02090177 (2) OF
NO
CI BUILLDIING DIViSIiONNDPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11043 FIRETHORNE DR JUST WATER HEATERS INC 0209017E77
SUB
R7A YIAELL LILLIAN L TRUSTEE 1764 NATIONAL AVE APPLIc09N/ 26/2002
( PHONE: (510) 293-9901 SANITARY NO. CONTROL NO.
COO ARCHITEC(ENGINEER: / BUILDING PERMIT INFO
U BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
z 1 hereby man mat 1 am Ircemad ander fCha t 9 tcomme«in Job Description
az_c rat pr°,nrio^.^ P=r, g REPLACE WATER HEATER
F:t-w with Scnian7000)of DivisonJ of the Business and Professions Code,and myli<ense
a m s is in mu force and effect. ( 40 GALLON GAS)
z u 6 Licenss Class Lic.a
3 y Data Contractor
ARCHITECT'S DECLARATION
,g 1 understood my plans shall be used as public records
w p O Licensed Pmfessiowl
OWNER-BUILDER DECLARATION
1 hereby.mire mat 11. exempt from the C Professions
o :License, Taw for the
2 Z a following mason.tgechoI )0315.Business and tie.derions Cade:Any ciry s worry
f s❑ which raquim n permit re coresmct,alcor,improve,demolish, file
refinery swnum
pn t r al q ' .th ipphcantfor such Permit roBleasigned statement __.._...- ._. r .__..__._..__..,.._._..,
tpthe 51 bsWpuis an to the provisimnsofthe Contractors License Law(Ch ptcr9 Sq FI F.loor•A ea,- , e VaEa 'on
(c c g idISecow7000)ofDivision3ofineBuuncssagdProfessionsCodc) t'{;'�'j'(t��:,."itita a)yl•rit�(-I9•.:'
or mat he rs exempt rM1ercrrom and me basis farthest]egal&empuon.Any violation.
-
of Station 9031.3 by any applicant for a permit subjects me applicant to a nvil pc......
or
or not me than eve hundred dollars(35W). APN Number Pr;a1Tr :r. Occupancy Type
al.uow«rormepmpnr.orm>empmyaswirhwagasmiheasolee....a.inn. 502 - FINAL PLUMBIN ENERGY
-will do he workand the'sourm.is nor intended'or ofWd'for'sale(sac:700.4,-
Bdsina;and PPofie mns code:The Contractor.License Law does not apply to an 506 - GAS TESTRequired Inspections
owner of pmpe ry Who builds or improves thereon,and who does such work himself 5 0 7 - FINAL PLUMBING
or through his own employees.t Wilding
that mch improvements wi not intended e r or _.._
-uRemd for sale If.Fowever,rfie budd'n mens Id rh "one -----""— "-'"---- `-""""'"'"'--"'
1.. ge burden of year or //�►, (t__�`' -_ _
completion,the owner-builder ral .),will have the burden of proving that he did not Wild or �,(J�'L rim{G 111.111,
improve for puryose of sale).
r
_._.
01, ofine propeny,am Busses alacontracting- wahbcensed contractor;to OCT 2 (� it comournI.I
License the peeprojn(Sec, to a Buse d P f ;ora Cade)Thc improves
the tui s
_ -
License law does not apply d.an owner of pmpeny who Wilds or improves Mertone
--and w .comuacts.focsuch.projme wim.a.coavacmgs).liccmedyurs
uancm me ._._ _ .. _...... -___..._
C tract f L easeV .__._ ____. _ .._._.._. _------
ho
❑I exempt
tuod<r Se 'B&PCT this mann I-
BUILDING
- .. .
"WORKER'S COMPENSATION DECLARATION
I hereby amrm under,penahy of perjury o«of,a
fte following derlemrions:
❑ 1 ha7e'end'svill`Aiiintain a Cenificate-of Conseni to.self-insure for Worker's
.� Compensation.. as provided for by Section 37W of the Labor CWq-for me
'pelf^rmance of the work for which this permit is ion d_
'J v ❑1 have andwillrimain Worker's Compensation hismihc'e.as ryuimd by Section
- _ 9700 of the tabus Cade,for the peRummnce of the"work:for which this permit is
s: dMYW rk YsC pe. to Insu 'cit ❑P lcY nu ncam
.. Cam r f S4. i.l 1 Ff I 1 '.:Pol cy No, • \c,l .(I I ,� 1'+'%r n v 'i s ❑ _- -u
y I(CERTIFICATION OFM,EREMPTION FROM WORKERS 4 ��r.tl_41 v ,' .lA} y t t r i ev Att3
COMPENSAl10N INSURANCE
�rljc§ion-need not,be
completed if the permit is for one hundred dollars PF RVI tin
(3m0)tole')
sh tl<erffjthhi me pcnmi cemfth kf uhchm perms s'iss cdl LiG'I; til ]S ,C�1v� L � s fs•••r J Jam• �'i-_..
shall not mpl Y'a-Y a y nn m bcrxs bjm m rhd W rkers t3'
Co i f California'Date ' ` '
=APPlc�ntr nlaw ,.
NOTICE TO APPLICANT If B rm kr gm Cen fc r fExemption,
empt you sho hi p
Z 'Me me s bj t in the Work Compe rat pm f he labo Code,yo u
00 fdnh rm ply with h p thisPermit shall be dermerl e _,.
..ok.etd...
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'- ...
... ..._,_v'...i
_� IaPCNSTRUfIONLENDINAGECI.
1hembm 1yiyamume nnma nk dmg8 c forthPMrtnave
l11 ;itch thispermit 9su d(S 3007 C CWrG�,q m .. : 'Lcc
a.Z .
_
Und Addie. -... - r gyp:• i.t. �('Ij.r.(.r -_-_. . _ -..
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..I eenlfy.that 1 have mad this application and.nate that he above information is
ayh F .aor'rcct.I agree to comply.wim all city and county ordinances and umm laws minting
-'PkU robuildingconsouction:and hereby concoct mpmsemarivee of this city to tmer upon
}-fy :the abuvc-remionedpmpany forimspaaion purTri
'.� S (Wlog to e indemnify and beepM1uml xs the CityofC pen no ago hsr
W list hues,judgments,costs d e pe ate. which may_in any y e gainsr said,
'V.Z 'City n<onsequence'nf me gmming of This"mot.
TAPPLICANT UNpERST,NDS AND WILL COSIPLY iv1TH ALL NO,WP01�-f''
- . = 'soHleeE'ReeueATIDNs.,j;- Issued bye Date
sig t fApplicon con,, mr Re-roofs
HAZARDOUS MATERIALS DISCLOSURE D tti,, .
;� wnme ppheantorftmebalding«cupam raeorhatbl narardon mammal Type of Roof. .,
caddefined,by rh Cupen to. Lord rwl Cod Ch ptc 9.1i and th Hei dS lety -
'CodaSect n2533 (q)VIj s - l t t'rA f .i:; p f, �<` n 9 •r -
.
__ATI roofs shall be inspected prior-to any roofing.material being installed
„t, twRm ppic to urn w'Idig cps . eqp t p
e5 "ch If a roof is installed'with'out first obtaining an inspection,'Fagree to'remove
em;,1,
haz rd a sitcoms r darned by m B y Area A 0 Dinh, M""gome i
°i""" all new materials for inspection Applicant understands and will comply with.
.,y ❑Yes •j ❑No' Y , :: . _. . -
1 r r q r, l all non-point source regulations.,e„;;,
1 h e read the h ' rum,maters I requirements under Ch plc 693 of the
atcrisisHeolm'8c Salary
Code.Sections 25505.23533 and 2333x.Pund<mand ma
-iQh budding tlrcs not curtcnrly hascatenam mauls yresponsibilityt notify me”
'«c p at of m quireme r itch must be t poorm i, an f C mBcam of.
' ' _ _Signature of Applicant. Dale
�,-' ON nutlmrardager, Dmea•
�17 µ _ All roof coverings to be Class "B"or better
""OFFICE -- ---.