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<br />EXPIRATION
<br />SPECIFIED DECLARATIONS
<br />INFORMATION
<br />LICENSED CONTRACTORS DECLARATION
<br />Inspection Division has installed an
<br />I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)
<br />Every permit Issued by the Building
<br />of Division 3 of the Business and Professioce Code, and my license Is in full force and effect
<br />Official under the provisions ofRthls
<br />License # Expiration Date
<br />Code shall expire by limitation and
<br />Date Contractor
<br />become null and void H the building
<br />Date Owner i
<br />or work authorized by such permit
<br />OWNER -BUILDER DECLARATION
<br />Is not commenced within 180 days
<br />I hereby aNirm that I am exempt from the Contractor's License Law for the following reason (Sec.
<br />from the date of such permit, or H
<br />7031.5, Business and Professions Code: Any city or county which requires a permit to construct, aHsr,
<br />the building or work authorized by
<br />Improve, demolish, or repair any structure, prior to its lasuance, also requires the applicant for such
<br />such permit Is suspended or
<br />permit to file a signed statement that he Is licensed pursuant to the provisions of the Contraclor's
<br />abandoned at any time after the
<br />License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
<br />work Is commenced for a period of
<br />Professions Code) or that he M exempt therefrom and the basis for the alleged exemptlon. Any
<br />160 days. Work shall be
<br />of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not
<br />considered abandoned H an
<br />n five hundred dollars ($500.00).):
<br />Inspection has not been recorded
<br />ZProfessions
<br />within 1SO days.
<br />s owner of the property, or my employees with wages es their sole compensation, will do the
<br />contact them at (209) 466.4581.
<br />rk, and the structure Is not Intended or offered for sacs. (Sec. 7044, Business and
<br />Code: The Contractor's License Law does not apply to an owner of property who
<br />As a reminder, PG&E and the
<br />builds or Improves thereon, and who does such work himself or through his own employees,
<br />telephone companies also
<br />provided that such Improvements are not Intended or offered for sale. If, however, the
<br />recommend you make
<br />building or Improvement Is sold within one year of completion, the owner -builder will have the
<br />INSPECTION
<br />burden of proving that he did not build or Improve for the purpose of sale.)
<br />INFORMATION
<br />1, as owner of the property, am oxcluslvely contracting with licensed contractors to construct the
<br />1. Permit Number (Mandatory)
<br />project. (Sec. 7044, Business and Professions Code: The Contractor's License Law doss not
<br />The San Joaquin County Building
<br />apply to an owner of property who bullds or Improves thereon, and who oonlracts for such
<br />Inspection Division has installed an
<br />projects with a contractor/contractor(s) license pursuant to the Contractor's License Law.)
<br />automatic rocording device to
<br />Dote Ap/✓ .r ., GGc-CQ%�✓!
<br />NOTICE TO APPLICANT: if, after maid this Certificate of Exemplion,, me wb}ect 10
<br />receive inspection requests. This
<br />I am exempt under Sec. , of the Business and Professions Code for the
<br />service will be available 24 hours a
<br />;ollOWing reason:day,
<br />seven days a weal. Cali* will
<br />Date Owner i
<br />be taken off the recorder at 3:00
<br />1 hereby affirm that there is a construction lending agency for the performanoe of the work for which
<br />p.m. every workday and distributed
<br />WORKERS' COMPENSATION DECLARATION
<br />for inspection the following
<br />I hereby affirm that 1 have a certMcate of consent io self -Inoue, or a certificate of Workers'
<br />workday.
<br />Compensation Insurance, or a certified copy thersof (Sec. 3600 labor Code).
<br />INFORMATION
<br />Expiration Dodo Compsny
<br />To request an Inspection, please
<br />Certified copy Is hereby furnished. CertMed copy Is filed with the County Building
<br />El
<br />call (209) 468-3165. You will be
<br />Inspection Division
<br />requested to provide the following
<br />Dais Applicant
<br />information:
<br />CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE
<br />1. Permit Number (Mandatory)
<br />(This section need not be completed H the permit Is for one hundred dollars ($100) or less).
<br />2. Your Name
<br />I certify that in the performance of the work for which this permit Is Issued, 1 shall not employ any
<br />3. Job Site Address and Nearest
<br />person n a manner as to become bje�f Worker laves CalHornla
<br />Cry Street
<br />4. Telephone Number
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<br />NOTICE TO APPLICANT: if, after maid this Certificate of Exemplion,, me wb}ect 10
<br />S. Day Inspection Preferred
<br />the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such
<br />6. Type of Inspection
<br />provisions or this permit shelf be deemed revoked.
<br />CONSTRUCTION LENDING AGENCY
<br />1 hereby affirm that there is a construction lending agency for the performanoe of the work for which
<br />tib permit Is Issued (Sec. 3097, Civil Code).
<br />PG&E
<br />Lender's Name Address
<br />cny/slat. Peon.
<br />INFORMATION
<br />DIVISION OF INDUSTRLAL SAFETY PERMIT CERTIFICATION
<br />PG&E has asked that we notify all
<br />i hereby certify that no excavation five (5) or more toot In depth Into which a person Is required
<br />persons who will need new gas or
<br />to descend, will be made In connection with work authorized by this permit, and that no
<br />eioctric service to consult them as
<br />Ilding, structure, scaffolding, fakwwork, or demolition or dismantling thereof, will be more
<br />to proper location of both meters.
<br />n thirty-six (36) feet high. (Chap. 3.2, Grp. 2, Art. 2, Sec. 341, Title 11, C.A.C.)
<br />it your building project involved
<br />As owner -builder, 1 will not empty anyone to do work which would requirea permit from the
<br />utilities supplied by PG&E, pisses
<br />n of Industrial Safety, se noted abnless such person has a permit to do such work
<br />Division above, u
<br />contact them at (209) 466.4581.
<br />from the Division.
<br />E] DWIslon of Industrial Safety Permit No.
<br />As a reminder, PG&E and the
<br />telephone companies also
<br />recommend you make
<br />I cert that I have read this application and state that the above Information le correct I agree to
<br />lfy aPPI
<br />arrangements with them as ssrty u
<br />comply with all city and county ordinances and *tate laws rotating to building construction, and
<br />possible to minimize delays In the
<br />hereby authorie represent�a,Itiv of this county to Ont fLjj/W(1 t-he!/aabove-rnenttiionee.'dd property for
<br />connection of your service.
<br />tea
<br />(fl*peCliOf purposes._l . l.f vl lb 1ee11r�M IX�I�I •/
<br />1
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