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Jun.H. 1999 8:51AM CL BRY,ANT cTrY of TRACY PERMIT APPLICATION PART I CONNONM DEVEXA NUM DEPA,RrAM'r 8lJQ WG PSWIuG WXi CAVON APT f LCA [2c7AVIlRA TTT t ilJl4IBER 99-1649 PROJECT 574 W GRANT' 1.,IJqE RD STREET ADDRESS APR 2334034-41 DESCRIPTICIIH OF WORK KEPAll3 TAJW MR FUEL JDXW9NW4G EQUXP S iJMON 76 V43W PERMIT #199-276 AtOF05913 U% OR 0CCLw"Cy VALUATION OF PROJECT 0vvNw SINGIa, SAITNAM ETAL 574 W GRANT 1<.ITylu RD TRACT CA 9953760000 PHONE ( ) FAX � ) CXXqrRACTOR D do S DRA,GLM SLtR'VICE INC POBOX7W WS BANOS CA. 93635 PHONE (209)w3-:3416FAX ( ) STATE IICBNSE NUMBER X331 C,fl'Y' BUSWE&S LICENSE NUMBM HPIGIH�R or AdiCTAiI�CT PFIONR ( ) - FAX ( ) A.4X WAJ+rI' D & S DR,A Cylim SERVICE INC r U sox 709 LOS I{RANGS Cate. 93635 PHONE (209)&'U-3416 FAX ( } - I CTIkn" THAT HAVE READ THIS APR"-nON AND STATE THAT TETE $KOWN XhWkMATION IS CORRECT. AND THAT I AM THE OWMR OR OUILY AUTHORIZED AGENT OF THE OWNEIL I AGREE TO C't7WLY VnT H ALL. CITY AND STATE LAWS R KI-A(1'IIAIG TO BLIRDING C0NVMt7CI'I0N_ I MEBY AUTHORIZE R20WnDITATWEiS OF THE (3TY. OF TRACY TO F>Tefl'PIl THR AW)VE TFIT K*a D PROPBR'T Y,, Folk MSPPC'T M PIMPOSM SIGNAT URE } a-! a °:{• �„e' -'� j� v O Q2VT wt NTRACMR 0 AGENT FOR. OWMR C1 AGEW l)li,LX)NF .ACT'OR RECEWED BY DATE fi.+lo PLAN CHECK, Ott RECEIPT rNSmut17'lmm w ism - FROPFRTY FLE PM - OWN WAPPLlCALtT 4o.0584 P 4/5 94 U10 Bh1d., T mey, CA M76 (20) 83140 Fax No. (2109) 5314604 I pecy im Request Lias (2" 831462] - VCRNSSD CONTR40WR DWLAUTTpiU- I hetmby drum t tdW rba penalty a(pon y that I amt iiaeased tatder pwviuk= of Chapter 9 (oommtascial with Semina 7WW of Division 3 of the Business and Pru kms tide and my Tleenesa is in full force mm effect 65=1 C3713AZA 9!30100 Lisa M 3 c f _ Lkx= Class talim Daae QOaltaetCaae -�J " t �� a�`Yf •,� � "'�'�- '..' � � d�e�L�-� �.s�- � i.,. . � =`! �i u - O'R'A,B:ITl�l61[ i7.tI�AX�AI'lL1N (Sec 70313. Bu pemtle w eslnrtwAe attar 4map " dnnouth, ar espair any arve me prior to IN isaaa*w. Awry to 4aiiet die applkw fear wh peant to f L- a signed sw - -neat 1601 be of sibs.4 lirxnaed pumaat to Ilio pmvisaam of the C4nuartors L ecusis Late {Ch+paer 9 (twrnmcwcing prith Sedum 7iJ00) of Division 3 of the Beisium and pro6ossioAs Codw), or that be oar site is pmt tAwNAVm 040w basis frr tbR Altegsd arrneptarAs. Amy violation of Secam 7031.5 by sdsy apphcam far a permit sobF= the appiwam iD a civ0 Peoaky of teat snare ilio five ht0"eI dollars ('My I Looby affirm updo die penally of pwjary sat I ens exempt fro ttta Cortractom EA wee Law far the following reasons- _% as owner of the yropraty. or my employers widr wmpm as thea aolc c®tpenaatioa, will do iiia wedr, and the knwawe to sat intended or olload Yoe sate i4es- 70". Bteaismst and Prufasiow Cod- 7fae CoatrwabaLs Limns .Law does viii apply to an owner of property who bmlda or improves d mmea and wid does such work himself Or h e elf Or d amngb hls or ber etxowjeed, pravided tear saclr i mprovemeats are no Intended or oekmd