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PJ 1 1 I.1. 0111' 110.111 S I UI?S 1 F CIIECKIiU lli'IIE. An appllcaLiun for abut permit has been submitted In your name list- SAN JOAQUIN COUNTY BUILDING INSPECTION DIVISION my yourself as builder of the properly Improvements specified. 1810 E. Ilazelton Ave., Stockton, CA 95205 For your protea len, you should be aware that as "owner-bulldar" you are thio REQUIREMEiIT OF STATE OF CALIFORNIA IIEALIII 6 SAFETY CODE, Sec. 19030 responsible party of ►ocord on such► a permit. Building permits are not re- rlulr•ed to be signed by property urgrers unless they are personally performing OWNEII-BUILDER VERIFICATION Lholr uwn work. If your work is being performed by someone other titan your- Attention Property Owners self, you may proleet yourself from possiblo liabl.11ty If that person applies for the proper permit In his or her name. An "owner-builder" building permit has been applied for In your name and Contractors aru requlred by law to be licensed and bonded by the State of bearing your signature. Please complete and return this Information to CAII(orrlla, and may be required to have a business license from tl►e city or avoid unnecessary delay In processing and Issuing your building permit. couoLy. May art; also requlrad by law to put Lholr license number on all No building permit will be Issued until this verification Is received. permits for which uruy apply. If uu plait to d.► 1. 1 personally plan to provide the major labor and mVairlals for the y 1 your uwn work, uldh the exception of various trades that conDuction of the proposed property Improvement (Ye or No)__ Uyuu pian Co sub-cunlract, you should be aware of the (ollowing Information �fur your benefll and proteetlonr 2. 1 ( havenot) signed an application for a building Ir yuu employ or uLlierwlse engage any persons other than your Imrmedlate fam- peror the proposed-work. , and the work (Including malerlals and other costs) Is $200 or more for 3. 1 have contracted with the following person (firm) to provide Lhe e entire project, and such persons are not licensed as contractors or sub- proposed constructlon► contractors, then you may be an employer. . If you are an employer, you must register with the Stale and Federal govern- (lame Phone count as an employer and you are subject to several obligations Including Address 51:aLe•and Federal Income tax withholding, Federal social security taxes, Workers' Compensation Insurance, Disability Insurance costs, and unemployment cumpensatiun conLr City Contractor's License ile. ` ihere may be financial risks for you If yon do not carry out these obligations 4. 1 plan-to provide portions of t1►e work, but I hava.lilred tl►e following and Lhase risks are especially serious with respect to Workers' Compensation person to coordinate, supervise and provide the major work: lusurance . For niers specific Information about your obligations under Fedora{ law, con- flame Phone tact the InLeroal Revenue Service (and, If you wish, ilia U.S. Small Business Address AdmlrrlstratiWr). For more specific Information about your obligations under SLate law, Lhe Department of Benefit Payments and the Division of Industrial City Contractor's License- No. Accident's uruy be contacted If Lhe structure is Intended for sale, property owners who are not licensed S. I will provide tome of the work but I have contracted (hired) tl►e contractors are allowed to perform their work ppersonally or through their own following persons to provide the work Indicated► employees, WithuuC a licensed contractor or subcontractor, only under limited currdItIoil s. llama Address Phone 1ype of Work �fregount practice of unlicensed persons professing to be contractors is to secure an "o►rner-builder" building permit, erroneously Implying that the property owner is providing his or her own label- and material personally. Uullding Permits are not required to be signed by property ownors unless they are performing their own work personally. Information about llcensed contractors may be obtained by contacting the Corttr•actors' Slate License Board at 1020 "N" Street, Sacramento, CA 95814. Ilia State of California Ilealth and Safety Code, Section 19830, Chapter 9,. Signa Property Owner Paul; 3, Olvislun 13, requires us to make you aware of Lhese laws and ordl- P y nances, and requires you to canhlete the form on the right and return It to Hal llig Address\/24 �j i1lG A 1 Clt us before ire may Issue your permit. Y C Ar . An contractor you list must have his State Contractors License number on Location of But dln to be Done °e C44 4 Y y 9 E. }�-u t-, lel o file In Lhis Department, and a current, valid Certificate of Workers' Com- pensation Insurance (or waiver) also on file in this Department Social Security Number s _9 (p 9 Dato 5-11- 60 If you are hiring sornuone other than a contractor to do the work, your Workurs' Cornpensatlon Insurance must be on file in this Department In the REOUIRE11ENi OF TIIE STATE OF CALIFORNIA IIEALTIi 6 SAFETY CODE, SEC1IOiI 19030 � (orrn of a valid, current certificate from your Insurance Agent. RID AI C 2° —�q