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CITY ST
<br /> 01AW
<br /> &MUNITY DEVELOPMENT
<br /> DT DEPARTMENT•
<br /> BUILDING DIVISION, CITY HALL PHONE: (209)937-8561
<br /> STOCKTON, CALIFORNIA 95202 24 Hr. Inspection Request
<br /> PERMIT 937-3560
<br /> LICENSED CONTRACTORS DECLARATION
<br /> I hereby affirm that i am licensed under pmvislons of Chapter 9(commencing
<br /> win Section 70110)of Division 3 of the Business and Professions Coda,and my license
<br /> is in full force and effect.
<br /> CONTRACTOR Application Numb r
<br /> LICENSE NO, 99 00001693
<br /> LICENSE TYPE DATE-
<br /> STOCKTON BUS,LIC.N
<br /> ATEsTocKTONBus.uc.NENNRgOECLONNENT&A�DIT INC Job Address
<br /> A A 0 lases Gate
<br /> OWNER-BUI E
<br /> hereby affirm that I am exempt from the contractors License law for the 5400 PACIFIC AV 5/28/99
<br /> fallowing reason(Sec.7031.5 Business and Professions Code:Any city or=only which
<br /> requires a permit to construct,alter,improve,demolish,or repair any structure,prior to
<br /> its issuance,also requires the applicant for such permit to file a signed stetemerd that Permit Type COMBINATION BUILDING PERMIT-21L
<br /> he is licensed pursuant to Me provisions of the Contractor's Ll=nae taw(Chapter 9
<br /> commencing with Section 7000)of Division 3 of the Business and Professions Code)or Subdivision ,
<br /> that he is exempt therefrom and the basis for the alleged exemption.Any violation of parcel Nbr 102 240 20
<br /> Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
<br /> not more than eve hundred dollars($500.): Geo Code 3305 03 01 01 0
<br /> ❑ 1,as owner of Me property,or my employees with wages as their sole Owner Name , STONE EROS & ASSOC
<br /> compensation,will do the work,and the structure is not intended or offered for sale
<br /> (Sac.7044).Business and Professions Code:The Contractor's License Law does not Address 1024 W R08INHG00 DR
<br /> apply W an owner of property who builds or Improves thereon,and who does such work
<br /> himself or through his own employees, provided that such improvements are not STOCKTON CA
<br /> Intended or offered for sale.If,however,Me building or improvement Is sold within one
<br /> year of completion,the owner-builder will have Me burden of proving that he did not STOCKTON CA 95207
<br /> build or Improve for the purpose of sale.)
<br /> ❑ 1, as owner of the property, am exclusively contracting with licensed Appl Type ADD, ALT & REPAIRS-NON RESIDENTIAL
<br /> contractors to construct the project(Sec.7044,Business and PrOfeaslona Code:The Desc of Work OTHER STRUCTURES
<br /> Contractor's License Law does not apply to any owner of property,who builds or
<br /> Improves thereon, and who contracts for such projects with a=ntrador(s) licensed NON RESIDENTIAL
<br /> pursuant to the Contractor's License Law.) Valuation 15000
<br /> ❑ lam exempt under3aic ,B&P.C.forthis Square ftg , G Zoning . , . , C4
<br /> Data rata owner Occup Group N Const Type SN
<br /> RETURN CHECK POLICY.1 AM AWARE IF MY CHECK IS RETURNED TO THE C
<br /> CRY,THIS PERMIT IS REVOKED.I AM ALSO AWARE,IF ANY WORK HAS BEEN Special Notes and Conditions
<br /> STARTED, THE CRY WILL IMPOSE AN INVESTIGATION FEE, (PER SMC 13-
<br /> 304(C))PLUS ANY OTHER REQUIRED FEES. ENVIRONMENTAL AUDIT 606348 EK 11/1999
<br /> NOTE:To protest the Imposition of any development fee,dedication,reservation CITY LICI 99.59617 EK 12/31/99
<br /> or other exaction imposed on your project,you must file written notice with the SOIL AND GROUND WATER CLEANING SYSTEM
<br /> City Clerk's office within 90 days after approval of the project or Imposition of the
<br /> fees, dedications, reservations or other exactions stating that the required
<br /> payment Is tendered or will be tendered when due,or that any conditions which
<br /> have been Imposed are provided for or satisfied, under protest,along with a - - - - - - - - - - - - - - FEE✓c - - - - - - - - - - - - -
<br /> statement M the actual elements of Me dispute and the legal theory forming the -
<br /> baslefortheprotest. PERMIT FEE 225,53
<br /> WORKER'S COMPENSATION DECLARATION PLAN CHECK FEE 164.64
<br /> I hereby affirm that I have a certificate of consent to sed-insure,or a Mediums A20-GPNI (.001;VAL)----KK 15.00
<br /> of Workers'Compensation Insurance,or a cerUeed copy thereof(Sao.3800,Lab.C.)
<br /> Policy Na. AIS-SMIP-STRONG NOTION-N9 3,15
<br /> Company A35-LAND UPDATE--------NN 2.50
<br /> ❑ Clarified copy is hereby furnished.Expires A10-MICROFILN FEE------LO 3.25
<br /> ,/,/C,e4rtlflea=py is filed with Me oily drug= I department. A30-PERNIT TRACKING----MM 10.00
<br /> oat e�_4 /v / APPlican, 'i, A25-SPAS (,00051UAL)---ILL 1,50
<br /> CERTIFICATE OF EXEMPTION FROM ORKE® ' MPENSATION INSURANCE
<br /> Thio section need n01 be completed If the permit is for one hundred dollars ---------
<br /> ($100)or less. PERNIT TOTAL 431.57
<br /> I eerily Mat In the performance of the work for which this permit is issued,I shall
<br /> not employ any person in any manner so as to become subject to the Workers'
<br /> Compensation Laws ofCalifomia. PLAN CHECK DEPOSIT 300,00
<br /> Dale Applicant ....-_...
<br /> NOTICE TO APPLICANT: If,atter making Mis Certificate of Exemption you should TOTAL DUE 131,57
<br /> become subject to the Workers'Compensation provisions of the Labor Code,you must
<br /> forthwith comply with such provisions or this None shall be deemed revoked.
<br /> certify that have reed this application and state that the above m r laden is �!• � � V
<br /> coracL agree to comply with all dly and county d state tha and state laws relating to
<br /> building construction,and hereby au z resenta0ves of this city to enter upon Me
<br /> above mentioned props r map mases
<br /> SIONEO
<br /> JOB ADORERS ADDRESS
<br /> APPLICATION APPROVAL
<br /> THIS PERMIT DOES NOT BECAME VALID UNTIL SIGNED BY THE BUILDING
<br /> OFFICIAL OR HIS DEPUTY AND FEES ARE
<br /> PAID.
<br /> SIGNATURE,
<br />
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