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SR0046557
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4200/4300 - Liquid Waste/Water Well Permits
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SR0046557
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Last modified
10/12/2021 1:20:59 PM
Creation date
12/1/2017 1:17:33 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0046557
PE
4372
STREET_NUMBER
3970
STREET_NAME
WILCOX
STREET_TYPE
RD
City
STOCKTON
Zip
95215
APN
08723004
ENTERED_DATE
5/3/2006 12:00:00 AM
SITE_LOCATION
3970 WILCOX RD
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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SJGOV\wng
Supplemental fields
FilePath
\MIGRATIONS\W\WILCOX\3970\SR0046557.PDF
QuestysFileName
SR0046557
QuestysRecordID
1985566
QuestysRecordType
12
Tags
EHD - Public
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JOB ADDRESS: PERMIT#: <br /> LICENSED CONTRACTORS DECLARATION <br /> I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business <br /> and Professions Code and my license is in full force and effect. <br /> License# z Expiration Date <br /> Date y ' Contractor I r� " <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 <br /> Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair'any structure, prior to <br /> its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the <br /> Contractdr s License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he <br /> is exempt herefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects <br /> the applicant to a civil penalty of not more than five hundred dollars($500)): <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 t <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 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 sale.) <br /> ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044, Business <br /> and Professions Code (B&PC): The Contractor's License Law does not apply to an owner of property who builds or improves <br /> hereon,and who constructs for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) <br /> ❑1 am exempt under Section , B&PC for this reason <br /> Date: Owner <br /> t x , <br /> WORKERS' COMPENSATION,DECLARATION <br /> k <br /> ereb ha a ce ' tate of ns t - re,or ifi to f Work rs' om ensation Insurance, or a certified <br /> c t CO ect' a ode <br /> it e C pan <br /> ❑Ce i ereb he - <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 dollars($100)or less) <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 /> became subject to the Workers' Compensation Laws of California. <br /> Date: Applicant <br /> NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' <br /> Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. <br /> s <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 <br /> 3097,Civil Code). <br /> Lender's Name <br /> Lender' Address <br /> DIVISION OF INDUSTRIAL SAFETY PERMIT CERTICATION <br /> ❑ I 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 b37the 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 <br /> noted above,unless such person has a permit to do such work from the division. i <br /> i <br /> ❑Division of Industrial Safety Permit# j <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 construction, and hereby authorize representatives of this <br /> county to enter upon the above-mentioned property for inspection purposes. <br /> Date Applicant <br /> EHD 43-02-007 LICENSED CONTRACTORS DECLARATION' <br /> 12/11/2002 <br />
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