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<br /> - N..JOAQU.iN .GOUNTY $UILn1NG INSPECTION. DI�li51 W
<br /> ermit has bee- mitted in _eco' name 1'st.- 1810 E. Hazelton Ave., Stockton, C S
<br /> An epp}icat}oR for a building P ro ert imprc••erents specified.
<br /> itha yourself as builder of hep P Y "owner builder" you are the REQUIREMENT OF STATE OF CALIFORNIA HEALTH & SAFETY CODE, Sec, 1983Q
<br /> r�or you erotection, you should be aware that
<br /> r arty of record on such a permit. '$uildin permits are not re- OWNER-BUILDER VERIFICATION
<br /> Building r
<br /> es') n t ie P owners unlas_ 7rev are personally performing Owner:
<br /> uirej# -o be signed by property Attention Property
<br /> their,
<br /> e ir,you mavkprotect you�f your wrselfrk ifrom1ng posseiblzrT?aab��tYmefnthathpersoRn your An "owner-builder" building permit has been applied for in your name and
<br /> self,apples for the proper permit in 'his or her :a-.e' the State of bearing your signature. Please complete and return tris information to
<br /> I to be license= and bonded by avoid unnecessary delay in processing and issuing your Duildi,^gcPereit.
<br /> Contractors are required by N buildingpermit will be issued until this verification is
<br /> California, and may be required to have
<br /> business Iirllicense fnumbereon�allor
<br /> They are also required by
<br /> county, required
<br /> I personally plan to provide the major labor and materials ror he
<br /> permits `or which they apply-
<br /> r own vork, rrith the ex:"-ion of various trades that construction of the proposed property irprovement ;Yes or i•lo) �
<br /> if you cion to do you the following information 2 I (have/have not) signed an application for a building
<br /> you plan to sub-contract, you should be aware Dr permit for the proposed work.
<br /> for your Denefit and protection:
<br /> If you employ or othe revise engage any persons other than your immediate for 3 I have contracted with the following person (firm) to provide the
<br /> is $ZOO or more for
<br /> ily, and the work (including materials and t.ict-lecosts)
<br /> construction:
<br /> the entire Project, and such persons are not ;icensed as contractors or sub- proposed phone
<br /> - contractors, then you may be an employer.
<br /> Name
<br /> the State and Federal govern-
<br /> If you are an employer, you must register ,t
<br /> wAddress
<br /> meet as an employer and you are subject gtoF5e%eralyob'a�asecurittions Rctaxesg Contrac*pr's License ..o.
<br /> State and Federal income tax '-'J Disabi ,t _Trance costs, and unemployment City -
<br /> Horkers' Compensation insurance, Disabili _- '
<br /> compensa'ion contributions. t pro portions of the work, but I have or , the following
<br /> There nay be financial risks for you if you c not carry out these obligations �+• 1 plan o p
<br /> person to coordinate, supervise and provide the ma}ar 'nor c:
<br /> and these risks are especially serious with -esoect to 'Horkers' Compensation Name Phone
<br /> Insurance .
<br /> For more specific information about nd, i fb}ogawish, thee SedsmalllBusiness Address
<br /> tact the internal Revenue Service land, Contractor's License No.
<br /> Administration). For more specific informatio�n�bo�e your obligations
<br /> City
<br /> Payments State law, the Department of Benefit Pay. the
<br /> Accidents may be contacted 5. I ;+ill ?rovide some of the r+ark but ! have contracted (hired)
<br /> ro e--_ owners who are not licensed Folio,+Ing persons to provide the s•+ork indicates:
<br /> If the structure is intended for sale, p P �e of 'Work
<br /> contractors ore allowed to perform their wpr+ ersonally or through their own Address Phone —
<br /> Name
<br /> employees, without a licensed contractor or subcontractor, only under limited
<br /> conditions.
<br /> A frequent practice of unlicensed persons professing to np contractors to
<br /> builder" building permit, erroneously imp
<br /> secure an "owner- lying that the
<br /> labor an
<br /> property owner is providing his or her own d material personally.
<br /> Building Permits are not requiredowners unless they
<br /> to be signed by property
<br /> are performing their own work personally. contacting the
<br /> Information about licensed contractors may 5eSoreet,eSacramento, CA 95814,
<br /> Contractors' State License Board at 1D20 N' r Q Proper-1 Qr,ner
<br /> Coce, Section 19830, Chapter 9, Signe C
<br /> The state of California Heal and Safety
<br /> Part to Division 33, requires us to make you a�:are of these laws and ardi- Mailing Addrass
<br /> nances, and requires you to complete the for^ on the right and return it to
<br /> is before vie may issue Your permit. Location of Building to be Done
<br /> Any contractor you list must have his State Contractors License number on Date
<br /> file in this Department, and a current,
<br /> valid Certificate of Workers' Com' Social Security Number
<br /> pensation insurance (or waiver) also on file in this Department
<br /> If you are hiring someone other than a coontractto'nt�hdo theis work, your
<br /> rthe REQUIREMENT OF THE STATE OF CALIFORNIA HEALTH & SAFETY CODE, SECTION 1983D
<br /> Y file
<br /> Workers ComPensatian Insurance roust e
<br /> r Insurance Agent.
<br /> form of a valid, current certificate from you
<br />
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