02030154 OF
CI BUILD NG DIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1587 POPPY WY JUST WATER HEATERS INC 02030154
OWNER'S NAME: APPLICATION SUB DATE
JUNE LI 1764 NATIONAL AVE 03/26/2002
PHONE: SANITARY N0, CONTROL NO.
(510) 293-9901
ARCHITEC MNGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
IJ L�
y2 LICENSED CONTRACTOR'S DECLARATION Job Description
i z
=p I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
t.so wimSection 7000),I'Divian3ofnheBuameaam,dProresuon,Code.and any license REPLACE WATER HEATER.
m full force and effect.
d< denclan ue. (5 0 GALLON GAS)
Data Contractor
aO y ARCHITECTS DECLARATION
; I understand my plans shall he used as public retards
1 i p ne Licensed Professional
that I
ar c R BUILDER DECLARATION
I li '—" I hereby affirm the 1. exempt from the Contractor',Cod License Law conM1e
C?a following arena(Section]031.5,Business and ve thiloud h,or Any city slmutny
E Ftp which q permit to...., cl Iter.improve Jemol sM1 or open any arvctua
de
e I.tsssince.also"of.Neapplicanl for such permit m fika signed su,enem
3m Dunhe?fcsPdpuAmir{tgfeproa.ronsoftheContractorsLicenseLaw(Chapter9 Sq.-Ft. Floor-Are Valuation
(sum g ith Sect7M) f n ision 3 of the Business and Professions Cole) s-;)'x. ( .i,e_'s.l.)kr, k.,;:k J'[r it i �.�C
or that he Is exempt therefrom and the basis for the alleged elempmbn.Any violation
-mf
.four annonre 70ra3i1n.5 BbKy nnu rddred dollars
r a permit subjects the applicam m a civiPpenalry
.,Solo). A N umber Occupancy Type
El 1,as owner ofthe property,or my employees with wages a.,thcir sole compensation. 1 a
will do the work;'and-the structure is not intended or offered for sale(Sec:7(s.,4, y�+; w•A
Business oil Profession.,Cade:The Comrdcmr's License law does not apply to an 506 - GAS TESRequlre �)• eet3o a.
own of properly Who Wilds P ves thereon. d who d such k himself
orthroughn owe ply provided th, n improvements not intended or 507 - FINAL PLUM) N�,
0200
offe ear I If-Iiw ,h hIf'g " p t !-' Id Illyir'or
completion,the owner-Wilder will have the burden of proving that he did not build or ,' t
improve for purpose of sale.).
ro n lusivd contmctin ish Festml convectors to .9 t ' ': rn
O l,.a mvner mrmep ce y,ameaa BUILDING!
onsweI Inc project(Sec.7044,Business and Professions Code:)The Contractor's
License law does not apply to an owner of property who builds or improves,hermn,
. .old who contras.for such pmjecus with a contracta(s)licensed purcont to Ne ._ ._ _.__. __._- .—
......_. _._._.._ - _...._. _ I ...___.....___
_ Commc,or's License law. - —
❑IomenemptunderSec. ,B&P C for this reason
Owner" Da¢
WORKER'S COMPENSATION DECLARATION
' Inercby afOnn under pcwlty,uf perjury ane of Ne following dedvm,ions:
O 1 have dad will initiation a Certificate of Consent to self-insum for Worker's
Compcvsmion. as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued,.
01 have and will meinain Worker's Compenamiov lmmrm e,as¢yuireJ by Section
3700 of the labor Cade,for the perfmmanee of be work for which,his permit is
issiucd.My Workers Campcnsaiion Insurance carndaed Policy number arc'
Carver ..-CERTIFICATION OFEKEMPFION FROM'WORKERS± 1 r% ��,f� M1.ar -t..k
COMPENSATION INSURANCE'
___._— _
Th s do.heed nm be completed if the permit Is for one hundred dolldm - s' Il.l f,.i It 1,-'1
(SI W)Ol lEss.)
_r l I mfr that in,he perfmmyme manner
s work for which u s penmt rs Workers'I _;i• ,v ,
shall not employ any;person in any ma a to become subject to the Wwkcls'
nn o
Compo tri n ' of California.Date
berm.NOTICsubject
PLICANHIf Compeafter akingmlindamcateof of Labor ion.youu ould
most
a
Q Q rdnM1with comply tonin such pronsmns or this pc
boon¢zub'ca,o the W'orker's Com ,ion rovisons of tine Labor Codc,you most
min shall W deemed revoked.
_I
.�r CONSTRUCPIONLENDING AGENCY " '• "" f '
�._' T hemby'dRrtn that mere is a coslmaim.lending agency far the perfurrnance
,.,, of the work'for which this permit is issued lSec.3097,Civ,C.)ld�
-Q -Lender's Nom •. '
e'. :. .-_. ... .........._ _
tz Leader, es
aAddrd
.
V' s,l cantly the,l have mail mis application and state that he above information is
tet' E. refired.I agree m comply with allcity end county ordinance ad aim
state laws ing
Qa) to Wilding constriction,and hereby omhoriierepi,'smudives of this city to enter upon
. W the above-mentioned property for mspcnion purposes., •, _
Cw (We)egrcc',o saver Indemnify and keep hadesithe City of Cupenindlgainst
.Fa y liabilities,judgmems,coxa and expenses which may in any way accrue against said
U Z City in consequence of the granting of this pemdt.'
APPLICANT.UNDERSTANDS AND WELL COMPLY WITH ALL NOWT'
POIN " I
SOURCE REGULATIONS. "� Issued by: Date
Signaum of Applicanl/Contrmr ec """ ' Dae"-.. Re-roofs /
HAZARDOUS MATERIALS DISCLOSURE 'I "
Wdl me applicant or future bJ Idmg o sopa t store or Wrotehdiard aterial Type of Roof
f as d fined by me C pen M 'p I Cod Chapter 9 12 and tin H bin d Safety ..
Cola Sector 25533(.1 S' ._ :f l;: s'1 , -' t : . I : p' 1 a ' ls I, 1
•ore., ,.I.I ' IDN -I5 - ) All roofs shall.be inspected riot io any.roofing material being,installed.Will the.ppl cat home building occupant use equipment d which If a roof is installed'Without first obtaining an inspection,'I agree to'remove
emit fortuitous air cont ,: defined by it B,Are.At,O I ty Management
District+ all new materials for ins ection. Applicant understands and will comply with ,
ora ❑Nm all III
es source regulations.
I
have rcad'the l m dons materials rcquocmmll under Chapter 695:of the
California HeoliK&Safety Cade,Section.25505:25533 and 25534.1 understand that
if me Wilding does not eurently have a ocrant.mat it is my rtt,iffibili y m notify me
occupant of the requirements which must be met prior to issuance of a CertiGcaa of
OgenPanty. „
Signature of Applicant Date `
' . a �.
on,
preathgvedoge tDae..- All roof coverings to be Class "B" or better .
_ , I OFFICE- ,