PERMIT NO:  B2019-00175
ON-LINE PERMIT
   TUOLUMNE COUNTY
   2 South Green St., CA 95370

INSPECTION REQUEST LINE
(209) 533-5940
PERMIT TYPE
  ELECTRICAL SERVICE

PERMIT SUB-TYPE
    

JOB VALUE     2000
APN     861400500
DESCRIPTION
    Replace power on pole
APPLIED DATE
2/8/2019

APPROVED DATE
2/12/2019

ISSUED DATE
2/12/2019
 
Seal    
 
    PERMIT INFORMATION
FEE SUMMARY
    SITE 16110 HIDDEN VALLEY LN
SONORA, CA 95370

    APPLICANT BENDIX ELECTRIC
P.O. BOX 189
SOULBYVILLE CA 95372

    OWNER FRENCH, CYNTHIA A 1/2
16110 HIDDEN VALLEY LN
SONORA CA 95370

    CONTRACTOR BENDIX ELECTRIC
P.O. BOX 189
SOULBYVILLE CA 95372
BUILDING STANDARD$1.00
CASP FEE (STATE)$4.00
BASE FEES FISCAL YEAR 18/19$363.00
Total Fees Collected:$368.00
NOTE: This job copy of this permit shall be kept on the job site to make the required entries thereon. The permit will expire if work is not started in 180 days, is abandoned, or does not receive an inspection for more than 180 days. Additional fees will be collected to renew expired permits. This is a Building Permit when properly filled out, signed and validated, and is not transferable. Construction Hour: Construction is limited to the hours of 7:00am to 7:00pm each day. No work shall be performed on certain holidays (MMC V-213-3(b)).
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
License No: Expiration Date: Contractor:
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the contractors license Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Pofessions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by an applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):

_____ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner or property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided
that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burdon of proving that he or she did not build or improve for the purpose of sale.)

_____ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner or Property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law.)
I am exempt under Sec. _____________________ B.P.C. for this reason _____________
DATE ____________ OWNER ______________________
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_____ I have and will maintain a certificate of consent to self-insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the permit is ussued.

_____ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are:
Carrier/Policy No:    ________________________________________________
(This section need not be completed if the permit is for one hundred dollars ($100) or less).
____ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any number so as to become subject to the workers' compensation laws or California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
DATE    _________________ APPLICANT:    ______________________________
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, 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 PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
DATE    _________________ APPLICANT:    ______________________________
* I certify that I have read this application and state that the above information is correct. I agree to comply with all city ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes.
SIGNATURE OF APPLICANT OR AGENT  ;_________________________________ DATE    ____________
INSPECTION SUMMARY

______  FINAL
______  TEMP POWER
Permit Finaled Date:  __________    Inspector Name:  __________________    Signature:  __________________