COMPLIANCE INFO 2002 TANK TOP UPGRADE

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1. - PERMIT CITY OF LODI - COMMUNITY VELOPMENT DEPARTMENT- Buildi ispection Division - (209) 333-6714 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - =- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Permit No.: B4948 Date Applied: August 16, 2001 Job Address: 1145 SHAM LN Date Issued: October 15, 2001 APN: 031-040-21 Subdivision: Lot No: Owner: LODI, CITY OF Owner's Address: City,State Zip: Contractor: CITY OF LODI Phone: (209)333-6714 State Lic. No. 345678 Type: Contractor Address: 00221 W PINE STREET City, State Zip: LODI CA 95242-0000 Applicant: CITY OF LODI - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Work Description: Foundation for compressed natural gas equipment @ 1331 S. Ham Lane(MSC) Total Sq. Ft.: Sq.Ft. Valuation: $ 200,000 Construction.Type: No. Stories: 0 No. of Bdrm.: 0 Occupancy: Zoning: Type Project: COMMERCIAL Plan No: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Licensed Contractor Declaration: I hereby affirm under penalty of Owner-Builder Declaration: I hereby affirm under penalty of perjury perjury that I am licensed under provisions of Chapter 9(Commencing that I am exempt from the Contractors License Law for the following reason with Sec.7000)of Division 3 of the Business and Professions Code,and (Sec.7031.6 of the Business and Professions Code states Any city or county my license is in full force and effect. Date: which requires a permit to construct,alter,improve,demolish,or repair any Contractor: structure prior to its issuance,also requires the applicant for such permit to fife a signed statement that he or she is licensed pursuant to the provisions Workers Compensation Declaration: I hereby affirm under penalty of the Contractors License Law(Chapter 9 commencing with Sec.7000 of of perjury one of the following declarations: Division 3 of the Business and Professions Code)or that he or she is exempt I have and will maintain a certificate of consent to self-insure for therefrom and the basis for the alleged exemption. Any violation of Sec. workers'compensation,as provided for by Sec.3700 of the Labor Code, 7031.6 by any applicant for a permit subjects the applicant to a civil penalty for the performance of the work for which this permit is issued. of not more than five hundred dollars($500). I have and will maintain workers'compensation insurance,as I,as owner of the property,or my employees with wages as their sole required by Sec.3700 of the Labor Code,for the performance of the compensation,will do the work,and the structure is not intended for sale. work for which this permit is issued. My workers'compensation (Sec.7044 Business and Professions Code,the Contractors License Law carrier and policy number are: does not apply to the owner of a property who builds or improves thereon, Carrier: and who does such work himself or herself or through his or her own Policy No.: employees,provided that such improvements are not intended or offered for I certify that in the performance of the work for which this permit sale. If however,the building or improvement is sold within one year of is issued,I shall not employ any person in any manner so as to become completion,the owner-builder will have the burden of proving that he or she subject to the workers'compensation provisions of Sec.3700 of the did not build or improve for the purpose of sale.) Labor Code,and I shall forthwith comply with these provisions. I,as owner of the property,am exclusively contracting with licensed Date: contractors to construct the project(Sec.7044,Business and Professions Applicant: Code,states that the Contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts WARNING: Failure to secure workers'compensation coverage is for such projects with a contractor(s)licensed pursuant to the Contractors unlawful,and shall subject an employer to criminal penalties License Law). and civil fines of up to one hundred thousand dollars($100,000), I am exempt under Sec. B.&P.C.for this in addition to the cost of compensation,damages as provided for reason: in Section 3706 of the Labor Code,interest,and attorney's fees. Date: Construction Lending Agency I hereby affirm under penalty of Owner: perjury that there is a construction lending agency for the performance of the work for which this permit is issued: 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 ordinances and state laws relating to building construction,and hererby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. Contractor Owner Agent for: _ Contractor _ Owner Issued by: LW Signature of Contractor,Owner or Agent Date NOTICE THIS PERMIT WILL EXPIRE BY LIMITATION IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE,OR IF WORK IS ABANDONED FOR MORE THAN 180 DAYS. DO NOT CONCEAL OR COVER ANY CONSTRUCTION UNTIL THE WORK IS INSPECTED AND IS RECORDED ON THE INSPECTION RECORD FORM.