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1LICENSED CONTRACTOR'S DECLARATION1 hereby affirm tnat 1 am licensed under provi-sions of Chapter 9 (commencing with SeclionCCUlm
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OWNER-BUILDER DECLARATION- 1 hereby affirm that 1 am exempt from the Con-CD
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(Sec. 7031 .5 Business and Professions Code), Anycity or county which requires a permit to con-struct, alter, improve, demolish, or repair anyTE LICENSE1-
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structure, prior to its issuance also requires theapplicant for such permit to file a signed state-GNEfl'S PHONEin
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sions of the Contractor's License Law (Chapter 9commencing with Section 7000 of Division 3 ofthe Business and Professions Code) or that is ex-empt therefrom and the basis for the alleged ex-.8Ss
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2^1 <MINED THE COMPLETALL INFORMATION HAGREE IF A PERMIT 1VS GOVERNING BUILC3T. l.ALSO AGREE TOSBAD AGAINST ALLl<\^>f>^05:
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person in any manner so as to become subject tothe Workers' Compensation Laws of California.NOTICE TO APPLICANT: If, after making this Cer-tificate of Exemption, you should become subjectto the Workers' Compensation provisions of theLabor Code, you must forthwith comply with suchprovisions or this permit shall be deemed revoked.i,;
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