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CITY OF STOCKTON ^ COMMUNITY DEVELOPMENT DEPARI.....,NT ©4 BUILDING DIVISION, CITY HALL PHONE:(209)937-8561 STOCKTON, CALIFORNIA 95202 24 Hr. Inspection Request PERMITAD937-8560 plication Number 95 00001490 LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 em licensed under provisions of Chapter 9 (commencing with Sect iorr��II'` �pp��/ pFy¢� 3j^ 1 the Business and Joh Address Professions Code,and my I L�Itd�YslTn FuYfiZSrce'en lfect. dress_____________ Issue Date CONTRACTOR 401 N SAN JOA99IN ST -5/09/95- LICENSE NO. LICENSE TYPE DATE Permit Type GENERAL BUILDING PERMIT-----2L STOCKTON BUS.LIC.NO. Parcel Nbr 139 150 05 OWNER-BUILDER DECLARATION Geo Code : 0100 02 11 04 0 I hereby affirm that I am exempt from the Contractor's License Owner Name . . UNITED STATES OF AMERICA Lew for the following reason(Sec.7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve' Address . . . X demolish, or repair any structure. prior to Its issuance• also requires the applicant for such permit to file a signed statement that he is licensed 00000 pursuant to the provisions of the Contractor's License Law (Chapter App] Type ADD, ALT G REPAIRS-NON RESIDENTIAL commencing with Section 7000) of Division 3 0l the Business and Pro- fessions Code)or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Desc of Work NON RESIDENTIAL subjects the applicant to a civil penalty of not more than live hundred Valuation 1700 i dollars($500.): s ❑ 1,as owner of the property or my employees with wages as their Square ftg 0 Zoning C3 sole compensation, will do the work, and the structure Is not Intended or offered for sale (Sec. 7044), Business and Professions Code: The Occup Group B2 Const Type SN Contractor's License Law does not apply to an owner of property who f builds or improves thereon•and who does such work himself or through his Own employees, provided that such Improvements are not Intended 5 ecial Notes and Conditions 4 or offered for sale. It.however,the building or Improvement Is sold within Q--- one year of completion,the owner-builder will have the burden of proving CLEMEPlS CONSTR. C0:ST LICIT 525424 that he did not build or Improve for the purpose of sale.) I; ❑ 1, as owner of the property, em exclusively contracting with EXP 2/29/95 licensed contractors to construct the project (Sec. 7044• Business end N/C EXP 1/1/9b Professions Code: The Contractor's License Lew does not apply to an owner of property who builds or Improves thereon, and who contracts CITY BUS LIC#276 EXP 12/31/95 ,r for such projects with a contractor(s)licensed pursuant to theContrector's License Lew.) BACKFILL EXCAVATION W/A COMMERCIALLY ❑ 1 em exempt under Sec. ,B.8 P.C.for this PROCESSED ROCK, (PEA GRAVEL) PRODUCT reason THEY HAVE A PERMIT FROM FIRM TO REMOVE Date Owner (2) UNDERGROUND FUEL STORAGE TANKS CONSTRUCTION LENDING AGENCY TALKED TO ERIC E. RE THIS PERMIT 1. 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued(Sec.3097,Clv.C.). _ _ _ _ _ _ _ _ _ _ _ _ _ _ FEES - - - - - - - - - - Lender's Name PERMIT FEE 54.P4 1 Lender's Address A20-GPMI (.00I*VAL)----KK, 1.40} ,r WORKERS'COMPENSATION DECLARATION p15-5MIP-STRONG MOTION-N9 .50 I hereby affirm that 1 have a certificate of consent to self-Insure,or e certificate of Workers' Compensation Insurance, or a certified copy A35-LAND UPDATE--------NN 2.50 thereof(Sec.3800.Lab.C.)Policy No. Company A30-PERMIT TRACKING----MM 10.00 O Certified copy is hereby furnished.Expires A25-SPAS (.0005*VAL)---LL .B5 ' 9qCertified copy is filed with the cif Ilding ns 11 department. r D8104J / 7 ,Applicant ��`��--+ �� --------- PERMIT TOTAL 69.49 CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE This section need not be completed If the permit is for one hundred 'dollars(5700)or less. 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 become subject to the Workers'Compensation Laws of California. • Date Applicant NOTICE TO APPLICANT: If, alter making 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 shell be deemed revoked. I certify that I have recd this application and state that the above Information is correct.I agree to comply with all city and county ordinances and btate laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for Inspection pu ses. ,//�,/� p SIGNED 06'.441K 4 435 ��44 L�fj / ADDRESS JOB ADDRESS 44rel l A -5� C Q�4:V r(' i®!/ APPLICATION APPROVAL THIS PERMIT DOES NOT BECOME VALID UNTIL SIGNED BY THE BUILDING OFFICIAL OR H_IIS/S DEPUTY AND FEES ARE PAID. SIGNATURE: