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WP0041020
EnvironmentalHealth
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LOWELL
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4200/4300 - Liquid Waste/Water Well Permits
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WP0041020
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Entry Properties
Last modified
11/24/2021 11:56:34 AM
Creation date
8/18/2020 7:58:05 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041020
PE
4372
STREET_NUMBER
2421
Direction
W
STREET_NAME
LOWELL
STREET_TYPE
AVE
City
TRACY
Zip
95377-
APN
23860030
ENTERED_DATE
7/30/2020 12:00:00 AM
SITE_LOCATION
2421 W LOWELL AVE
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2020
Tags
EHD - Public
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Jos ADDRESS: 2421 W Lowell Avenue. Tracy. CA 95377 PERMIT II: <br /> LICENSED CONTRACTORS DECLARATION <br /> I hereby affirm that I am licensed under the provisions of Chapter 9(commenting with Section 7000)of Division 3 of the Business and <br /> Professions Code and my license is in full force and effect <br /> License# 899451 Expiration Date 06130!2021 <br /> Date 06/29/2007 Contractor Middle Earth Geo Testing, Inc. <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 rile 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(E5W)) <br /> ❑ 1,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 budding or improvement is sold within one year of <br /> completion,the owner-budder will have the burden of proving that he did not build or improve for the purpose of sale) <br /> ❑1 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 Contractor's 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 Contractors License Law.j <br /> ❑I am exempt under Section B&PC for this reason _ <br /> Date: Owner <br /> WORKERS'COMPENSATION DECLARATION <br /> I hereby affirm that 1 have a certificate of Consent to self-insure or a certificate of Woreers Compensation Insurance or a certified copy <br /> thereof(Section 3800.LabqrCode). <br /> Expiration Date -1y2nI Company Middle Earth Geo Testing, Inc. <br /> 13 Certified copy is hereby furnished (Example provided.we can obtain a certified copy if needed) <br /> ❑Certified copy is filed with the Environmental Health Department <br /> CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE <br /> (This Section need not be completed if the permit is for one hundred dpllais(5100)or Iessi <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 WorkersCompensation 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 /> I 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 Ccde) <br /> Lender's Name <br /> Lender's Address <br /> DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION <br /> ❑ 1 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 constriction,and hereby authorize representatives of this <br /> county to enter upon the above-mentioned property for inspection purposes <br /> Date Applicant <br /> E14043-02-007 LICENSED CONTRACTORS DECLARATION <br /> &2609 <br />
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