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WP0039619
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4200/4300 - Liquid Waste/Water Well Permits
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WP0039619
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Entry Properties
Last modified
11/19/2024 10:36:11 AM
Creation date
7/31/2019 9:53:59 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0039619
PE
4372
STREET_NUMBER
0
STREET_NAME
I-5
City
STOCKTON
ENTERED_DATE
5/17/2019 12:00:00 AM
SITE_LOCATION
I-5
P_LOCATION
01
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2019
Tags
EHD - Public
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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 and <br /> Professions Code and my license is in full force and effect. <br /> License# 938110 Expiration Date Sept. 30th, 2019 <br /> Date 05/16/2019 Contractor Cascade Drilling L.P <br /> OWNER-BUILDER DECLARATION <br /> I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5,Business and Professions <br /> Code: Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure, prior to its issuance, <br /> also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's <br /> License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt <br /> herefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant <br /> to a civil penalty of not more than five hundred dollars($500)): <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 Code: 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 /> ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and <br /> Professions Code(B&PC): The Contractors License Law does not apply to an owner of property who builds or improves hereon, <br /> 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'Compensation Insurance,or a certified copy <br /> thereof(Section 3800,Labor Co e). <br /> Expiration Date f Company � L��w� <br /> Certified copy is hereby furnished <br /> ❑Certified copy is filed with the Environmental Health Department I <br /> CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE !!!! <br /> (This section need not be completed if the permit is for one hundred dollars($100)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'Compensation <br /> provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. <br /> CONSTRUCTION LENDING AGENCY <br /> hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Section 3097, <br /> Civil Code). <br /> Lender's Name <br /> Lender's Address <br /> DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION <br /> KI 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 permit,and that no building structure,scaffolding,falsework, or demolition or dismantling <br /> thereof,will be more than thirty-six(36)feet high.(Chapter 3.2,Group 2,Article 2,Section 341,Title 8,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 noted <br /> 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 /> ( <br /> EHD 43-02-007 LICENSED CONTRACTORS DECLARATION <br /> 6-26-09 <br /> 1 <br /> a <br /> gry4 <br /> 9 <br />
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