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CITY OF MANTECA `, 1001 W. Center St, Manteca, California 95337 (209) 456-8550 BUILDING PERMIT ns(209) n Recorder (209)456-8552 Permit Type: Tenant Infill/Remodel Commercial Permit No: 2016-00000182 Date: 4/7/2016 Address: 137 N MAIN ST A.P.N. 21721053 Subdivision: NORTH MANTECA Lot Number: Owner: BANH, RICHARD & MANG CHI Address: PO BOX 246026 SACRAMENTO, CA 95824 Professional: Other Issued To: TBD Address: Work Description: 1800 sq ft TI for Habibi's International Market and Deli Install Equipment, ADA Bathroom TBD Square Feet: 180000 Valuation: 80000.00 Property In Floodplain: Yes No Initial LICENSED CONTRACTOR DECLARATION CONSTRUCTION LENDING AGENCY I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of I hereby affirm under the penalty of perjury that there is a construction lending the Business and Professions Cada.and my license Is in full force and effectagency for the performance of work for which this permit is issued.Section 3097, License Class:0 License Number:0 License Expiration Civil Code. Lenders Name Signature: Dale: Lenders Address: OWNER BUILDER DECLARATION I hereby aRnn that I am exempt from the Contractors License Law for the following reason(Sec.7031.5 Business and Professions Code). Any city or county which requires a peond to construct,alter,improve, demolish or repair any structure,prior to its issuance also requires the applicant for such permit to file a signed SMOKE DETECTOR AND CARBON MONOXIDE ALARMS statement that has licensed pursuant to the provisions of the Contractors Chapter 9(commencing with section REQUIRED 7000 of Division 3 of the Business and Profession's Code)or that he is exempt therefrom and the basis of the INSPECTION REQUIRED DURING INSTALLATION alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not morethan five hundred dollars($500) 1.ALL WORK SUBJECT TO FIELD INSPECTION )Q I,as owner of the property,or my employees with wages as their sole compensation will do the work,and NO OCCUPANCY OF STRUCTURE UNTIL OUTSTANDING structure is not intended or offered for sale(Sec.7046.Business and Professions Code. The Contractor's FEES ARE PAID License Law does not apply to an owner of property provided that such improvements are not intended or offered for sale.If,however the building that he did not build or improve for the purpose of sale). I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec 7044.Business and Professions Code. The Contractors License Law does not apply to an owner of property THIS PERMIT SHALL EXPIRE AND BECOME NULL AND VOID WHEN who builds or improves thereon,and who contracts for such projects with a conmoor(s)licensed pursuant to the NO INSPECTION HAS BEEN PERFORMED FOR ANY 180 DAY PERIOD Contractors License Law). AFTER THE PERMIT HAS BEEN ISSUED. I am exempt under the ContractorsState License Law for the following reason. By my signature below I acknowledge that,except for my personal residence In which I must have resided in for 1 hereby certify that I understand and agree that all permits are at least one year poor to completion of the improvements covered by this permit,I cannot legally set a structure subject to California Health and Safety Code Section 19850 and Mat I have built as an owner-builder if it has not been constructed In its entirety by licensed contractors.1 Government Code 6250 and as such are considered Public Records. understand that a copy of the applicable law.Section 7044 of a B&P Code is available by request or at wwwleainfo.ca.aoy/cal"hi Applicant Initials L— Signature of Property Owner/ANhonzed Ag t: 2�� Date: WORKERS COMPENSATION DECLARATION I hereby athnn under the penalty of perjury the following declarations'. I hereby certify that I have read this application and all information I have provided is correct. I agree to comply with I have and will maintain a certificate of consent to self-insure for workers compensation,issued by the Director all applicable city and county ordinances and state laws of Industrial Relations as provided for by section 3700 of the Labor Cade,for the performance of work for which relating to building construction. l authorize the this penny is issuetlrepresentative of the City to enter the identified property for Policy Number' inspection purposes. I have antl will maintain workers'compensation insurance as required by section 3700 of the Labor Code,for the performance of work for which this permit is issuetl.My workers'compensation insurance canter and policy $t natur of Property Own r r A thorized Agent. number are: - Comer Policy Expiration Date: _xt -t.� ------ Policy Number: Name of Agent 7 -4- 7 /„ Date: Off/ rf' manner Nat,o the performance of the work for which the permit is issued, shall not employ any person in any manner so as to became subject to workers'compensation laws of theCalifornia,brand agree that,if should became subject to the workers'compensation provisiyts Section 3700 of the Labor potle.1 shall forthwth comply cath A Proved by: these / SignaU Min Dale: Y' / V"I D;ate WARNING.FAILURE TO OBTAIN WORKERS COMPENSATION INSURANCE COVERAGE IS UNLFAWUL, Amount Paid:$2933.00 AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.