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Home My WebLink About_SOLR23-0478_DECLARATION updated 9-14-21 (27) PALM DESERT PERMIT CENTER 73-510 Fred WaringDrive, Palm Desert, California (760)776-6435 permitcenter@cityofpalmdesert.org DECLARATION CONTRACTORDECLARATION – CONTRACTOR LIC#: PERMIT#: I HerebyaffirmunderpenaltyofperjurythatI amlicensedunderprovisionsofChapter9 (commencingwithSection7000) ofDivision 3 of theBusinessandProfessionsCode, andmy licenseis infullforceandeffecthave andmaintaina City of PalmDesert Business License. Worker’s Compensation Declaration:WARNING:FAILURETOSECUREWORKERS'COMPENSATIONCOVERAGE IS UNLAWFULANDSHALL SUBJECTANEMPLOYERTO CRIMINAL PENALTIESAND CIVIL FINESUPTOONEHUNDREDTHOUSANDDOLLARS ($100,000), INADDITION TOTHECOSTOF COMPENSATIONDAMAGESASPROVIDEDFORINSECTION3706 OFTHE LABORCODE,INTEREST,ANDATTORNEY'SFEES. I hereby affirmunder penalty of perjuryONE of the following declarations(MUST CHECK ONE OF THE FOLLOWING): I haveandwillmaintain a certificateofconsenttoself-insureforworkers’compensation,asprovidedforbytheDirectorof IndustrialRelationsasprovidedbySection 3700 oftheLaborCode,forthe performanceoftheworkforwhich thispermitisissued. I haveandwillmaintainworkers’compensationinsurance,asrequiredbySection 3700 oftheLaborCode,fortheperformanceof theworkforwhichthispermitisissued. Myworkers’compensationinsurancecarrierandpolicynumberare: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to becomesubject to the Workers’ Compensation Laws of California, and agree that if I should become subject to the workers’ compensationprovisions ofSection 3700 oftheLaborCode, I shallforthwithcomplywith those provisions. Date:Print Name:Signature: OWNERBUILDERDECLARATION – PERMIT#: I herebyaffirmunderpenaltyofperjurythat I amexemptfromtheContractors'StateLicenseLawforthereason(s)indicatedbelowby the checkmark(s construct, alter, improve, demolish, or repair any structure, prior to issuance, also requires the applicant for the permit to file a signedstatementthatheorshe) I haveplacednexttotheapplicableitem(s)Section 7031.5 BusinessandProfessionsCode:Any cityorcountywhichrequiresa permit to islicensedpursuanttotheprovisionsoftheContractors'StateLicenseLaw(Chapter 9(commencingwithSection 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt and thebasis for the alleged exemption. Anyviolation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).) I hereby affirm under penalty of perjury ONE of the following declarations (MUST CHECK ONE OF THE FOLLOWING): I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intendedor offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of propertywho builds or improves the property, provided that the improvements are not intended or offered for sale. If, however, the building orimprovementissoldwithinoneyearofcompletion,theOwner-Builderwillhavetheburdenofprovingthat itwasnotbuiltorimprovedforthepurpose ofsale.) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and ProfessionsCode:TheContractor'sLicenseLawdoesnotapplytoanownerofpropertywhobuildsorimprovesthereon,andwho contractsforsuchprojectswith a licensedcontractorpursuanttotheContractors'StateLicenseLaw.) I am exemptfrom LicensureundertheContractors' StateLicenseLaw forthefollowing reason: Date:Print Name:Signature: