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Permit No: Address: ----_— Subdivision: Owner: Address: Professional: Issued To: Address: r(� T,r Center UI 1 T nr MAttTC W. Le St, Manteca GA foU 1 ' California 95337 (209 456-8550 BUILDING PERMIT _�� 'r•, i\I ��' Ins p"' P' aGI Recorder 2016-00000458 Permft Type: Commercial Shell Building (209) 456.8352 1231 N MAIN ST Date: 5/31/2017 HIWAY FARM LLC 28214 LEAF DRIVE TRACY, CA 95304 Contractor Chada Construction Co 7010 Hughson Av HUGHSON, CA 95326 Work Description: Square Feet: A.P.N. 21634059 Lot Number: 0 Construct 4,200 SF shell building for future tenants alon 4200.00 g with site Improvement plans Property In Floodplain: Vaivatlon: 400000,00 Yes No initial 1 hereby affirm that I am hcensad sneer provisions of ChaptrR9 ECLgRATION the eus:�ess and Professions Code and my pcense is in full force and eat with Section 7 G00i of Division 3 of Signature License Expiration. 1 / /O Date - OWNER BUILDER DECLARATION ! heresy affirm ;hat I am exempt from IPC COrltraCtri License Law for file following reason (SeC 7031 5 demolish and pair a mane Code) Any sty or county which requires a permit to corutruct, alter, ,Improve demolish dr repair any srudure, poor to its IssiiancC also iequlres the appllcartt for such Permit to Poe a signed sfetemf Division that be is licensed pursuant to the Pruvitsiiats of the Contractors Chapter 9lcommencing wrath section 7� 01 exmp3 0l the Business and Profess, Srj s Code) or that ire is exempt pier 9 (m and the basis M the alleged exemption Any violatioc of Section 7031.5 by any appiiCant for a permit subjects the appkant to a civil penalty of not more than five hundred dollar (5500) 1 as owner of the properly or my employees with wages as their sole compensation wnl do the work, and structure ,s not intendea or offered for sale (Sec 7044 Business and prof MOM Code. The Conlractof s License law does not applyever to an owner of property provided that such imPrnvemarns are not intended or offered for salt If, however the building that he did not build or improve for the purpose of sale? I, as owner of the property, am exclusively confracbng with licensed contractors to Construct the project (Sec who Business and Professions Code The Contractors License Law does not apply to an owner of properly who builds or Improves thereon and who contracts for such projects wtth a contractor(s) licensed pursuant to the Conlndors License Law), am exempt under the Contractors State I ,cense Lax. for the following reason my s,grDhow I acknowledge that except at leas onee year prior to templInn my personal residence in which I must have restde0 in for at year on of the impravemerts savored b this that I have built as an owner -builder if it has nal been consb'uued iny permit, b I cannot legally sell a Structureunderstand that a copy of the its eMuetby licensed apWirawe few Section 7044 of the BdF CcomraCors I ode is available try request oral www.leaiM.o c8 ovrcalaw Mm! Property Owner/Authorized Agent Signature Date WORKERS COMPENSATION DECLARATION I hereby affirm under Ina penalty of perjury the following dartarations. I have and will maintain a cendicate of consent to "if -insure forwoikers compensation. Issued by the Director of Industrial Relations ac provided for by section 3700 of the Labor Code for the Performance of work for which this tis issued Pak Number__ have and will maintain wbtkers' compensation Insurance as required by section 3700 of the Labor Code. for the Performance of work for w'Iic?l this perm 1 is issued My workers compensation illaia'a ni"ber are np carier and pobc Mr,, A T�'QUN I� _ Policy Expiration Date Q ZOr Policy Number ,- __qI _ _q`J--I Z --- �! Name of Agent i!�[dA7 0 %le I certify that, in the performance of the work for which the permit is Issued I soak not employ an manner so as to become subject to workers compensation laws of Cahfomia. and a p y y person in any sub ed to the workers corn enation provisions of gree that if I anoum become 1 p these Provisions. Section 3700 of the Labor Cndw Signature-- rr'A h A 571 -31 Date WARNING FAILURE TO OBTAIN WORKERS COMPENSATION INSURANCE COVERAGE IS UNLFAWUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0001, IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND ATTORNEY'S FEES CONSTRUCTION LENDING AGENCY I hereby affirm under the Penalty of ear u agency for the performance of work for wryr;J, this is a construction lenomg Civil Code permit Is issued Semon 305' Lenders Name Lenders Address SMOKE DETECTOR AND CARBON MONOXIDE ALARMS REQUIRED INSPECTION REQUIRED DURING INSTALLATION L] ALL WORK SUBJECT TO FIELD INSPECTION 1-1 NO OCCUPANCY OF STRUCTURE UNTIL OUTSTANDING FEES ARE PAID THIS PERMIT SHALL EXPIRE AND BECOME NULL AND VOID WHEN NO INSPECTION HAS BEEN PERFORMED FOR ANY 180 DAY PERIOD AFTER THE PERMIT HAS BEEN ISSUED. I hereby Certify that 1 understand and agree that all permits are subject to California Health and Safety Code Section 19850 and Government Code 6250 and as such are considered Public Records, Applicant Initials: I hereby certify that I have read this application and all information 1 have provided is correct. I agree to comply with all applicable city and county ordinances and state laws relating to building construction. 1 authorize the representative of the City to enter the identified Property for inspection purposes. of Prope owner or Authorized Agent: Date: S 3 Approved by: Date Issued:_ S Amount Paid: $53262.34