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Pan Joaquin County
<br /> Community Developm6nt Department Permit Number:
<br /> 1810 E.Hazelton Ave,Stockton,Ca 95205
<br /> Business Phone(209)468-3121 BP-1702966
<br /> Request For Inspection Phone(209)468-3165(24 Hour Recorder)
<br /> or on the web at sjgov.org
<br /> LICENSED CONTRACTORS DECLARATION 11851 i71�
<br /> I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Permit Address• W VALPICO RD
<br /> Division 3 of the Business and Professions Code,and my license is in full force and effect.
<br /> License a Exp.Date Cross Street: CORRAL HOLLOW
<br /> Date Contractor City: TRAC
<br /> OWNER-BUU,DERDECLARATION Owners Name: PENA,AURORA
<br /> I hereby affirm that I am exempt from the Contractor's License Law for the following reason. Phone:
<br /> (Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,
<br /> alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for
<br /> such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's Applicant Name: RICARDO MARRUN
<br /> License Law(Chapter 9 commencing with Section 7000)of Division 3 of the Business and
<br /> Professions Code)or that he is exempt therefrom and the basis for the alleged exemption. Any Address: 38152 HASTINGS CT
<br /> violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of City; FREMONT CA 94536
<br /> not more than five hundred dollars(5500.00).)
<br /> I,as owner of this property,or my employees with wages as their sole compensation,will do Phone: 510-414-8310
<br /> the work,and the structure is not intended or offered for sale.(Sec.7044,Business and
<br /> Professions Code: The Contractor's License Law does not apply to an owner or property Contractor Name:
<br /> who builds or improves thereon,and who does such work himself or through his own
<br /> employees,provided that such improvements are not intended or offered for sale If, Address:
<br /> however,the building or imr,provement is sold within one year of completion,the City
<br /> owner-builder will have the burden of proving that he did not build or improve for the
<br /> of sale.) State License: Exp:
<br /> 13,7-owner of the property,am exclusively contracting with licensed contractors to construct Phone:
<br /> the project.(Sec.7044,Business and Professions Code: The Contractor's License Law docs
<br /> not apply to an owner of property who builds or improves thereon,and who contracts for
<br /> such projects with a contractor/contractor(s)license pursuant to the Contractor's License Designer Name:
<br /> Law.
<br /> Address:
<br /> F71 am exempt under Sec. of the Business and Professions Code for the
<br /> following reason: City'
<br /> License#:
<br /> Date '/ 7 Phone#:
<br /> WORKERS'C SATION DECLARATION
<br /> I hereby affirm under penalty of perjury one of the following declarations: Scope of Work: ELECTRICAL AND SHEET ROCK
<br /> aI have and will maintain a certificate of consent to self-insure for workers'compensation,
<br /> as provided for by section 3700 of the Labor Code,for the performance of the work for FOR EXISTING DETATCHED GARAGE
<br /> which this permit is issued.
<br /> FII have and will maintain workers'compensation insurance,as required 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 /> ----- ------------------------------ ---------
<br /> workers'compensation insurance carrier and policy number are on file with the State 1000 Building Fee 108.35
<br /> Xaclors License Board. 1004 State Smi p Fee 95% .47
<br /> I certify that in the performance of the work for which this pcmut is issued,I shall not 1005 Smi p Fee — CDD 5% .03
<br /> employ any person in any manner so as to become subject to the workers'compensation laws 1006 st Green Bl d standards 10 .10
<br /> of California,and agree that if I should become subject to the workers compensation 1010 Imaging/Technology 15.00
<br /> provisions of Section 3700 of the Labor Code,I 7 fe twith comply with these 1019 Electrical Fee 100.00
<br /> provisioru. q_� 1026 Build Investigation Fee 108.35
<br /> Date C� ' ict — 1029 Elect Investigation Fee 100.00
<br /> WARNING:FAILURE TO SEC URE RS'COMPENSATIONCOVERAGE IS 5030 General Plan Implement 10.42
<br /> UNLAWFUL AND SHALL SUBIE AN EMPLOYER TO CRIMINAL PENALTIES AND 6023 St green BLD Standard90 .90
<br /> CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION
<br /> TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706
<br /> OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. Please see reverse side for important information.
<br /> CONSTRUCTION LENDING AGENCY
<br /> I hereby affirm that there is a construction lending agency for the performance of the work for which
<br /> this permit is issued(Sec.3097,Civil Code).
<br /> Lender's Name Address
<br /> City/State Phone
<br /> DMSION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
<br /> khereby certify that no excavation five(5)or more feet in depth into which a person is
<br /> I
<br /> quired to descend,will be made in connection with work authorized by this permit,and that
<br /> no building,structure,scaffolding,falscwork,or demolition or dismantling thereof,will be
<br /> more than thirty-sec (36)fat high.(Chap.3.2,Grp.2,Art.2,Sec.341,Titlell,C.A.C.)
<br /> TV 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 from the Division.
<br /> F7 Division of Industrial Safety Permit No
<br /> I certify that I have read and state that the information given is correct. I agree to comply with all
<br /> state laws and county ordinances relating to building construction,and authorize representatives of
<br /> the Issuing Jurisdiction to enter upon the above-described property for inspection purposes.
<br /> Signature of Legal Owner or Autho e
<br /> Date (7 �' �� _Appll a
<br /> Accepted:JH Approved JH Applied Date:08/04/2017 Issue Date:08/04/2017 APN:242-050-04 Valuation:$1,000.00 SgFt:0
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