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F4FILE No.330 07/03 '02 16:44 :CITY OF TRACY DEV & ENG FAX:2(QQ)831 4606 SAGE 2, 4
<br /> Y.
<br /> CITY OF T CY
<br /> PERMIT APPLK ATION
<br /> F MA41"TV n>NTR&OP NT n".10t"JI-141M PART I
<br /> 52R Tracy Blvd.,Tracy,CA %-3% (209)831.46w
<br /> Fax Na a")831-0604
<br /> I"Pe"109 Request Lune (M)931.4621
<br /> TaU1LD11�G PROJECTIDENTIFICAI'Y�N LICEN'SiED CONTRAC70R AECU"TION.
<br /> x I hereby affirm underole pamdty of perjury that Ism licensed under provisions of ptxplgr 9 tconwienein
<br /> APPUCATIOAl1P1?RM1T NUMBER with Section 7 g
<br /> )6cf�tvlsian 1 of!}ie Business and Profr�ei ria Code and my license is'n f 11 fOtce atuS
<br /> PRCUFyCT Cffect- 777990099 B (:•B HAZ➢a �13�/94
<br /> 2005 KROHN RD License# Licaase Expiration(kite
<br /> STREET ADDRESS
<br /> APN 240.030-04
<br /> OWNLR-SVILDER DECLARATION-
<br /> ' (Sec 7031 S. By mesa and Professions Code) Any city whk t roqutms A permit to Bona mer,alter improve,
<br /> F'
<br /> AFRI %W0A*5700 LITER CONCRETE CLARIFIER demolish,Or it any stA+etur:prior to its ismanco,nlsa requires rho appllc4n,for such perms[to file a
<br /> signed shitemen that he tw slue is Ilconsed pursuant to the provision of the Contractors WceA4 Law
<br /> (Chilptcr 9(con ening with Section 7000)of Divisioa 3 of the Business fled Professions Code),or that he
<br /> Or she is exdmiK b=11fam and the basis for the alleged exemption. Any viofation of Section 7031-S by any
<br /> 211'Ph am for a Pt M(Atb)ctts the applicant to a civil penalty of not more than five hundred dollars(5500).
<br /> I hm&y affirm I Inder the penalty of perjury that I Am exempt fro the Contractors Liecnso Law for the
<br /> following reason
<br /> { PROPOSED USE L as owticr the property,or ray employees with wages as thcie sole Dompettsation,will do the wart,
<br /> I1 OR OCCUPANCY an4 Md spwtc is not ma
<br /> b ded or offered for elan(Set. 7044. $astute&&and Profession Code.. The
<br /> t ! CoatrAcrors Law 4a®t oat apply to m owl[ct of property who builds or improves thereon,and who S
<br /> VALUATION �5,fl 0 Q does such walk h inwif or herself or tltrottgh his of her employe:&,provided that such improvements are rust
<br /> OF PROJECT' intended or off for sale. If,however, the building of improvenimnt is sold wi[hin oac year of
<br /> complrtNIte
<br /> MILLER, NATHAN I ion,the o r-builder will have the burden of proving that hit at she did not build or improve fol-ft
<br /> OWNER pwpase of sale.)
<br /> 2040 R RO BN RD --],as owner of the property,am exclusively contracting with liceotcd contractors to construct the pmject
<br /> TRACY
<br /> (Sac.70U. Bus" and Professions Cod-, The Cpniraceom License Law quos ml apply to an owner of
<br /> C A 953740000 the property who builds or improves thereon,and who contracts for such projects with a eontrtrctor(s)
<br /> 1 ( } ( } - licensed pursuant to the Cuntractors Lioettso Law.)
<br /> PFIONk FAX
<br /> I em ere p[ under Sec. Business and Professions Code for this reason
<br /> CONTRACTOR
<br /> PARADISO MECHANICAL INC.
<br /> { P.O. BOX 1836 p, Date
<br /> SAN LEANDRO CA 94577
<br /> [510)G14.8390 { ) -WORIXRS'COMPENSATION ARCXARATfON
<br /> rPHONE FAX I hereby affirm u penalty of parjury one of the following declarations.
<br /> STATE LICENSE NUMBER 677909
<br /> CrN BUSINESS LICENSE NUMBER --1 have and ill maintain workers'compensation inUnnca,as mquirm4 by Section 3700 of the Labor
<br /> Code,for the pert rmance of the work for which this permit is issued, My workers'd0mp n ation insuranro
<br /> ENGINEER or ARCHITECT carrier and policy number ora: ('Itis suction need not be completed if the permit is for out:hundred dollars
<br /> tf1 (Sly)or�) PMOSTRIAL I��TpItpq:�,fpWerrry��rr JY52IG43.1 1/1108
<br /> Cam' 'Pbl�cy'1VYf�blr Expiration Oate
<br /> —1 certify that in ft pa turmarxe of the work for which this permit is issued I shall aur employ say
<br /> ( ) person id any mou aef so 19 to b000me subject to the workers'compensation laws or California,acid agree
<br /> PHONE FAX ) that if I should ou*subject to the workere compdpsa[ion provisions of Section 3700 of the Labor Coda,
<br /> I shail forthwith l with those rovi na.
<br /> APPLICANT ply P
<br /> PARADISO MECHANICAL INC. A � (-1 Date 7
<br /> P.O. BOX 1836 WARNING: FA4 UAllOSXUUWORKERS'COMPENSATIONCOVERAGE ISUNLAWFUL,AND
<br /> F SAN LVANDRO CA 94577 SHALL SUAJE .r AN EMPLOYER TO CRD41NAL PENALTIES AND CIVIL,FINIS Up TO ONE
<br /> PHONE FAX
<br /> ( } HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST Of COMPENSATION.
<br /> FAX DAMAC+BS AS PROVIWiD FOR IN S13CTION 3706 OF THE LABOR CODE, INTEREST, AND
<br /> F
<br /> 1 CERTIFY THAT I HAVI?RP-At)THISAPPL4CA't10N AND STATE THAT
<br /> ATTORNEYS FUES.
<br /> THE SHOWN INFORMATION IS CORRECT, AND THAT I AM .CONSTRUCTION LENDER-
<br /> THE OWNER OR DULY AUTHORIZED AGENT OF THE OWNER. _—Applicnni of firms under the penalty of perjwy that thorn is a toitstruetiae lending agmncy for the
<br /> I AGREE TO COMPLY WITH ALL CITY AND STATE LAWS Pcdormsndc of chi,work for which the permit is issued(Section 3097,Civ,C)
<br /> RT'I.gTING To BUILDING CONSTRUCTION. 1 H]�BY AUTHORIZE Lender&Name. Address
<br /> REPRESENTATIVES OFTHE CITY OP TitACY TO ENTER THE ABOVE
<br /> ' MEN'1'ION>D PROPERTY 111R INSP I PIJRPDSI?S. �---�`�l"^'"[ under iota pcnaltY of payurY that there is no consiruc[ion Ending agency for uhc
<br /> MMIONED PROPERTY 111R INISP 17 PLMPOSF-S.
<br /> performance of dic.work for which the permit is issued(Snetion 3097,Civ.C)
<br /> �14ATUR�~ IMPORTANT-
<br /> BApplicaticn Is by made to the City of Traoy Conuuunity Development Dep&nmmar for a permit subject
<br /> - to the Candiiion aid restrictions set forth on this uppllcation,and all applicable city and state laws and
<br /> OWNER O CONTRACTOR adinattoas_
<br /> CP AGENT FOR OWNER AGIsNT FOR CONTRACTOR I, Each person up whose behalf This application is made and each person at whose request and for whose
<br /> baneft work is pe 'armed under or Pursuant to tiny pdrtnil issued as a result of this application sgracs to,and
<br /> ED BY DATE shall,indemnify a d hold harutlesn the City Of TtAcy,its offteert,agents and emProyeos in Accor4ance with
<br /> all applicable city nd state laws and ordinances.
<br /> 2. Any Plan Pcv' w bcontu null acrd void after ONE HMDRED EIGHTY(180)days from the date or
<br /> HSC t EpOSIT RECEIPT
<br /> NOTE.- A LID PERMIT 10.IG'JUI.TS WIJPN PART f1 IS I3SIJ1?I) IIs TIi$
<br /> CITY OF TRAC V COMMUNITY DEVELOPMENT DEPARTMENT
<br /> 01STRLBUITON: WHITE•PROK$rlY MV PINK•OWNeWAPPLICANI' APRIL, Ott
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