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XY 11-1- ()11'1' II()-I'll S1 UI?S It" (:Illi(:KI:1) 11KI(I: An application fur a building permit has been submitted In your name list- SAN JOAQUIN COUNTY BUILDING INSPECTION DIVISION ing Yourself as I,ulidur of .Lhu .proparty Improvements specified. 1810 E. IlaieTton Ave., Stockton, CA 95205 Fur your proLec:Llwt, you should he aware that as "owner-bullder" you are the rusponsible party of eacord on such a permit. Building permits are not REQUIREMENT OF STATE OF CALIFORNIA IIEALTII 6 SAFETY CODE, Sec. 19830 re- quired to be siynnud by property unnners unless they are personally performing OWNER-BUILDER VERIFICATION Lheir own work. If your work Is being performed by someone other than your- self, you may protect yourself from possible llabi.lity If that person Attention Property Owners applies for the proper permit In his or her name. An "owner-builder" building permit Itas been applied for 1n your name and Contractors arts required by law to be licensed and bonded by the State of bearing your signature. Please complete and return this Information to California, and may be required to have a business license from ilio city oravoid unnecessary delay In processing and Issuing your building permit. counLy. Thuy are also required by law to put thuir license number on all No building permit will be Issued until this verification Is received. perutiLs for which Lhey apply. If you plan to du your own work, w1Lh the exceptlon of various trades that 1. I pa!5Aj1naI1Iy plan to provide the major labor and a els for the Yale plait Lo sub-cuntract, you should be aware of the following Information Co on of the proposed property property Improv men (Yes or No) ter your benefit anti protections 2. 1 (have eve not) ✓(/ signed an appllcat for a btu) ding If you employ or otherwise engage any persons other than your Immediate fam- for the prop se work. Ily, and the work (including maLerlals and other costs) Is $200 or more for 3. 1 have contracted with the following person (firm) to provide the Lite entire project, and such persons are not licensed as contractors or sub- proposed constructions - 1racLors, Llcen you may be an employer. you are an empluyer, you must register with tice Stale and Federal govornc- llama Phone muni as an eenployor and you are subject to several obligations Including Sl:aLe and Federal Income tax withholding, Federal social security taxes, Address 'Workers' Compensation Insurance, Disability Insurance costs, and unemployment cuuytensatlun contributions. City Contractor's License No. There may be financial risks for you If yon do not carry out these obligations 4. 1 plan- to provide portlons of the work, but 1 have.Iltired the following and Lleesa risks are especially serious with respect to Workers Compensation person to coordinate, Insurance . supervise and provide the major works for more specific Information about your obllgatlons under Fedora) law, con- llama • Phone tact the Internal Ilevuntus Service (and, if you wish, Elia U.S. Small Business Address Adininistratiunt). for more specific Information about your obligations under SLate law, the Oapartment of Benefit Payments and the Division of Industrial Accidents stay hu cuntaeted City Contractor's License No. If Lite structure is lotanded for sale, property owners who are not licensed 5. 1 will provldo some of the work but I have contracLed (hired) the cutiLractors are ailuwed to perform their workpersonally or through their own following persons to provide Lite work Indlcatedt euytluyees, WithuaL a licensed contractor or subcontractor, only under limited cundILIoil s. Name Address Phone jype of Work A fc•egtnunt practice of unlicensed persons professing to be contractors Is to sccure an "uwner-bullder" building permit, erroneously Implying that the perty owner Is providing his or Iter own labor and material personally. illnig Purio are not required to be signed by property owners unless they W�K performing their onn pork personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board at 1020 "N" Street, Sacramento, CA 95814. The State of California Ilealth and Safety Code, Section 198309 Chapter 9, , o ['art 3, Division 13, requires us to make you aware of Lhese laws and ordl- FREOUIREMENT1 Property Owner Lmanses, and requires you to complete the form on the right and return It toress Z G it) f Cltus before rte may Issue your permit. L Q, p ( C1�Any contractor yon list must have (cls State Contractnrs License number onBuilding to be Done C . AIA IA {�file In Llils Department, and a current, valid Certificate of Workers' Com- pensation Insurance (or waiver) +Iso on (Ile In thio Department rity Number -�-q y(Q Dat 5-)�-QIf you are hiring someone other Chan a contractor to do the work, yourWoekurs' Compensation Insurance must be on file In this Department in tine OF THE SATE OF CALIFORiIIA IIEALTII b SAF Y CODE, SECT1011 19030 form, of a valid, c"rrenL• certificate from your Insurance Agent. 2 09 3 3, _(:)q q