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<br /> '--•F , an Joaquin County
<br /> �- r, If. Community Development Department Permit Number:
<br /> 1810 E.Hazelton Ave,Stockton,Ca 115205 i�
<br /> Business Phone(209)468-3121 Br-1504448
<br /> Request For inspection Phone(209)468-3165(24 Hour Recorder)
<br /> or on the web at sjgov.org
<br /> LICENSED CONTRACTORS DECLARATION
<br /> I hereby affirm that I am licensed under provisions ofChapler9(commencing with Section 7DDo)of permit Address: 31411 S KASSON RD
<br /> Division 3 of tlic B ss ode,and my license is in Gilii ice d eff t.
<br /> License H —L>� Exp.Date t_� Cross Street: DURHAM
<br /> Date --Contractor City: TRAC
<br /> OWNER-B D .DECLARATION 0%vncrs Namc: PETLANSKY,JOAN M�IR ETAL
<br /> 1 hereby affirm that t am exempt from I ontracurrs License Law for the following reason. Phone:
<br /> (Sec.7031.5,Business and Profcssiotu Any city or cotmty which requires a pemili to construct,
<br /> alter,improve,dcnolish,or repair any sae,prior to its issuance,also requires the applicant for
<br /> such permit w file a signed statentcnt a<he is licensed pursuant to the provisions of the Contractors Applicant Name: SKYLINK SOLAR INC
<br /> License Late(Chapter 9 commencing •-h Section 7000)of Division 3 of the Business and Address: 3 i 21 S WETZER RD STE G
<br /> Professions Code)or that he is exempt therefrom and the basis for the ellc6-A exemption Any ,
<br /> violation orSection 7031.5 by any applicant for a permit subjects the applicant to n civil penalty of City: LOOMIS,CA 95650
<br /> not more than five hundred dollars(S500.00).):
<br /> Ot,as owner of this property,or my employees with wngcs as their sole compensation,will do Phone: (530)308-0286
<br /> the work,and the structure is not intended or offered for sale.(Sec.704.1,Business and
<br /> Professions Code. The Contnutor's License Law does not apply to an owner or property Contractor Name: SKY LINK SOLAR INC
<br /> who builds or improves thereon,and who does such work himself or through his own
<br /> employees,provided than such improvements are not intended oroffcred for sale. If, Address: 3121 S W ETZER RD,STE G
<br /> however,the building or immprowntent is sold within one year of completion,the City: LOOMIS,CA 95650
<br /> owner-builder will have the burden of proving that he did not build or improve for the State License: 944323 Exp:03/31/2016
<br /> h se of sale.)
<br /> 1.as ownerof the property,am exclusively contracting with licensed contractors to construct Phone: (530)308-0286
<br /> the project.(Sec.7044,Business and Professions Code: The Contractor's License Law does
<br /> not apply to an owner of property who builds or improves thereon,oW who contracts for
<br /> such projects with a contractorlcontractor(s)license pursuant to the Contractors License Designer Name:
<br /> Law•) Address:
<br /> F7 1 am exempt under Sec. of the Business and Professions Code for the
<br /> following reason: City:
<br /> Date (Tuner
<br /> License#:
<br /> WORKERS'COMPENSATION DECLARATION Phone#:
<br /> 1 hereby affirm under penalty of perjury one of the following declarations:
<br /> F1Ihave raid Will maintain acertificate ofconsent to self-insurcforworkers'compensation, Scope of Work: GROUND MOUNT PHOTO VOLTAIC
<br /> as provided for by section 3700 of the Labor Code,for the performance of the work for FOR SFR
<br /> hicl is permit is issued.
<br /> 1 have and will maintain workers'compensation insurance,as requited by section 3700 of
<br /> the Labor Code,for the performance of the work for which this permit is issued. My Item Description Tot Fee
<br /> wurkers'compensation iruurancecarrier and policy number amonfile with the State ----- ------------------------------ ---------
<br /> Contractors License Bwrd. 900 Plan Check Fee 200.00
<br /> I cenily that in the performance of the work for which this permit is issued,I shall not 1000 License & Permits 100.00
<br /> employ any person in any manner so as to become subject to the workers'oompensation laws 1009 Plot Plan Review 50.00
<br /> of California,cad agree that if l should become su 'eco to the worke mpcnsation 1010 Imaging/Technology 15.00
<br /> 1019 Electrical Fee 300.00
<br /> provisions ofScctitm3700ofthe Labor C ,1sh forthwit ply wit se
<br /> provi5030 General Plan Implement 20.00
<br /> Dotesi hs. Applicant
<br /> WARNING:FAILURF.TOSECURE WO RS'COMPF.NSATIONCOVERAGE IS piea5e see reverse side for important information.
<br /> UNLAWFUL AND SItALL SUBJECT n, E YER TO CRIMINAL PENALTIES AND Please
<br /> CIViL FIN LS UP TO ONE HUNDRED OUSAND DOLLARS(S100,000),IN ADDITION
<br /> TO THE COST OF COMPENSATION AMAGES AS PROVIDED FOR IN SECTION 3706
<br /> OF THE LABOR CODE,INTEREST, ND ATTORNEY'S FEES.
<br /> CONSTR CT10N LENDLNG AGENCY
<br /> 1 hereby affirm that there is a construction tending agency for the performance of the work for which
<br /> this permit is issued(See.3097,Civil Code).
<br /> L.erxler's Name Address
<br /> City!State Phone I
<br /> DIVISION OF IN D USTRIAL SAFEIV PERM rr CERITMATION I�
<br /> Al herebycartify that no excavation five(5)or more feet in depth into which a person is
<br /> required to descent!,will be made in connection with work authorized by this permit,and that
<br /> no building,structure,smlrolding.felsesvork,or demolition or dismantling thereof,will be
<br /> more than thirty-six {36)feet high.(Chap,3.2.Grp.2,An.2,Sec.341,Titia,C.A.C.)
<br /> 0 As owner-builder,I will not employ anyone to do work which would require a permit from
<br /> the Division of Industrial Safety,as noted above,unless such person has a permit to do such
<br /> work Bum the Division.
<br /> O Division of Industrial Safety Permit No.
<br /> I certify that 1 have read and state that the information given is correct. 1 agree to comply with all
<br /> state laws and county ordinances rel ing o wilding construction,and authorize representatives of
<br /> the issuing Jurisdiction to enter upon he ve described perry for inspection purposes.
<br /> Signat of Legal 0 e or Autho' A ent
<br /> Date rkpplicant
<br /> Accepted:JN Approved:JK A plie Date: 11/09/2015 Issue Date: 11/24/2015 APN:255-340-01 Valuation:$0,00 SgFt:0
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