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CITY OF MANTECA 1001 W. Center St, Manteca, California 95337 (209) 456-8550 Inspection Recorder BUILDING PERMIT (209)456-8552 Permit Type: Commercial Demolition Permit No: 2019-00003004 Date: 8/27/2019 Address: 405 S VASCONCELLOS AVE A.P.N. 22802041 Subdivision: Lot Number: 0 Owner: S S J E PROPERTIES INC Address: PO BOX 3 MANTECA, CA 95336 Professional: Contractor Issued To: Suts-Superior Underground Tank Services Inc Address: OUT OF TOWN 200 B Norris Canyon PI SAN RAMON, CA 94583 Work Description: 10,000 GALLON TANK CLOSURE IN PLACE CLEAN & CAP LINES SUT'S SUPERIOR UNDERGROUND Square Feet: Valuation: 7000.00 Property In Floodplain: Yes No Initial LICENSED CONTRACTOR DECLARATION CONSTRUCTION LENDING AGENCY I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of 1 hereby affirm under the penalty of perjury that there is a construction lending the Business and Professions Code,and my license is in full force and effect agency for the performance of work for which this permit is issued Section 3097, Civit Code. License Clasel q21 License Number 482356 License Expiration: Lenders Name_ Stgnatu6 _� Date._ r _ Lenders Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Sec.7031.5 ❑ SMOKE DETECTOR AND CARBON MONOXIDE Business and Professions Code). Any city or county which requires a permit to construct,alter,improve. ALARMS REQUIRED demolish or repair any structure,prior to its issuance also requires the applicant for such permit to file a signed 13 INSPECTION REQUIRED DURING INSTALLATION statement that hovi e is licensed pursuant to the provisions of the Contractor's Chapter 9(commencing with section 7000 of Division 3 of the Business and Profession's Code)or that he is exempt therefrom and the basis of the 1:1 ALL WORK SUBJECT TO FIELD INSPECTION alleged exemption Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars($500) ❑ NO OCCUPANCY OF STRUCTURE UNTIL ❑I,as owner of the property,or my employees with wages as their sole compensation will do the work,and OUTSTANDING FEES ARE PAID structure is not intended or offered for sale(Sec.7044.Business and Professions Code. The Contractor's License Law does not apply to an owner of property provided that such improvements are not intended or offered for sale.If,however the building that he did not build or improve for The purpose of sale). 1,as owner of the properly,am exclusively contracting with licensed contractors 10 construct the project(Sec THIS PERMIT SHALL EXPIRE AND BECOME NULL AND VOID WHEN 7044,Business and Professions Code. The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contraclor(sl licensed pursuant to the NO INSPECTION HAS BEEN PERFORMED FOR ANY 180 DAY PERIOD Contractor's License Lawl AFTER THE PERMIT HAS BEEN ISSUED. ❑1,11a exempt under the Conlractors'State License Law For the following reason By my signature below I acknowledge that,except for my personal residence in which I must have resided in for I hereby certify that I understand and agree that all permits at least one year prior to completion of the improvements covered by this permit,I cannot legally sell a structure are subject to California Health and Safety Code Section that I have built as an owner-builder if it has not been constructed in its entirely by licensed contractors.I 19850 and Government Code 6250 and a5 SUCh are =1untlerstand that a copy of the applicable law,Section 7044 of the B&P Code is available by request or at 1eginfo.ca,ctovlcalaw.hhtml considered Public Records. Property OwnerlAuthorized Agent Signature Date Applicant Initials:�� WORKERS COMPENSATION DECLARATION I hereby certify that I have read this application and all 1 hereby affirm under the penally of perjury the following declarations information I have provided is correct. I agree to comply C1 I have and will maintain a certificate of consent to self-insure for workers compensation,issued by the with all applicable city and County ordinances and state Director of Industrial Relations as provided for by section 3700 of the Labor Code,for the performance of work laws relating to building construction. I authorize the for whichthis pem,itisissued Po1iyy Number . representative of the City to enter the identified property 17I-have and will maintain workers'compensation insurance as required by section 3700 of the Labor Code,for for inspection purposes. the performance of work for which this permit is issued My workers'compensation insurance carrier and policy f, number are z Sig at71. - f Property Owner or Authorized Agent: Carrier 7 fiL4-7%--t [v_i= f a_> . L� Policy Expiration Date, _ _ _ Policy Number 14��}�-C> ' j<__Name of Agent�.. - — - �— G I certify that.in the performance of the work for which the permit is issued.I shall not employ any person in any Date: manner so as to became subject to workers'compensation laws of California.and agree that,if I should become subject to the w rkers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions _ pj? Approved by: Signature— Date i 4L' r� WARNING FAILURE TO OBTAIN WORKERS COMPENSATION INSU ANCE C VERAGE IS UNLFAWUL. Date Issued: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS Amount Paid: $412.46