02030124 CITY I OF c DIVIiSiONNO CONTRACTOR INFORMATION:
' PERMIT
BUILDING ADDRESS: PERMIT NO.
.6445 BOLLINGER RD JUST WATER HEATERS INC 02030124
OWNER'S NAME: APPLICryTION S B DATE
FRUEN WILLIAM J JR AND LYNET E 1764 NATIONAL AVE 03/21/2002
PHONE:
OF
(510) 293-9901 SANITARY NO. CONTROL NO.
u O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
<u G BLDG ELECT PLUMB MECH
F`<i L= 1=1 C_l L..J
�?= LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that 1 am h mcd under provisions of Chapter 9(commencing
mew withSection]U00)ofDivision3oftheBusinessandProlessionsCide.ondmylicense REPLACE WATER HEATER.
5m f, is in full farce and effect.
:.-a License Cmxr Lie.x (4 0 GALLON, GAS)
w Dam - Cummaor
5 3 a ARCHITECT'S DECLARATION
C,< l understand my plans shall he used m public records
3 z p O Licensed Professional
- or - OWNER BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
h?a following reason.(Section 7031.5,Business and Professions Code:Any city or county
8 o which requires a emmi w cnnsmuct,altar,improve,demolish,or mpair any structure
to 3 priono is also q s the pjsl'cam fw such peon t m fl gemd comment _ _ ... _ .. _ _
(nota dpamuattm)p inrofthememesand v Ca9 S Ft,FloorArea-.h ,.
(commencingthsmo7000) rn .ion3'flheBminesxJProfessionsCode) !-(';?s�-R f' '-,q''t a., Y„e -t':y . Valuation
.,,bar he is exempi thdmfmm and the basis for the alleged dempt on.Any rotation - k �:'
of Section 7031:5 by any applicant for a permit subjects the applicant to a civil pri alry
I5nnq1 nn
of not harm than me hundred dollars($500), APN Number .' Occupancy Type
C 1,as'writer of me propeny,ur,ny employees with wages ss a¢o-sale compensation, PLIIMBTN�
will'do the work,and the swnure is not intendedoroffered mr'sale(Sec:-7044',
Business and Professions Code:The Con tor aors License law does not apply to an 506 - GAS TESRequired Inspections-
ne - •'
w r of property Who builds or improves merc'n,and who does such work himself
- o
or roma Fhh,Awn empl,ree.provided they such improvemems are non intended or 507 — FINAL PLUMBING
-:offered ',sale.If,hbwevel.the building <menfis sold withinonc -"'"" -"- -"-'-" -"" "--' ""'-__'"_""'—"--`-- - - --------. ... __._ _.
ar improv year of ----__.--__._.__ _
completion,the owner-builder will have the burden of proving thin he did not build or
improveprovefor for purpose of sale.).
❑Las owner of the n -- ------------ -.--...__. _._
grope yam Business a d Professions
withbdc:)Th Cont,ct m
_
consumer me does
(Sec. to an Business and property
who
Cada)The improves
theme.,
License Law Jmcs nut apply les an owner of progeny who builds or impmres mercoo, i
tend.who.comosels for such projens.with asomracmr(s)licensed punuant.tm.the
O l ahacmrs License taw..
❑lm exempt und<r Sec. ,B&P C for this reason n;,;
Owner Date •. ...
( ': WORKER'S COMPENSATION DECLARATION �����
' I hereby affirm under pewltyo(perjury oLc of the following decmmtions:'
C I have and will maintain'a cei ificnte-of Consent to self-insum for Worker's 20
Compensation, m provided for by Section 3700 of the tabor Code, for the
performance of the work for which this permit is issucd "
Clhire E vvill n,siman Worker Comi;t'i'laturn firessuarce.as req'rtd by Seeln
3700 of the Lebor Code for the performance of thework for h h this permit is - yvl�ll•
issued.My W k CompensationI m
Insurance carrier d P licy a be DING
Ceirie Policy No. - . ll1 . .
CERTIFICATION OF EXEMPTION MOM WORKERS' - k. s�.y� l `'�..[s„t.,. t 'ct 5`31.➢
COMNSATI
PEON INSURANCE_ _.` ........
Miss ,econ need not be co npleieJ d the permit is for one hundred dollars •• �... i Ci,I LI^:
1$100)or less) - -
1- m fy that thep f <e m r Is.,;r h h m object
t' tied,I - -
shall temploy- )pe o y antic as m bttomc b)e<t tin the Workers - / ` 't e -
CompcnsntionlawsofCalifomna Dater
Applicata
NOTICE
subject
APPIhCANT If after Compomakingion C n fie fGu npuon y' h Idbecome Compensation
t us 'u •t.
pe p 's ons of the labor Code,you must
z 0 fonhwitti comply with such provininns or th s permit'hall be deemed rtv'ked.
CONSTRUCTION LENDING AGENCY
rl 7 1
fz7 h mat therea c lending agency f theperformance-
oho k:fe,which th Permit is issued(S c 3(5] Civ C)Q Lc
Lends Add ess
I codify that 1 have real this application and state that he above information is
Cork"d egret to comply with all city and county on(Imnces and stain laws relating ✓�
.cif) tobuil t-menaces,dgpimy Fa by authonum,mc.., of thin city menter upon //�lf�✓� _ of
thbiddin-mnntructi pmand fnr,insprti ionpurpctes.,,
(Noe)egtctcsavq indemnify and keep harmless the City of Cupmmo dgai nor V
.14 liabilities,judgments,costs and expenses which may in any way accme against said
U Z City in consequence of thegrang of thin permit 11
APPLICANT UNDERSTANDS AND WR.LCOMPLY WITH ALLNON-POINT
1 SOURCE'REGULATIONS Issued by: Date
Signature of Apphctnt/Cmuscreor „ Dem ,','
e' HAZARDOUS MATERIALS DISCLOSURE ` Re-roofs
N R the npplica d m for--Wilding ac prod knot or handle haxardo s material
as defined by the CupcmnoMunicipal Code Chapter 9.12a il be H ahh and Safety Type of Roof; _ . . .. .. .. _
Code;S ct 25532(1)'. -n" t f r. t . sr T..`-.') x -
oY �" ' ,All roofs,shall.be in
prior to.any roofing material being installed.
,. Will the apd m r t building o nt - which ---_-
emirhaoardous ircontaminants asdefined b)the BayAriaAir Qual ty Management If a roof is installed without first obtaining an inspection;I agree to remove
rn- [) all new materials for inspection. Applicant understands and will comply With
- oYs „_ ,• oN -.1 1. PPP .P. Y .
all non'point source regulations...
1 M1a re d th nax dous roam els rtgmre nu under Chapter 695 of me
if the mm building
do&Safety Cmde Section,25505;25533 and 25534 1 understand that
(the budding Jots not currently have a tended:that it is my eclonsibiliey tb notify the
acup5m of the requirements which most W met poor to isivanitt or a Certificate of
..... .._..
Signature of Applicant_ _._ _ _ -_. __ - „ Date
T.- Owncrorauthorized after Dam All roof coverings to be Class "B"or better
e -
t e -,• �_.. - _ ..'i` i OFFICE - - -" - -- - — - - _--