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            "text": "(For City Use Only)",
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            "text": "Building Permit No.: ___",
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            "text": "DEVELOPMENT SERVICES",
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            "text": "BUILDING AND SAFETY DIVISION",
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            "text": "Sustainability/ C&D Waste Plan: YES / NO",
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            "text": "69-825 Highway 111, Rancho Mirage, CA 92270",
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            "text": "General: 760.202.9253",
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            "text": "OWNER-BUILDER DECLARATION",
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            "text": "I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Sec.7031.5 California Business and Professions Code(B&PC)): Any City which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Ch.9 (commencing with Sec. 7000) of Div. 3 of the B&PC) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violations of Sec. 7031.5 by any applicant for a permit subject to the applicant to a civil penalty of not more than five hundred dollars ($500.00).",
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            "text": "I hereby affirm under penalty of perjury, one of the following declarations (SELECT ONE):",
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            "text": "I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, B&PC: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)",
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            "text": "LICENSED CONTRACTOR",
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            "text": "I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect."
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            "text": "Lic. No.: _____ Class: _____",
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            "text": "Rep.: _____ Tel. No.: _____",
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            "text": "I hereby affirm under penalty of perjury, one of the following declarations (SELECT ONE):"
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            "text": "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 become subject to the workers' compensation laws of California and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.",
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            "text": "I have and will maintain a certificate of consent to self-insure for workers' compensation, as provided for by Sec. 3700 of the Labor Code, for the performance of the work for which this permit is issued.",
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