for sake. If. however. the building or improycrunt is sold within are year of wadpktim die owner-bmi der will No,* The b iukao of p mviv that Joe or $be did ant build or improv fix the purpose of rale,) _.Las owwrof the prmpnrt am ewluitdycounacdngwith ii=sedeoegtrsctm to a theproject (Ace_ 7044_ Bin is and PcoiknAwas Cade- flue Contractors Lkowe tAw does dot apply w as oww of the pmpWW wttp bailor oat Wa prows thaeaa, and who oamucm fps arch projects with A Omen°A Mm Q licensed prrseeant to thr. Contacusas Lkzm f.aw:i _ I ars, exempt tinder Sex _ EOsinsas and Professions Code for thio wAsoa (lwarc Date • gDikIP.S' G�tT�N.RtAG'I..dlfA2'[ii dN I Itaeby affirm wxkr penalty of prajury Ons of the following declarations. _I have and will maintain wwkcW caompmostioa insurance, as tequbed by Secbm 3700 of the Labor Cada, kir the prtfasnarea oI dna work far wltldt dila ptvtnit is isausd i'h wOekeeY'eemtpeoeaddn iretrar+ee crar�r and policy sauobQ exec iTleia aaddioa need ant bo careapktt+d if flue pcxmie is far core teogelrs,d dollmr� (1100X ar teas) Csrrlev LXAR>dll4VWMVe-oeba 01ID[0004000�Do- W2".9- ---I 2&99_I certify that in the performance of fie work 69r whirl# dila permit is mime , I shall not employ any pssoat it any manner w as to bwmw abject to the wrxkcss' corrtpenastioa laws of California. mad agree that if I andaid became subject to the wsrker a Opcupefldatios provhsiwm of Sdctior 3700 Of rias LAW CDde. I shall forthwith comply with bears provisions. WAJIM43;fAl1MWT*SECUS&W0FJMi3'0""UBION[(, ERAM119tA+1t;AWIPM,AND 9HAIL SUBIECC AN EIdPLOYHit TO C2AMNAL PEX&L IBS AND CIVIL FRES UP TO ONE Ut71JI'sXtX,l3'X WUSAM DOLLARS 3100.000I6 Di ALtDTII[fJly TO THE COST OF OOMX9O1bYATT K DAMAGES AS PROVIDED FOA IN SBi'MN 3706 OF THE LABOR CODE, WMREST. AND ATTOlLIa167f'S FM. - Cp11RSTBIII=vx 411"= - _,#ApOieaut afiama under the Pendry Of perjury that thus is A eonatuetior tutding armcy fm rte perfurmame Of ilio wit fes which Om prem& is issued (Satins. 3M. Civ- Cj LXnaes Natae Address __bpp*ma affiwo ander dw penalty of Pequry that dress is no conatactwo Ie"as asmy far the pedorma= of the wet 1b r wWoh the permit is issaed (Section 3D97, Qv. L) - IJ04ORTA NY - Ayp)tCaatrJe is booby a?mde W the City of They Crurrsdursidy Xir•velop neat Deparnmedt frit' a P—it -Nod W lite condition and restrictions act forth an this applaratm, ad all gVirable cO and [Riad lawn 11011 Ordlioatedea_ l._ each primo apart wtsdse babstU this application is MWC No am* person as wltm req art mud fbrwhorc bentu3it ware is pexfimrmed ortder «patrateaet iu any ptxsoit isa0ad m a rteatlE mf this application aysrra to, rand dtafl. kWmnn* mxd hold har[n]ess ate ($ly aif'tMay, its oft —. sprits and employers id accordance with All Applkable city and slain laws and orduancma. 2., Any Plan RvWew bamnes mill sod void Aller ONE HLMRED BKWlY (I&% days from fie dose of this AplNiucation. NOTE; A, VALID PF$MIT R 71.Tl9 1W%ii>fi7 PART IT TS ISSUED BY TRE CITY OF TRACY COADRWITY DEVELOla1y#IM DEPAHTMElff ANJL 1991