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PERMIT CITY OF LOOT - COMMUNITY DEVELOPMENT DEP T, BUILDING INSPEfTICN DIVISION, 221 W PIN EET, PO BOX 3W6, IOUI, CA 95241 1910 - — -- ---.. _._...__ —_----------- - Appliation No 11165 Application Date: 9/30/98 Permit Date: 9/30/96 Permit No.: 29810 Job Address: 00251 S TICKNOR CT Assessor Parcel No.: 35-140-000, Subdivision: Lot No.;, t. Property Omer: HOYEN, ROBERT G R J K 2. Phone No: Meiling Address: 1008 VIENNA DR City/State: LODI CA Zip Code: 95242-0000 pWWt C ass: ADD ALTE REMODEL Permit Types: DEMO —— —UBC Grate. ^ T^ UBC Type: Project Description: DEMO OF EXEMPT'HDME HEATING 011. TANK Project Manager: MARTIN THORPE subs (Y/N): Phone No.: 209-368-6175 contractor: JIM THORPE OIL INC License No.: 495699 Phone No.: 209-368-6175 Address: PO BOX 351 City/st: ICQ CA Zip; 95241-0000 lender Name: Address: Census No. Brocade Description ---- AfD� @tyjVelue--BV9 - iUnits 181dg --Value - -Sewer _. 649 F DEMOLITION, FUEL TANK REMOVAL 1 2,800 30.1 1 1 2,800 Total qty/Value: _ Total Value:-- 2,600 Zoning,_r.-___,----_-_---------- FEE DATE FEE _ DATE_..._____ Building Permit Fee 50.00 9/30/96 Additional UBC Fees Pre-Paid Bldg. Permit Fee Adidnistrative Fres Plan Review Fee Special Inspection Additional Plan Review Fee Code Connliance Fee Mechanical Equipment Fees Zoning Plan Review Electrical Equipment Fees Water Meter Deposit Plumbing Equipment Fees Wastewater Capacity Fee S.M.I.P Fees: Commercial Water Service Claryes S.M.I.P Fees: Residential Wastewater Service Charqes _ _ TOTAL FEES = 50.00 WORKERS CCIPENSATICN CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSUtANC_E_- I hereby affirm that I haa certificate of consent to I certify that in the performs x:a of the worts for Whirl this ve - self-insure, or a certificate of Workers Compensation permit is issued, I shall not employ any person in any manner Insurance, or a certified copy thereof (Sec 3800, Labor Code) so as to bea«unaa subject to the Workers Compensation Laws of California. Policy No. 1095135-96 Company STATE FUND -- --- Date Applicant _ ...... - NOTICE TOO PERMITEE: if, after Baking tis Certificate of Certified copy is hereby furnished Exemption, you should teow. subject to the Workers Corruensation Provisions of the Labor Code, you must forthwith caroly with such Certified copy filed with Building Inspection Division provisions or this permit shall be deemed revoked. I certify that I have read this Permit and state that the above information is uarea. I a•yrea to coq ly with all City Ordinances and state Laws relating to Building Construction, and hereby authorize representatives of the City of Lodi to enter upon the above- mentioned property for inspecti Contractor Date /�� Owner Signature .f C rector, Owns r Agent Agent for _Contractor _Owner Issued by: _.. .-. ADDRESS OF AGENT CITY STATE ZIP TELEPHONE NOTICE S PERMIT WILD EXPIRE BY LIMITATICN IF WORK IS NOT STARTED IN 180 DAYS OR IF WORK IS ABANDONED FOR MORE THAN 180 DAYS 00 NOT Co" OR COYER My CONSTRUCTION UNTIL THE WORK 16 INSPECTED AND 15 RECORDED ON THE INSPECTION RECORD CARD