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FACTOR PSF ADJ:AREA/VALUATION �, �O � OYJNER-BUIiOER DECLAFtATIpN SFR/A�D/REM � � • �� .,Q' ' I HEREBY�FFlRM UNDER P€NALTY OF PERJURY THAT�AM E%EMPT FROM THE CONT(iACTORS L.I- G8f8J9/GBfPD�[ � W � CENSELAWFOPTMEFGLLOWING EASON(SEC.70.97.5BUSINE95ANOPROFESSIONSCODE:FNYCITYOq (n ';Z ,-.COIINT/WHlCHREWIRESAPER�TlOGON97RUCT,ALTER,IMPROVE,OEMOLISFS,ORREPAIFlANYSIRUG W PaIlO/DBCI( '� � ' .I W 'NRE,PRIOR TO IT5 ISSUANCE,ALSb REQUIRES THE APPLfCANT WR SUqi PEFMIT To FiLE A SIGNED ;�� ��. STATEMENT THAT HE OR 5HE IS ICENSE�PURSUANT TO iHE PP041SIONS OF THE CANTfiACTORS LI� , .� I. CENSE LAW(CHAPTEH 9(COMME CiNO WITH SECTION 70o0}��OF DIVISION 30F THE BUSINESSANO PRD� V'� POOVSp2 �� FESSIONSCWE)ORTHATHEOR�HEISEXEldPTTHEREFRGMANDTHE0ASI5FORh1EALLEGEDEXEMP� �. � ';TION.ANYVICLATIONOFSECTIOPIi7031.58VANYAPPLICANTFOAAPERMITSUB3ECFSTkEADPLICANTTO � Ry-AOOf � - � F, ' A CIVIL PENALTY 6F NOT MORE THAN FIVE HUNDRED DOLLARS(SSOD).�: . � ,�� ❑I.ASOYdNER�FTHEPROP�RTY,ORMYEMPLOYEESNdITHYo`4GESASiHEIfi30LECOMPENSATION, Q COR?R12�CIal ' � � ��N7LL 00 THE WORK,AND THE STRUCTUflE IS NOT INTEN�E�OFi OFFERED FOR SALE(SEC.7044,BU54 .J ,y ��. NESS AND PflOFESSIONS CDDE:THE CANTRACTOflS LICENSE iAW DOES NOT APPL'f TO AN OWNEf�OF �� . � �, PROPENTVYNiOBl11t.�SORIAIPR9VESTHEREON,AMDWHO00ESSUCHWORKHIMSELFORF{ERSELFOP '�'� �� THHOUCiH HIS OR HER OWN EMPLOVEES,PROVIDED THAT�UCH IMPROVEMENTS ARE NOT lNTENOED OR 'm W� i3OFFEREDWRSALE1F,HqWEVE THEBULDINGORIMPROVEMEUTISSOLDWl7l11NONEYEAROFCAMPLE �,Z', '�,"TION,THE OWNER-BUILDER WI�HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NO7 BUIID OP. � � , . ��,�'''IMPFKIYE FOR iNE PUfiPOSE OF�uALEj. ❑I,ASOWNEROFTHEPROPERTY,AMEXCLUSIVELYCANTRACTIkGW:iHLIGEP75EDCOhTRACTORS � ..�'� �TO CONSTRUCT THE PHOJECT(�C.7044,BUSINE55 AND PROFESSItlNS GOGE:THE CONTSACTORS Li- Vr1lLflilOP1 _ ADJ.AAEA �LlJ�, ��..CENSELAW�OESNaTAPPLYTOKd�10WNEROFAPRQPERTYIWCBWLDSOflIMPAOVESTHEREON,AND �'� .VhIOCONTRACTSFONSIICHPAd�IEOTSWITHArOMRACTOFl(S�L6CENSEDPURSUANTTOTHECONTNAG pUANT!TY DESCRIPTION FEE . TORS LiCENSE UIW.). � J �O; ❑i AM EXEMPT UNDER S�C�I B.4 F.C.FOR 7HI5 REASON � �i���'.. ' I� � DATE_ .�WNEfi � WN Z � ����,0, ,� LICENI EDCONTRACTO�?S DECLNRATI� �j , ,� '�1 HEFEBY AFFIRM lk1�ER PENALTiY OF PERJURY TNA71 AM LICENSEO UNDER PPOVISiONSOF CHA?TER P - , 'p,; '�e(COMMENCINp WITH SECTION�I000j OF DNISION 30FTHE BUSINE55 AND PROF'eS510N3 CCDE.AND Z �'f�� � ' > � ��MY UCENSE iSIN FULL FOFiCE AND EFPEC7. '� g '� �i,u.�Gi,S �rr"" <�� a, ��LICENSE CLASS ' '� , LIC.NO _ ��.�����. � . 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W,�il WARNINGFAILURETOSECUREIYJORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,APlDSHALLBE EPIERGYPIC � •�4ti'u` �S� LL�'., SUBJECTAN EMPIAYERTO CRlPAINAL PENALTtES AND CIVIL FINES UP TOONE HUNDIiED?HOUSAND ENERGY PERMIT '�`n���� �: DOLLARS(S7oo,000),INAD�I710 TOTHEWSTOfCOMPENSATION,DAMAGESASPFiOVI�EDFORIN J'�'. SECTIOPI37080FTHELABOR DE,INTEFEST,AhDATTOFNENSFeES. RETENTIONFEE: C('i" 1 a°�'��. C�NSTRUG�CION LENDING AGENCY pAE-ALT FEE: � � ��.� I HEiiE6V AFFIRM UN�ER PENA OF PERJl1RV THAT THERE IS A CONSTRLICTION LENDING AGENCV � FORTHE PERFOFiMANCE OF TI'. WORK FOR WHI(]1 THIS PERMIT IS ISSFIEO(SEC.309],CIY.C.). Z.'., t11.!! I . � � .. �����; LEN�E{YS h'AME il F"'�. LENDER'SA��RESS I . �':' ICERTIFYTHATIHAVEREADTHSAPPLICATIONANDSTATETHATTHEABOVEMFDRMATIONISCORREC2 TOTl9L FEGS ���a�O . 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