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i CITY ST
<br /> COMMUNITY DEVELOPMENT
<br /> DT DEPARTMENT
<br /> BUILDING DIVISION, CITY HALL PHONE:(209)937-8561
<br /> AQ0STOCKTON, CALIFORNIA 95202 24 Hr. Inspection Reques
<br /> 1 93'_$56°
<br /> PERMIT
<br /> .iwrllci{lith ML':.n2f
<br /> ?5 00005029
<br /> LICENSED CONTRACTORS DECLARATION
<br /> I hereby "firm that I am ll.antd under PI,Maan& Of CMpte, 9
<br /> (eo.mancmg with Section 77gp0}._gig tXv'iadn }�oS the Business and
<br /> PrObwions Cade.and my lionai ialh'IblMwca-sd'ilidt. IY� AI�ITQE_ I_;uE Gi{E
<br /> CONTRACTOR nc E ALPINE A
<br /> LICENSE NO. n.n
<br /> LICENSE TYPE �. F y E.:E;AL BL.� . RM„
<br /> OATS Til. T 2 f• ITL�j1G I PERMIT
<br /> STOCKTON BUS.LIC.NO. ParLSI NbT '1! !4 0-
<br /> Y4 A
<br /> . J.
<br /> OWNER-BUILDER DECLARATION Gad CudE !440 1,11 29 12 a
<br /> I hereby adl"" that 1 a. "amp, from the CAabaClare License
<br /> Law lot the following reason(Sae 7031.5.Business and Protwelon$Code.. OWEr MARLER IFOBSTRIES RX
<br /> Any city or county which requires a permit to construct, altar, improve. Ai"r"s , 1 4•U - AVE
<br /> demolish, or re0ail an, afuctu". Prior to its issuance. Use requirY ��' n.."Lw1 Al
<br /> the applicant for Such permit to Ills•Signed Statement that he is licensed '$$ .A la. CA gc1i21)
<br /> pursuant to the Provisions of the ConlrYtoh License Law (Chapter 9 -
<br /> commencing with Section 7000) of Of...ion 3 OI the Business and Pia- ApNI Topa LOT ie E,;tiUP9 '
<br /> Ikemon$Capel or that Mie*...Of thwelrom atw Ins basis for Ins Ulagatl `
<br /> .-.motion.the
<br /> Anse vwlnlan al Section 7031.5 by any applicant for•permit iii lUai1SG 2°4vi
<br /> dowse," Ins tOplicant to a owl' Penalty Of not more man IN, hundred
<br /> donate 15500.1: SIjL'3T2 1{y :' _Biting C2
<br /> ❑ I,as owns,of the Property,or MY employe"with wage$as thNrOi�1- r
<br /> able compensation. will do the --M. and Ins structure Is not intended r GreEj , LV.,3{ L')ra ,
<br /> Or Oftel" for all (Sec. 704), Business and Prof.si a Code: The
<br /> CionhemOYs License La. do,, not apPIY to an owner OI Property who
<br /> bunds or improv" thereon.and was doe.Such woe himself or through S_G•cCe3j Mu{23 and CJ^a;ilar,5
<br /> me awn wrdl ..... pe"ipso that such improvement. era 001 intends,
<br /> or offered for"Ie.Il,howevet.Ina budding Or improvement ie.Old within RM TNORPE. �? LILI i9�t�Pu CT !i9li?�`
<br /> ane yew of completion, the owner-builder will have the burden Otve pdvmp I),('
<br /> Inas he did not build or improfor the purpose Ol sale.( 1- ciP 8111.!Q6
<br /> ❑ I. as owner of the wooer,y. am eaewsively contracting whit CjTY 9L1$ I IC; 9$- 595;4
<br /> Professions
<br /> contractor. la construct the project IS... 70"4, Business and p
<br /> PralsYions Coo. The Contractors Lice... Law does not apply 10 an - n,
<br /> owner Of pro who bunds or improves thereon, an, who contracts TNT �'EAI' UP Aji SACK,- F N,O,LE :;JE
<br /> for such projects Won a camraetor(sl licensed pursuant to tMCOnlloeabrl O FJEL TAW REMO'r'AL
<br /> License Law.) c ErT 0 E r,
<br /> ❑ I am OXempt under Sit. .S.A P.C.for this INEP_C I OP.. ROS_RS
<br /> reason SPECIAL INSPECTION FORM FOR COMPACTION
<br /> TO CO""-R b BILL 9E COMOj?f'?tI OF FINAL
<br /> Dale Owner
<br /> CONSTRUCTION LENDING AGENCY F
<br /> I hereby Affirm that there is a COnsbuctlan lending agency for tog - - - - - - - - - - - - - - FEES - - - - - - - - - - - - - - _
<br /> pefpmlance
<br /> Of the work for which this Permit is issued(Sec.MY,Civ.C.). PERI.." FEE g
<br /> i
<br /> lie l�
<br /> Landers Nam. .ii�-LANOPOATE--------
<br /> ;nM ? `0
<br /> IRA .:I!IG - U-00
<br /> Lenders Address
<br /> n.. -PERMIT
<br /> WORKERS'COMPENSATION DECLARATION '
<br /> 1 hereby atllrm that I nave a certificate OI consent 10 Ylf-In,ura.or a ---------
<br /> ceMfleate of Work.,. Compensation Insurance, or a carolled copy
<br /> thereofW00.Lab.C.)Policy No. PER"IT TO.reof(Sec. TAL d^.50
<br /> company
<br /> ❑ Certified copy is Ibreby furnished. I Ian
<br /> ❑ CwrtlXd copy b Ind with t dry ai i" an�pa
<br /> Dale .Applicant
<br /> CERTIFICATE OF EXEMPTION FROM WORK WCOMKNS TI IINSUR
<br /> This Sedan need not be.,.pleb it the permit is for one h rd
<br /> dollar.(stool Cr Ie".
<br /> I certify that in the Performance OI the work for wnlch 1 permit
<br /> Is Issued,1 shall not whOwy any ..on in any manner d ae to become
<br /> Subject to the Workers Companuoon Laws of Celtlomiw
<br /> OM Applicant
<br /> NOTICE TO APPLICANT: IL 111.1 making this Certificate 01 Exemption
<br /> you should become Su,le,l to the Workers Compensation provisions of
<br /> the Labor Cape. Ness must forthwith comply with Such probYaN 01 this
<br /> Permit&hall be d"mad r"okd.
<br /> I cartlfy that I her' load this ap Ilwllbn and stab that iM above
<br /> information 1$Colreet.I apr" eomp with all an and 1. oche rem,
<br /> and slate laws rotating tp uil,in cansUbctlan, and arab" tulnotlae
<br /> for-no on . I. . 9th u0.n hand ora"a,
<br /> far maP!{�an pur00s
<br /> SIG
<br /> NEO1 llI,l
<br /> `` AO BS (�IV�
<br /> JOB AO ESE U V
<br /> APPLICATION
<br /> AVA
<br /> THIS PERMIT DOES NOT BECO BECOMEVALIDUNTIL SIGNED BY THE
<br /> BUILDING OFFICIAL (OR HIS DEPUTY AND FEES ARE PAID.
<br /> SIGNATURE t '/
<br />
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