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WP0041279
EnvironmentalHealth
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MOUNTAIN HOUSE
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4200/4300 - Liquid Waste/Water Well Permits
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WP0041279
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Entry Properties
Last modified
3/11/2021 12:17:24 PM
Creation date
3/11/2021 11:50:35 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041279
PE
4372
STREET_NUMBER
997
STREET_NAME
MOUNTAIN HOUSE
City
TRACY
Zip
95391-
APN
25455030
ENTERED_DATE
9/28/2020 12:00:00 AM
SITE_LOCATION
997 MOUNTAIN HOUSE
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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Tags
EHD - Public
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Joe ADORM: B n Road end Mountain House Parkway PERa§r/, <br /> LICENSED CONTRACTORS DECLARATION <br /> 1 hereby aflktn that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and <br /> Prohasions Code and my llamas Is In full force and effect. <br /> Lkenas! 1056336 Expiration Data 09/31/2021 <br /> Date 09/152020 Contractor ('decade frilling,L P. <br /> OWNER-BUILDER DECLARATION <br /> 1 hereby affirm that I am exempt from the Contractor's License Law for the folkrwing reason(Section 7031 5,Business and Profesawns <br /> Coda: Any city or county which requires a permit to construct,altar,Improve,demolish,or repair any structure,prior to Aa issuance. <br /> also requires this applicant tow such permit to foe a signed statement that he Is licensed pursuant to the provisions of the C6 mactors <br /> Liosnse Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professms Code)or Mat he fs exempt <br /> hereftom acrd the basis for the alleged exemption. Any violation of Section 7031.5 try any applicant for a permit subjects the applicant <br /> to a civil penally of not more than rive hundred dollars($600)) <br /> E3 1,as owner of the property,or my employees with wages an their sole compensation, will do the work,and 1M structure is nor <br /> intended or offered for sale(Section 7044. Business and Professions Code The contractor's License Law does not appy to an <br /> owner ol property who builds or Improves thereon,and who does such work himself or through his own employees provided that i <br /> such improvements are not intended or offered for%ale. II, 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 We) <br /> D 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and <br /> Professions Code(BEPC): The Contractor's License Lew 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 /> E3 1 am exempt under Section B3PC for this reason <br /> I <br /> Date: Owner <br /> WORKERS'COMPENSATION DECLARATION <br /> 1 hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers'Compensation Insurance,or a certified copy <br /> thereof(Section 3800,tabor Code). <br /> Expiration Date I1/Ol/2020 Company Cascadc Dulling,L.P. <br /> I <br /> O Certified copy is hereby furnished <br /> [3 Certified copy is tied 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 dollars($100)or less) <br /> I ceAdy 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 Workers'Compensation Laws of Califomia. <br /> I <br /> Dater 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 owe is a construction lending agency for the performance of the work for which this pemut is Issued(Section 3097 <br /> Civil Code)- <br /> La tiers Marne <br /> Landers Address <br /> DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION <br /> 13 1 hereby cerVfy 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 /> Owed,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 /> D As owns-budder.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 /> O Division of Industrial Safety Permit III <br /> I eeIVY IhM 1 have read this application and state that the above information la correct. I agree to comply with all city and county <br /> Ordinances and§lata laws relating to well construction and or sawaoe system construction,and hereby authorize representatives of this <br /> county 10 enter upon the ebov&nronboned property for Inspection purposes. <br /> Data Appikant <br /> EHp 434i2-007 LICENSED CONTRACTORS DECLARATION <br /> 62" <br />
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