BCIIDER DECLAHATION _ ... _ _ _ . � SFR/ADD/REM � - O , p 1 HEREdY AFFIRM UNOER DENALiV OF CERAJRY TMA1 I MI E%EMPT FHOM iHE CONTMCTORS l4 Gdfd9&C.afp011 � -- - -� - ' W CENSEUWFOqTNEFOLLOWW6REA50N(SEC.1031.66USWf55M10CROFESSIONSCODE:ANYGTYOR (n U GpUNTYWNICNREOUIqESA7EHAlITTOCONSTRUCT,ALTEFt&IPROVE.DEAIOU511.ORFePNPANYSTAUG� W PatiNDeck � -� Z iURE.7R10R TO ITS ISSUANCE.FLSO REOUIRES THE ADVL�GNT FOR SUCH iERL1ITT0 FlLE A SIGNE� w STATEl1ENT THAi HE Oii 6ME IS UCENSED PURSUANT TO THE PROVISIONS OF ME CONTRACTORS L4 W � �� CENSE UW(G/AGTEfl i(COMMENGN6 WITN SEGTION 7000)OF DiVISION J OF iNE BUSINe55 MJD GHO � PooVSpa GESSIONS CODE)Oil iMAi ME OR SHE IS E%EMPT TMEREFFOAI AND THE BASIS FORTNE ALLEGEO EXEMR� ViqN.ANYYIOLAT10NOFSEGTION7o7t.58VANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z RaRool � '� A GV�I VENKTr OF NOT MORE T1w1 FrvE HUNDFED DOLLARS(Ssool�F � Z ❑I,ASOWNEROFTHEGH07ERTY.OR4YEMPLOYEESNniHWAGE5A5TNEIRSOIECOMPENSATqN, � Cpmm0rCi11 � - - VnLL DO TME WORK,AND THE STRUCTURE IS NOT INTENOED OR OFFERED FOR SALE(SEG)aa,BU51- J NE55 AND PROFESSIONS COOE:THE GONTRACTORS UCEMSE UW DOES NOT A7PLY i0 AN ONMER OF N DROPERTYWHOBUILDSORIAIPROVESTHEREON.ANDWHODOESSUG/WORKHIMS"cLFORHERSFLFpi � - - Q THROUGlIHISORHEROwNEMVLOVEES.OROVIDfOTHATSUCMWVROVEAIENTSARENOTWTE�DE0W1 m _ W OFFEREDFORSALEIF,FqWEVERTMEBUiIAwOORiMGFOVEUENT155otDWITwNONEYEAROFWMVLE '----�..� ..p iqfl THE OWNER$UILDER WILL MAYE THE BURDEN OF PROYWa THAT HE OR SHE 01D NO7 6UItD Oq � -"��-- Z WPROYE FORTNE GURPOSE OF SALE} - � �=y,J ❑4A40NMEROFTHEPROPEHTY,AME%CLUS�VELYCONTPACTWOWITHLICENSEOLONTflACiORS . � 70 CONSTRUCT THE VROJECL(SEG TM�,BUSINESS AND PIiOFE55lON5 GODE TNE GONTRACTORS tF Valuation /10�.JIflEfl W CENSELAWDOESNOTAPVLYTOANOWNEROFAVqOVERTYNTqBI1kOSORWVROVESTHEHEON,AND � WHOWNTRACTSFORSUGI7RQIECTSWITiAWNTfUCTOR(S)LICENSEDPURSUANiTOTHECONTMG OUANTITY--� DESCRIPTION � - FEE � Y TORSUGENSEUW.1. �- . - 0 O IAM EXEMPT UNDFA SEC. &i P.C.FOR 71-IIS RE/SON v � . � � DATE OYMER �"' �- � ' � , Z . 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