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<br /> - CITY OF STOCKTON
<br /> . COMMUNITY DEVELOPMENT DEPARTMENi`—
<br /> BUILDING DIVISION, CITY HALL PHONE: (209) 9378561
<br /> 'PA - 05006 9 2 STOCKTON, CALIFORNIA 95202 24 Hr. Inspection Request
<br /> 937-8560
<br /> PERMIT A�'05a00004273
<br /> LICENSED CONTRACTORS DECLARATION
<br /> 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
<br /> with Section 7000)of Division 3 of the Business and Professions Cotle,and myJob Address ISSUE Date
<br /> license is in lull tome and effect.
<br /> CONTRACTOR 417S HORNER AV 7J13JOS
<br /> LICENSE NO.
<br /> LICENSE TYPE DATE Permit Type , : OUTSIDE CONNECTZD ----------2L
<br /> STOCKTON BUS.LIC.NO. 7VGdi Yt Si On ,
<br /> OWNER-BUILDER DECLARATION Parcell lbr ( 152 )OD 04
<br /> I hereby affirm that 1 am exempt from the Contractors License Law for the Geo LWs , i 2101 05 06 20 4
<br /> following reason(Sec,703f.5 Business and Professions Code:Any city or countyVT
<br /> which requires a permit to construct,alter,improve,demolish,or repair any structure,county .
<br /> Ram , gARCIA DA ID F 21 007E
<br /> prior to its issuance,also requires Me applicant for such permit to file a signed t 5 HL'kNEk AVE
<br /> statement that he is licensed pursuant to the provisions of the Contractors License Addrus , , , , 4.]
<br /> Lew(Chapter g commexIng with Section 700()of Division 3 of the Bustness and
<br /> Law Is ions Code)or that he is exemjq therefrom and the basis for the alleged STLtiKT'.rti DA $5215
<br /> exeapplies nto a ciivil Penalty of not mom Met five h�rledndolare(tfora$S ..):rbst ublects the APPVP °l Type e E CONNECT - SEWER
<br /> OUTSIDE
<br /> ❑ I,as ownor,of the property,or my employees with wages as their sole Gesc of Work , SEWER LINE
<br /> compensation,will do the work,and the structure M not interide l or offered for sale Valuation 0
<br /> (Sec.]044).Business and Professions Code:The Contractors License Law does
<br /> not appy to an owner of property who builds or improves thereon,and who does Square ft . . -0 Zoning . , 060
<br /> such work himseff or through his own employees,provided that such improvements 4 W d
<br /> are not IManded or offered for sale.If,however.Me building or Improvement is sold UroU
<br /> within one year of completion,Me owner-builder will have the burden of proving Mat Occup p CDn$t Type
<br /> Ne did not build or improve for the purpose of sale.) �A
<br /> Ll 1,as owner of the property,am exclusively connecting with licensed Special. Dotes aid Conditions
<br /> combectoB to construct the project(Sec.7044,Business end Pro/essions Cade: `ERMI T 6Y OWNER DAVID GdkCIA
<br /> The Contractors License Law does not apply to any owner of property whp builds or i'
<br /> improves thereon,and who contracts for such projects with a contractor(s)licensed
<br /> pursuant to Me Contractors License Law.) AN ENCROACHMENT PIRNIT Is LQUTRED rrRIOR
<br /> ❑ Iamexemptunder Sao. Ba P.C.for the TO CONNECTION TO A CITY MAINTAINED
<br /> reason UTILITY
<br /> Date Owner THIS IS A PERMIT FOR THE COLLECTION OF
<br /> SEWER CONNECTION FEES ONLY. A 6UILDIN6
<br /> F'EF,MIT MUST 6E OBTAINED FROM TIE COUNTY
<br /> OF SAN JOA HN PRIOR TO THE
<br /> NOTE:To protest the Imposition of any development fee, dedication, CONNENCEMENT OF WORK
<br /> reservation or other exaction Imposed on your project,you must fila wrhler
<br /> notice with the City Clerk's office within%days after approval of the project OUTSIDE SEWER CONNECTION
<br /> or Imposition of the fees,dedications,reservations or other exactions stating
<br /> Mat the required payment Is tendered or will be tendered when due,or that
<br /> any conditions which have been Imposed are provided for or satisfied,under
<br /> Protest,along with a datament of the actual elements of Me disputa and the ----------
<br /> egaltheory forming Me basis for the protest.
<br /> PERMIT TOTAL 00
<br /> WORKER'S COMPENSATION DECLARATION
<br /> I hereby affirm that I have a cedlffcale of consent to sett-insure,or a xitficate
<br /> of Workers'Compensation Insurance,or a certified copy thereof(Sec.N00,Left.C.)
<br /> Policy No.
<br /> Company
<br /> ❑ Certified copy is hereby furnished.Expires y7
<br /> ❑ Certff ed copy Is fill with the city building inspection department
<br /> Data Applicant
<br /> CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE
<br /> This section need not be completed if the permit is for one hundred dollars
<br /> ($100)or less.
<br /> 1 certify that in Me pertarmance of Me work for which this Parrott Is Issued,I
<br /> shall not employ any person in any manner so as to become subject to the Workers'
<br /> Conpernsadon Laws of Calffomia.
<br /> Date Applicant
<br /> NOTICE TO APPLICANT:If,after making this Cardboard of Exemption you should
<br /> become subject to the Workers'Compensation provisions of the Labor Code,you
<br /> must forthwith comply wfth such previsions his perlit shelf be deemed revoked.
<br /> cedity Mel I have read thus a'PlicatCn nd stale that the above Intormfltbn
<br /> is correct.I ogre to comply with ell city county ordinances and state laws
<br /> relating to b id 3 constructio ,antl hembyy hodze representaliv�s of this Iffy to
<br /> enter u bon mento ed prdpen fo pectlon purposes.
<br /> SIGN D
<br /> ADDF>ESS
<br /> CiAckla-
<br /> JOR D flES
<br /> APPLICATION APPROVAL
<br /> THIS PERMIT DOES NOT BECOME VALID UNTIL SIGNE BY THE BUILDING
<br /> OFFICIAL OR HIS DEPUTY AND FEES ARE PAID.
<br /> SIGNATURE1�i/
<br />
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