My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
SR0041798
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
E
>
EUCLID
>
3030
>
4200/4300 - Liquid Waste/Water Well Permits
>
SR0041798
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
10/12/2021 1:17:59 PM
Creation date
12/5/2017 1:43:35 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0041798
PE
4364
STREET_NUMBER
3030
Direction
W
STREET_NAME
EUCLID
STREET_TYPE
AVE
City
STOCKTON
Zip
95204
APN
10919019
ENTERED_DATE
4/5/2005 12:00:00 AM
SITE_LOCATION
3030 W EUCLID AVE
P_LOCATION
99
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\wng
Supplemental fields
FilePath
\MIGRATIONS\E\EUCLID\3030\SR0041798.PDF
QuestysFileName
SR0041798
QuestysRecordID
1733923
QuestysRecordType
12
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
3
PDF
View images
View plain text
JOB ADDRESS: PERMIT#: <br /> LICENSED CONTRACTORS DECLARATION <br /> I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business <br /> and Professions Code and my license is in full force and effect. , <br /> License# Expiration Date <br /> Date Contractor <br /> OWNER-BUILDER DECLARATION <br /> I hereby affirm that I.am exempt from the Contractor's License Law for the following reason (Section 703 1.5, Business and <br /> Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair'any structure,prior to <br /> its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the <br /> Contractor's License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he <br /> is exempt herefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects <br /> the applicant to a civil penalty of not more than five hundred dollars(5500)): <br /> ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not <br /> intended or offered for sale (Section 7044, Business and Professions Cade: The contractor's License Law does not apply to an <br /> owner of property who builds or improves thereon, and who does such work himself or through his own employees;.provided that <br /> such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of <br /> completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale.) <br /> ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business <br /> and Professions Code (B&PC): The Contractor's License Law does not apply to an owner of property who builds or improves <br /> hereon,and who constructs for such projects with a contractor(s)licensed pursuant to the Contractor's License Law.) <br /> ❑1 am exempt under Section , B&PC for this reason <br /> Date: Owner <br /> WORKERS' COMPENSATION DECLARATION <br /> I hereby affirm that I have a certificate of consent to self-insure,or a certificate of Workers' Com ensation Insurance,or d <br /> ec L Cod <br /> L� X <br /> Ji to mpa <br /> ❑Ce Pied coy here h 1) <br /> ❑Certified copy is filed with the Environmental Health Department <br /> CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE <br /> (This section need not be completed if the permit is for one hundred dollars( 104)or less) <br /> 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 <br /> become subject to the Workers' Compensation Laws of California. <br /> Date: Applicant <br /> NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' <br /> Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. <br /> CONSTRUCTION LENDING AGENCY <br /> I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Section <br /> 3097,Civil Code). <br /> Lender's Name <br /> Lender' Address <br /> DIVISION OF INDUSTRIAL SAFETY PERMIT CERTICATION <br /> 17 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in <br /> connection-with work.authorized_by_the_perinit,and_that.no-building_structure;scaffolding,_falsework,or_demolition-or-dismantling— <br /> thereof,will be more than thirty-six(3 6)feet high. (Chapter 3.2, Group 2,Article 2, Section 341,Title S, California Administrative <br /> Code). <br /> ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as <br /> noted above,unless such person has a permit to do such work from the division. <br /> ❑Division of Industrial Safety Permit# <br /> I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county <br /> ordinances and state laws relating to well construction and or sewage system construction, and hereby authorize representatives of this <br /> county to enter upon the above-mentioned property for inspection purposes. <br /> Date Applicant <br /> EHD 43-02-007 LICENSED CONTRACTORS DECLARATION <br /> 12/11/2002 <br />
The URL can be used to link to this page
Your browser does not support the video tag.
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).