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CITY OF STOCKTON %.LOMMUNITY DEVELOPMENT DEPARTMENT, BUILDING DIVISION, CITY HALL PHONE: (209) 937-8561 STOCKTON, CALIFORNIA 95202 24 Hr. InspeectionReque: 937-6560 �llcd(,GII nt � f PERMIT ar LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed uMer provisions of Chapter 9(cornmersdn9 with Section 7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect, JVt. Addl'33i 1b3U[ jdtc CONTRACTOR 3W IIkRLAN LICENSE NO. LICENSE TYPE DATE I'malt Inc OU ME LONII[CIloll- - - -- " l STOCKTON BUS.LIC.NO. JUDd 1 V 151 Un OWNER,BUILDER DECLARATION partcl NLr . 19; 210 if I hereby allies trial l am exempt fain Iha Contractor's License Law lar the Gev 6UUf: M1 U2 2i UU U following reason(Sec,7031.5 Business crud Professions Code:Any city or county which requires a peoul to esnarost,after,improve.demolish,or repair any stricture, U'Nnel11a'I8t . biiE1EVNNlA VUNIURE PRO!, E4' prior to its issuance,also requires the applicant for such permit to 11108 signed statement that he is licensed face m to the provisions.1the Contacts,License A3Jf @ j$ , 1408 EoUt U'.VUD D E' Law(Chapter 9 commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt ihemlran and the basis for the alleged LODI :A 8x140 ..piton.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil pmush,ofmirrare that live hundred calls.($500.): kepi Type OUTSIDE W114-0 SEkEL ❑ I.asowrarollheproedy,ornnyem*yeeswithwagesaslhMrsote bese of Goi. Nutt ItE3IDEtlTIAI f�ersatiort will do the work,eul the structure is not intended or offered lar sale 70041.Business and Professions Cade:The Contractor's License Law does 011 T E 4.' h E 11.E' nest apply to an owner of property who builds or improves thereon,and who does such work himself or through his aern employees,provided that such mmus ements y d 1 U3l l on U are Iwl intended or offered lar sate.II,however,Me buiklirg or improvement is sold within one year of completion.the owner-0uifder will have the burden of proving that '.Quare T T V r U eon 11}4 . . . L4 o be di not buiM or improve fm the purpose of sale.) .. tiecUp liri+Up Cvii5: IYi+t , ❑ I.as owner of Osie property,am exclusively contracting wilh licensed reel"etnrs to construct the project(Sec.7090,Business and Professions Cade: The Contractor's License Law roes not apply to any ewnm of property who builds or - improves thereon,and who contracts for such projects with a conlmctor(s)licensed •i 3 E ll0(e 5 a fiU '� .s u(i 5 L)ACIIAR ;E(I EedlkcD Pursuant to the Contractor's License Law.) "��'- ❑ I am exempt under Sec .BB P.C.for this (0830^ , Date Owner NOTE: To protest the imposition o1 any devetopmeM fee, dedication, reservation or other exaction Imposed on your project,you must file written notice with the City Clerk's office within 90 days after approval of the project 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 any conditions which have been Imposed are provided for or satisfied,under protest,alongg with a statement of the actual elements of the dispute and the - - - legal theory rorming the basis for the protest. WORKER'S COMPENSATION DECLARATION I hereby affirm that t have a certificate of erect to sell-insure,or a certificate of Workers'Compensation Insurance.or a canihed copy thereof(Sec.3800,Lab.C.) Poltcy No. Company ❑ Certified copy,i.hereby IumislrM;II I I j V 1;6. ed.Expires ❑ Certified copy is filed with the city building inspection department. 1,,.v)' t,1 LuCKtOn Dete .Apnlicent R31 CUSII) Lll `.i�.,IPI n CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE This sections need not be completed if Ore permit is lar one hundred date. Ud'GC.'ll III: 1'i,l Elill:� I fU5lF97 1I1 ($left)or less. &:P3 Bt rfui IIStlEi I cenity that in fire performance of Me work for which this permit is issued,I shall rid employ any parson in any manner so as to became subject to the Workers' Type SYCCd De5(:r3 pt1 Compensation Laws of California. U:} AG011lit Data Apptaant 2FtN/ 5 BR BUILDING PkliBTS NOTICE TO APPLICANT:ll,after making this Certificate of Exemption you shouts became subject to the Workers'Cotnpensetton provisions of the Labor Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. I certify I have read This applimntion and state That me alwve tnlormatbn Tende'f d 'tai l is coffees. to I with all ch and county ortlinances asM state laws relating n o e a (iz nlaliveaolthiscttylo CK Befp: it< $lEti41.2.; enterTotal Lendered: $10741.23 sIGNE notal paynfent: $10741.[:.1 'GEA Ess ✓ TranE Date: 1/615%417 11,1e. IS:SS':65 PI� P ifTWj�L�p, G49t THIS PERMIT DOES NOT BECOME VALID UNTIL SIGNED BY THE BUILDING BUQ IJ NOUR S; 9 Ali - Jkj4 OFFICIAL OR HIS DEPUTY AND FEES ARE PAID. SIGNATURE