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PERMIT <br /> CITY OF LODI - COMMUNITY DEVELOPHEUT DEPA6 NT, BUILDING INSPECTION DIVISION, 221 W PIN GREET PO BOX 3006. LORI, CA 95241-1910 <br /> Application No.: 11429 Application Date: 12/06/96 Permit Date: 12/11/96 Pewit No.: 29959 <br /> Job Address: 00450 N CHEROKEE LN Assessor Parcel No.: 41-300-0012 Subdivision: Lot No.: <br /> P, qty Omer: U HAUL REAL ESTATE CO CORP2. PROPERTY TAX Phone No: <br /> g Address: PO BOX 29046 City/State: PHOENIX AZ Zip Code: 85038-0000 <br /> Paint Class: ADD/ALTER/REMODEL P"t Types: DEMO UBC Group: UBC Type: <br /> Project Description: REMOVE 2 LNDERGROOND STORAGE TANKS <br /> Project Nanager: RONALD PERRY subs (YIN): Phone No.: 714-826-0352 <br /> Contractor: WAYNE PERRY INC License No.:-300345 Phone No.: 714-826-0352 <br /> Address: 8281 COMIAMTWEALTH AVE City/St: BUENA PARK CA Zip: 90621-0000 <br /> Lender Hare: Address: <br /> Census No. Subcode Description ANY Qty/Value BVD #!bits #Bldg Value Sewer <br /> 649 F DEMOLITION, FUEL TANK RE14-.VAL f 500 30.1 1 1 500 <br /> Total Qty/Value: Total Value: 500 Zoning: <br /> FEE DATE FEE DATE <br /> Building Permit Fee 50,00 12/17/96 Additional LBC Fees <br /> Pre-Paid 8163. Permit Fee Administrative Fees <br /> Plan Review Fee Special Inspection <br /> +dditional Plan Review Fee Code Compliance Fee <br /> 'chanical Equipment Fees Zoning Plan Review <br /> �Eiectricat Equipment Fees Water Meter Dep.rit <br /> Plurbin3 Equipment Fees Wastewater Capacity Fee <br /> S.M.I,P Fees: Commercial Water Service Charges <br /> S.M.I.P Fees: Residential — Wastewater Service Charges <br /> TOTAL FEES T 50.00 <br /> YORKERS COMPENSATION CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE <br /> I hereby affirm that I have a certificate of consent to I certify that in the performance of the work for which this <br /> 3alf-insure, or a certificate of Workers Compensation permit is issued, I shall not employ any person in any manner <br /> Insurance, or a certified copy thereof (Sec 3800, Labor Code) so as to became subject to the Workers Compensation Laws of <br /> California. <br /> Policy No. Z04129201 <br /> Ca Tang ZENITH INSURANCE COMPANY = Date Applicant <br /> NOTICE TO PERMITEE: If, after making this Certificate of <br /> _ Certified copy is hereby furnished Exemption, you should become subject to the Workers Compensation <br /> Provisions of the Labor Code, you must forthwith comply with such <br /> Certified copy filed with Building inspection Division provisions or this permit shall be deemed revoked. <br /> I certify that I have read this Perymt and state that the above information is correct. I agree to comply with all City Ordinances <br /> 3rd State Laws relating to BuildirwJ onstructi , and hereby authorize representatives of the City of Lodi to enter upon the above- <br /> u:nticned property for inspecti rpo . . <br /> Contractor Cate <br /> Owner Sign a of Contractor, Owner or Agent <br /> ,/ Agant for Contra r _ Owner Issued by: <br /> f�oart�l�._�- <br /> AGGRESS OF AGN CITY STATE ZIP TELEPHONE <br /> NOTICE <br /> THIS PERU WILL EXPIRE BY LIMITATION IF WORK IS MDT STARTED IN 180 DAYS OR IF YORK IS ABANDONED FOR MORE THAN 180 DAYS <br /> DO NOT CONCEAL OR COVER ANY CONSTRUCTION UNTIL THE WORK IS INSPECTED AND IS RECORDED ON THE INSPECTION RECORD CARD <br />