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CITY OF STOCKTON COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION, CITY HALL PHONE (209) 937-8561 STOCKTON, CALIFORNIA 95202 24 Hr. Inspection Request 937-8560 APP103a00008876 000876berPERM !T 8 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter (Commencing with section 7l force of Diviaio=of,ttatand Prc-si—Code,and my Job Address Issue Date license is In full toren and KR1n[ CONTRACTOR 632 5 EL DORADO ST 11/18/03 LICENSE NO LICENSE TYPE DATE Permit Type GENERAL ELECTRICAL PERMIT---2L STOCKTON-BUS'LIC NO SubdlYlslan . OWNER BUILDER DECLARATION Parcel Nbr 149 070 33 1 hereby af1Pm that 1 am exempt from the Contractors License Law for the Geo Code 0700 03 03 03 0 following reason(Sec 7031 5 Business and Professions Code Any My or county which requiresapermit toconstruct after improve demolish or repair any structure owner Kane R & L BUSINESS MGKT staernemthat eislicensedalso dpursu me applicant for such permit to tole a signed ions of the C:Qntractoes L=nse Address' . . . . 3826 GLENEAGLES DR Law (Chapter 9 commencing with S tectbn 7to the D0�Division 3 of the Business and 9 Professions Code)or that he is exempt therefrom and the basis for the alleged STOCKTON CA 4517 subloew the exemption to My peviolatnalty off not Section thatlhrehundred od liars permit) A1kP 1 T YP e ELECTRICAL, PLUMBING, MECHANICAL-ROH RBS ❑ I as owner of the property or my employees with wages asthsirsole Desc of ;park RON RESIDENTIAL compensation will do the work,and the stnrcture is not Intended or offered for sale PANEL UPGRADE (Sec 7049) Business and Profesaons Code The Contractor's License law does not apply to an owner of property who builds or improves thereon and who doss Valuation . 3,200 such work himself or through his own employees provided that such improvoments are not Intended or offered for sale if however the building or improvement is sold Square f tg 0 Zoning K2 within one year of completion the owner-budder wilt have the burden of proving that he did not build or Improve for the purpose of sale) OCCUP GrOUP CODSt Type ❑ I as owner of the property am exclusively contracting with licensed contractors to construct the protect(Sac 7094 Business and Professions Code Th.Contractoes License Law does not apply to any owner Of Property who builds or special Rotes and Conditions improves thereon and who contracts for such projects with a contractors)licensed r pursuant to the Contractor's License Law) CARR ELECTRIC 388146 EB 5/31/05 ❑ I am exempt under Sec. B&PC for this R/C STATE COMP EY 7/1/04 n BUS LICI 7149 E1 12/31/03 owner 200 AMP SERB a SUBFEED TO EQUIP, - - - - - - - - - - - - - - FEES - - - - - - - - - - . . - - - PERKIT FEE 56.70 NOTE To protest the Imposition of any development fee dedication A20-GPKI--------------"jhh 6.40 reservation or other exaction Imposed on your project,you must fila written aa notice with the City ClerICa office within 90 days after approval of the project Ali-SHIP-COKKERCIAL---xN9 6 I or imposition of the fees,dedications,reservations or other exactions stating that the required payment Is tendered or will be tendered when due,or that A35-i,AriD JPDATE-------"dh 2 75 any conditions which have been Imposed are provided for or satisfied,under protest slangg with a statement of the actual elements of the dispute and the A10-HICROFILK FEE-----:110 .30 legal theory Torming the basis for the proll A30-PERAIT TRACKING---'MM 11 50 WORKER S COMPENSATION DECLARATION I hereby affirm that I have a certificato of consent to set insure or a Certificate of Workers Compensation insurance are candied copy thereof(See 3800 Lab C) ---------- Policy No PERMIT TOTAL 78 32 Company ❑ Certified copy is hereby furnished Expires ❑ Ce�Ified copy Is filed with the d uddln nspe pa hent AC�ATE `� Appirean Sit OF EXEMPTION FR WORKERS COMPENSATION INSURANCE r This section need not completed if the permit is for one hundred dollars ($100)or less I certify that In the performance of the week 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 Date Applicant NOTICE TO APPLICANT If after me"this Certificate of Exemption you should become subject to the Workers Compensation provisions of the Labor Code you must forthwith comply with such provisions or this permit shall be doomed revoked I caddy that I have read this applkation and state that the above information is correct I agree to compty with all and county ordinances and state laws re [o bulldn construction and hereby aulhonze representatives of this city to th ve mentioned property or Inspection purposes ADDRESS 7FICIA DRESS APPLICATION APPROVAL PERMIT DOES NOT BECOME VALID UNTIL SIGNED BY THE BUILDING L OR HIDEPUTY qND ES EPA SIGNATURE