02050042 ci TY DIS
r ION
BUILDING PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22578 LAZY OAK CT WATER HEATERS ONLY 02050042
OWNER'S NAME: APPLICryryTION S'B DATE
BRAMMER STEVE 970 E. MAIN ST, SUITE 20 OS/ 07j2002
•PtiONF.: SANITARY NO. CONTROL NO.
(415) 566-2209
O O ARCHITECI'/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
,Z
�wZ LICENSED CONTRACTOR'S DECLARATION lob �. tL�t�
>L-p I herebya�tm Nur l am licensed anderpmvisinnsof Chapter 9 lanmmeneing REPLACE WATER HEATERMAL`a
yC with action 701%Bmf Division 3 of the Busieessand Professions Code,andmy license
iy S� isin Poll force vn oo�� [ DEC 1 7 2002
. e< License C J Lie., �' �5 7
O it.�O Dae_, � S DECci
El0< ARCHITECT'S DE publi TTIKKCIIIN --
�=O 1 undersand my plans shall Me used or public records
e p o
3 Licensed Profeasional BUILDING
'd cfi z OWNER-BUILDER DECLARATION
m I hereby°firm Lha 1 1. exempt from the Cnimecessions C s License c Low for she
C?a which
tarts(Semon 0031tr Business and Professions Code.Any city or roomy $700
O wM1 h rtq irts o Permit t construct. Ise p demolish,or rep y swnurt
e3- -prior toits sono c a1 recants theapplicantf h Permit to file aagWurrocia - ..___....._ .___ _ ._.. -
thmheslcS licensed! nttgth,Fe isb of like Commences Lic Law(Chapter9 ( A4 „, )aw.�r y.r ) e e Valuation
(co with Section 7") fDivi: ,3 ft Business and Professions Code? M1.1J.� t C3 Q'.I C,IybV7 .'V�il I,r,.,l^it,ka;
or that he is exempt therefrom and the basis for the alleged etiemp ibri Any violation
of Section 7031.5 by mry,applicant for a permit subjects the applicant to a civil penalty
.feetmm
nthanf.ehundreddo]].(s5m). 502aPNPftT10A1L PLUMBIN ENERGYOccupancy Type
01,as owner of the property,or my employees with wages as their sole compensation, 506 - GAS TEST
will ne me' Pro ssionsand structure is not intender a offered for snot(Sanappy toa n 507 — FINAL P$U468ES wpectlons
Business and Professions Code:The Contractor's License Law does not apply to elf
owner ofpropertyhis ow can builds or improves bar
such andimprovements
who docs such work himself
ofNrough his own howeitees provided rh t h'prove e i t monde:or _ . .._ _... _. _._._ ....
offered for wlc wlhowever the building p m m': IJ 'thin one year of-
cm n improve
the owner builder w II hove the burden of proving this he did net build or
improve for Purpose of sale.).
�01:oCowner of the o n.am exclusivcl - ...._ ----- -' - - '_ "-" - - - - --- '-- '-
Pr Pe y y contracting with The
Come cta to t b.
incense the project(Sec.70 W,Business and airy who
Codep The Co Lattice,
License Law does not apply Inan mjowner of properly who buildses improver thereon.
and whoCommer contracts&Livnfor such projurs with e.rontraztor(s)licensed pursuant to the
i Commctoh License Law. •.- -_ _ . .. . ..... .___-_. .-_...-__.. _
f P 0 l em exempt under See ',B&P C for this reason
Owner Data -
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declarations:
❑ 1 have and rill maintain a Certificate of Consent to self-insure for Worker's
L Compensation, as provided for by Section 3700 of Ne Labor Code, for the
Performance of the work for which this permit is issued.
nor,arid will maimuin Worker's Compensation Insomnia,as required by Section
of he Labor Code,for she performance of the work for which this pemut is
issued My Workers Compensation Insurance carrier and Pobeymm�bcr are
.. CCarrier -:v�kPnlcy No.: l3/ii/se4
+'CERTIFICATION OF EXEMPTION FROM WORKERS'411k - j i t'{^f�tYi t
COMPLNSATIONINSURANCE `" '
. .. . - , , . -._I.._ ,.. -,. ..__..__ .___-.._
'fThls senior need not be completed if the permit is for one hundred Jnllars 1 - -' `l .•..
Iaonl or leaa.j. '
-
1 certify
dao-in she Performance insayrm of the work for which his pemui c issued 1
shall not employ any person m any manner so ai m become subject ro Ne Workers
Compensation Laws of California.Date'
Applicant
NOTICE T'O AI•oLhe ANT.Work If,is aftCo pensmakatg lMa Certificof ate of of Labor io de,you
hittome Subject y the such Pr Colon,or thin Prov l,11all be dLabor Code;you mus
O 0
forthwith comply with such prosmons or dii,permit shall be domed revoked
ti . .. .. _ .. .. ... . ... . .. ... .._. . _ ....._. .... .. _ .
AGENCY `o ,
1 hereby whom this there u a sued(S m 1 ndieg agency for the performance
W
mike
work for which this permit is Issued(sec 3097.Civ.C.)
Land r's Name
nces and
Uoz OIindiygree to shave
ave.7ndcmniapplication
ify Pp kttp hardmlteas
tie tthheiCtihtey7adoabove I with all city and uly u`laws penfrtienmo eorgluetpiinnosorngaoussts city Ij ood reply
.d
r Wnc�eboneJ Property inspection proposes.
L (We)
Vi t
- -- - - - -- ,
UInI,L
listeliries,judgments,costs and expenses which may in any way accrue against said
V..^ City in comen,ance of the germing of this permit:
APPLICANT UNDER STAN s' ,' WILL COT'^LY WR3g ALLN �INT,
SOURCE REGULATI SA/qZ Issued by: i Date
Signmma of ApplicnMComreemr - Date Re-roofs '
- -•." HAZARDOU MATERIALS DISCLOSURE ,
Will the applicant ner frrebilding occupant store or handle barrel mooch) _Type.of-Roof,,. .. ., ...
.
res named by the Cuperrn Municipal Code Chapter 912 and the Health and Safmy "" - "" "'" '
Cord,Section 255321a1 - r r 1" I't 1, t L' •t _ - •..
C.
°Yf5 �°'' t i All roofs shall,be inspected prior'to_any.roofing,material being installed..
Will ra applicant r building occupantusecqupmcei rd devices which If a roof is installed without first obtaining an inspection I agree'to remove
call haaardi s nor dincormirmis a d fined b3 the Bay Area Air Qrmlity Management ,
Diarrnl all new materials for inspection, Applicant understands and will comply with
k
°Y" 'all non-point source regulations: —
'4'1d I Hishiad the hnzadmcy Codeno, . mmorials requirements a d tlerMS 4,I un erst6 95 of she
California'maHealth A Safety Code.Sections 25505,25533 nod 8534.1 understand that
if ounamldingdues bacon rtmly haveemnamance it is my responsibility to notify she
odedpanr of the re virememi which most be met prior to issuance of a Certifieau of -
Oaupnoc
Signature of Applicant Date
owner or an..... gear D&
All roof coverings to be Class "B"or better
.. _. _. . . '. .. •� c..__ --OFFICE ..... .. _... ... _. ._. _. ... ...... . . .. . . .. ....