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\ CITY OF STOCKTON <br /> S COMMUNITY DEVELOPMENT DEPARTMENT"` <br /> BUILDING DIVISION, CITY HALL PHONE: (209) 937-8561 <br /> STOCKTON, CALIFORNIA 95202 24 Hr. Inspection Request <br /> 937-8560 <br /> PERMIT Aopi06 000n Number <br /> 06 00002353 <br /> LICENSED CONTRACTORS DECLARATION <br /> I hereby affirm that I am licensed under provisions of Chapter 9(commencing <br /> with Section 7000)of Division 3 of the Business and Professions Code,and my Job Address Issue Date <br /> license is in full force and effect. 516 N Ok u AV 10116/06 <br /> CONTRACTOR <br /> UCENSE NO. Permit Tvpe : OUTSIDE CONNECTION----------2L <br /> LICENSE TYPE DATE Subdivision , <br /> STOCKTON BUS.LIC.NO. Parcel Nbr 143 330 40 <br /> OWNER-BUILDER DECLARATION Geo code 2101 03 01 14 4 <br /> 1 hereby affirm that I am exempt from the Contractors License Law for the <br /> following mason(Sec.7031.5 Business and Professions Code:Any city or county Owner Name STOCKTONIANS TO NEUTRALIZE DRU <br /> which requires a permit to construct,alter,improve,demolish,or repair any structure, <br /> prior to Its issuance,also requires the applicant for such Permit to file a signed AQQfe55 Vv BOX 30231 <br /> statement that he is licensed pursuant to the provisions of the Conm ch".License <br /> Law ICIwMa,u--Hnn with Cerfion 7nnnn M Oivinim 9 of Me Riminess,and STOCKTON CA 95213 <br /> Anpl Tvpe r OUTSIDE CONNECT - SEWER <br /> Desc of Work ; RESIDENTIAL <br /> SEWER LINE <br /> Valuation 0 <br /> `square ttq 0 Zoning , . . ; 054 <br /> Occup Group Const Tvpe , <br /> City of Stockton <br /> *** CUSTOMER RECEIPT * Special Notes and Conditions <br /> ** <br /> All ENCROACHMENT PERMIT IS REQUIRED PRIOR <br /> Batch ID: MJESUS 10/16/06 01 TO CONNECTION TO A CITY MAINTAINED <br /> Receipt no: 24409 UTILITY <br /> To Sv Description Ot THIS IS A PERMIT FOR THE COLLECTION OF <br /> SEWER CONNECTION FEES ONLY, A BUILGIN6 <br /> y 2086 Amounto2353 BP BUILDING PERMIT PERMIT MUST 6E OBTAINED FROM THE COUNTY <br /> S OF SAN JOAQUIN PRIOR TO THE <br /> 8 $984.43 1.0 COMMENCEMENT OF WORK <br /> Tender detail i - - - - - - - - - - - - - - FEES - - - - - - - - - - - - - - - <br /> CK Ref#: 943 $884.93 <br /> Total tendered: $894.93 IF ADMIN FEE 13.5W1 vKl 29,93 <br /> Total payment: $884.93 IF-WW-EXISTING-SICAL $AH 120.00 <br /> IF-WW-FUTURE-S/CAL *AI 105.00 <br /> Trans date: 10/16/06 Time: 13:30:41 IF-WW-COMB-SICAL TAJ 630,00 <br /> BUSINESS HOURS: 9 ON — NOON, I <br /> PM — 5 PM ---------- <br /> PERMIT TOTAL 864,93 <br /> CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE <br /> This section need not be completed it the permit is for one hundred dollars <br /> SIM)or less. <br /> I certify that In the performance of the work for which this Permit is issued,I <br /> shall not employ any person in any manner so as to become subject to the Workers' <br /> Compensation Laws of California. <br /> Date Applicant <br /> NOTICE TO APPLICANT:If,after making this Cer ificam of Exemption you should <br /> become subject to the Workers'Compensation provisions of the Labor Code,you <br /> must forthwith comply with such provisions or this permit shalt be deemed revoked. <br /> I certify that I have read this application and slate that the above information <br /> is cortact. agrne compN with all end cotyLy ordinances and state laws <br /> is coz to buil co shructioq and ei auto ze presenta[iva of this dry to <br /> enter upo mentioned pr pe 'ns ac t purposes. <br /> SIGN 124 <br /> ADDRESS <br /> JOB A ESS <br /> APPLICATION APPROVAL <br /> THIS PERMIT DOES NOT BECOME VALID UNTIL SIGNED BY THE BUILDING <br /> OFFICIAL OR HIS DEPUTY AND FEES ARE PAID. <br /> SIGNATURE '� <br />