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JOBADDRESS: 1.320 West Weber Ave, Stockton, CA PERMIT p:
<br /> LICENSED CONTRACTORS DECLARATION
<br /> 1 hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and
<br /> Professions Code and my license is in full force and effect.
<br /> License# 709029 Expiration Date 06/30/2021
<br /> Date 07/13/2020 Contractor Zx4
<br /> OWNER-BUILDER DECLARATION
<br /> I hereby affirm that 1 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 file 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 70315 by any applicant for a permit subjects the applicant
<br /> to a civil penally of not more than five hundred dollars($500)):
<br /> 0 T,as owner of The property,or my employees with wages as their sole compensation,will do the work,and the structure is not
<br /> intended or offered for sale(Section 7044,Business and Professions Code:The contractor's License Law does not apply to an
<br /> owner of property who builds or improves(hereon,and who does such work himself or through his own employees,provided that
<br /> such improvements are not intended or offered for sale. It,however,the building or improvement is sold within one year of
<br /> completion,the owner-builder will have the burden of proving that he did not build or improve for the purpose of sate.)
<br /> 00 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and
<br /> Professions Code(BBPC): Th!Contractor's License Law does not apply to an owner of property who builds or improves hereon,
<br /> and who constructs for such projects with a contractor(s)licensed pursuant to the Contractor's License Law)
<br /> Dater Owner
<br /> WORKERS'COMPENSATION DECLARATION
<br /> 1 hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers Compensalion Insurance,or a certified copy
<br /> thereof(Section 3800,Labor Code).
<br /> Expiration Date 12/31/20 Company Terracon Consultants, Inc.
<br /> M Certified copy is hereby furnished
<br /> 13 Certified copy Is filed with the Environmental Health Department
<br /> CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE
<br /> (This section need not be completed it the permit is for one hundred dollars f$l00)_or less
<br /> I certify[hat 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 Workers'Compensation Laws of California. Joshua Morgan, P.E.
<br /> Date: 07/13/2020 Applicant Terracon Consultants,Inc.
<br /> NOTICE TO APPLICANT 11,after making this Certificate of Exem ion you sh Id 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 Code).
<br /> Lender's Name
<br /> Lender's Address
<br /> DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
<br /> El I hereby certify that no excavation five(5)or more feel 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 budding 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 /> m As owner-builder,I will not employ anyone to do work which would require a permll from the Division of Industrial Safety,as noted
<br /> above,unless such person has a permit to do such work from the division
<br /> 0 Division of Industrial Safety Permit If _
<br /> I certify that I have read this application and stale 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 construction,and hereby authorize representatives of this
<br /> county to enter upon the above-mentioned property for inspection purposes.
<br /> Date 07/13/2020 Applicant �
<br /> Joshua organ, P.E.
<br /> Terracon Consultants, Inc.
<br /> EHO 4302.007 LICENSED CONTRACTORS DECLARATION
<br /> 6-2e-09
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