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CITY OF STOCKTON
<br />COMMUNITY DEVELOPMENT DEPARTMENT
<br />BUILDING DIVISION, CITY HALL
<br />STOCKTON, CALIFORNIA 95202
<br />I
<br />PHONE: (209) 937-8561
<br />24 Hr. Inspection Request
<br />209-937-8560
<br />Permit No: BP21-01528
<br />;SCITY OF
<br />STOCKTON
<br />PERMIT
<br />Description of Work:
<br />Issue Date
<br />Permit Type Outside City Limits
<br />Category Residential
<br />Permit Address 1121 ANNABELLE LN
<br />Parcel No. 17320012
<br />Owner 3 STAR INVESTMENTS LLC ETAL
<br />PO BOX 8871
<br />STOCKTON CA, 95208
<br />Applicant 3 STAR INVESTMENTS LLC ETAL
<br />PO BOX 8871
<br />STOCKTON, CA 95208
<br />Contractor
<br />Valuation
<br />LICENSED CONTRACTOR'S DECLARATION
<br />— I hereby affirm that I am licensed under provisions
<br />7000) of Division 3 of the Business and Professions Code, and my license
<br />License Type: License Number: Date:
<br />of Chapter 9 (commencing with Section
<br />is in full force and effect.
<br />Contractor: Stockton Bus. Lic. No:
<br />OWNER-BUILDER DECLARATIONS
<br />I hereby affirm that I am exempt from the Contractor's License Law for the following reason
<br />(Sec. 7031.5.Business and Professions Code: Any city or county which requires a permit to
<br />construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the
<br />applicant for such permit to file a signed statement that he/she is licensed pursuant to the
<br />provisions of Contractor's License Law (Chapter 9 commencing with Sec.7000) of Division 3 of the
<br />Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged
<br />exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to
<br />civil penalty of not more than five hundred dollars ($500):
<br />I, as owner of the property, or my employees with wages as their sole compensation, will do
<br />the work, and the structure is not intended or offered for sale (Sec. 7044) Business and
<br />Professions Code: The Contractor's License Law, does not apply to an owner of property who
<br />builds or improves thereon, and who does such work himself or through his own employees,
<br />provided that such improvements are not intended or offered for sale. If, however, the building
<br />or improvement is sold within one year of completion, the owner-builder will have the burden of
<br />proving that he did not build or improve for the purpose of sale.)
<br />I, as owner of the property, am exclusively contracting with licensed contractor(s) to
<br />construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
<br />does not apply to an owner of property who builds or improves thereon, and who contracts for
<br />such projects with a contractor(s) licensed pursuant to the Contractor's License Law)
<br />I am exempt und Sec. P. C. for this reason Special Notes and Conditions
<br />on the
<br />>1
<br />a Permit
<br />additional
<br />any inspections will
<br />will be required in
<br />for alterations,
<br />Required inspections:
<br />Additional inspections may be required depending
<br />scope of work for your project; please contact
<br />Technician or your Building Inspector for
<br />information,
<br />Potential additional inspections:
<br />Street address numbers must be posted before
<br />be made.
<br />Smoke detectors and Carbon Monoxide Alarms
<br />existing dwellings when a building permit is required
<br />repairs, or additions exceeding a $1,000 valuation.
<br />/B4,
<br />/5 Owner: Date:C---------- ------1
<br />\ NOTE: To protest th impos ion of any development fee, dedica reservation tion, reseation or
<br />'other exaction imposed n your project, you must file written notice with the City
<br />Clerk's office within 90 days after approval of the project or imposition of the fees,
<br />dedications, reservations or other exactions stating that the required payment is
<br />tendered or will be tendered when due, or that any conditions which have been imposed
<br />are provided for or satisfied, under protest, along with a statement of the actual
<br />elements of the dispute and the legal theory forming the basis for the protest.
<br />WORKERS COMPENSATION DECLARATION
<br />I hereby affirm that I have a certificate of consent to self-insure, or a Certificate of Worker's
<br />Compensation Insurance, or a certified copy thereof (Sec 3800, Lab. C.).
<br />Policy Number: Company:
<br />Certified copy is hereby furnished. Expires:
<br />Certified copy is filed with the city building inspection department.
<br />Date: Applicant:
<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 certify that in the performance of the work for which this permit is issued, I shall not
<br />employ any person in any manner so as to become subject to the Workers' Compensation Laws
<br />of California.
<br />Date: Applicant:
<br />NOTICE TO APPLICANT: If, after making this Certificate
<br />subject to the Workers' Compensation provisions of the Labor
<br />with such provisions or this permit shall be deemed revoked.
<br />I certify that I have read this application and state
<br />agree to comply with all city and county ordinances and
<br />hereby authorize representatives of the city of Stockto
<br />property for inspect' purposes.
<br />of Exemption you should become
<br />Code, you must forthwith comply
<br />that the above information is correct. I
<br />state laws relating to construction. I
<br />to enter upon the above mentioned
<br />Klr,
<br />SIGNED: ' --- — — PRINT NAME:
<br />,
<br />NIMI
<br />APPLICATION APPROVAL
<br />THIS PERMIT DOES NOT BECOM V LID UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS
<br />DEPUTY AND FEES ARE PAIDj
<br />Sionature: ,...
<br />, 7
<br />.-----' ..,
<br />THIS PERMIT SHALL BECOME VOID AND WORK SHALL BE CONS IF AN INSPECTION HAS NOT BEEN RECORDED
<br />AND APPROVEDIJHIN 180SAYS
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