01110085 CI nm OF GUDPERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
937 NOVEMBER DR HOT WATER INC 01110085
OWNER'S NAME: APPLICATION SUB DATE
AOL CHIN MARIE A 2531 GRACELAND AVE 11/19/2001
I PHONE: (650) 298-8494 SANITARY NO. CONTROL NO.
GwOO ARCHITECI'ENGINEER: BUILDING PERMIT INFO
&w G BLDG ELECT PLn MLCH
a IJ C_I ._.I I_:I
LICENSED CONTRACTOR'S DECLARATION
'5v 1M1ereb-omamthat1amlicnsedunder ons of Job Description
N-G 3 oro,isi p g
t_t, wit eedm]ono)nromiainn3anheRusmeasand PrmtasronaC,acanamyhtnsel REPLACE WATER HEATER.
cat -ren rorce an beet
z < ccno Cla, Lit.«
i 3 a O Ito / Comnanr
LLo. ARCHITECT'S DECLA A
I undemmnd my plans shall be used as public rcaots
Ed
5 O O Licensed Pmfasioml
OWNER-BUILDER DECLARATION
v5 1 hereby alfirm that 1 um exempt from the CmIl a rut's License Law for the
?a following mason.(Section 7031.5.Business and Pm@ssam,Code:Any city or county $500
x G which permit mne
taquires a penmu i.ahe.impam e,demolish, mm�urt
or rep i,any
a3C0 prior to it .. also q ther ant(Troch permit file asgned statement
_.
(hath rremed proximal to of the,muoctorsLmnselaw(ans Cas 9
(commencing _mit the d00andthe alis o the
ditai Anonacoae> �k'-. .-3.;3vg�;'�?6.T,'t. i, Valuation
TA; ):
or that hers 31.5 bi spy applicant
the Wer for the subjects
the uempnt to Any l penalty.
of Stenion]031.5 by enY uppllnm fora permit objutt the applicant So a civil penalty
of not more than fire hundred do)].($504 5 O�PlTIP
xl "'TVAL PLUMBI G ENERGf)ocupancy Type
❑1,as owner of She prmemy,or my employees with wages as their ole compensation,
will do the work:end'the struemre'is-not intended or'offened for'sale'(See:70LI,
Business and Professions Cole:The Cmuranor s License law does not apply to an 507 — FINAL pMqu*Vij @pections
owner of property Who Wilds or improves thereon,and who docs such work himself,
or through his own employees.Provided than such improvements are mu intended or,
offered for sale.If,h,iaever,the Wilding ' -paw S is old within unc f -- ---- _ - - -' '- ""'-- "-
I i the owncrbuilder will have te WN n oif,mo ten he did nm d,ililor - t
cnmp a,on, Droving
improve for purlxsse of soled.
❑1.as owner of the progeny I u siv eiy contracting lM1 fir c nued co damt to to
consumer the pmjcn(Sm.7044 Business art Profiession,Code:)The C t tor's ,
License Law don not apply to an owner of pro,say who builds -improves thereon,
add who nanracts for such p jos with t ams)licensed patrician So She
Co itioul rs License Low. /
❑lam exempt under Set. .B A,P C for this reason
Owner Dad -
WORKER'S COMPENSATION DECLARATION
I M1emby aRtm under penalty orperjuty ane of the following declarations:
❑ 1 have land will maintain a'Cenificam of Conserv Su self-irourc for Worker's'
Compensation, as provided for by Section 37W of the labor Code, for the
_ performance of the work for which this permit is issued.
O 1 have and will mainmin Worker'&Compensation Insurance,as required by Section
37of the Lahr Code,for the perfarmaMe of the work for which d,is permit is
ued M/y'W rker' Compe o In ranee Gamer andP ft umQbo are:
Cam
' ,N_; CERTIFlCATION'OFEXEMPTIONFROMWORKERS't" s f s i try ss 4, Hiss ' t ]iya,l' L, i �' t `l� •JI '
t COMPENSATION INSURANCE` ' '' _
(ni,uaton need not be mtplcmd if the permn is for one hundred dollars I'
(SIfM))mlessJt.
.
.shall, I'cenify Ihm'n th pert v f th k f r hmh th. pc 1 ..ued I '
not employ any person in any marriver so as to become subject to the Workers H '
Compensation Lows of Califomia.Dam -
Applicant
NOTICE TO APPLICANT.fbe Workers after Compensation
ng this C visions o of Exemption.Cos.you should •r
O CIncome subject m the Worker&Compensation previsions of the erred Code;you mon
forthwith comply with such provisions or this petmiS shall be deemed rooked.
E ^ - - ''' CONSTRUCTION LENDING AGENCY t - - _ -
I hemby affirm ro t,h communism leading Fcbcy f thepert miamc
�' the work for which this permi is issued(S 3U97.Cim C.) '
k:.Q Lenders Name. .... ,. .... _. .. . _.. . _... _ _ ._. ... .- .. . .. .. _ _ - _ — .. .
Z LenJer'i Addrers
V 0 1 minify that I have read this application and smte than the above infonnmion is '
Lr«.F., conk].I agree to comply with all citY''gnd county ordinances and.nate laws relating
:O.V to building construction.and hereby authorize mpreaenmovei ofthis city to enter upon
.}.� the above-mcmionW property for inspection purposes. _ ,.
(We)agree to save,indemnify and keep hamdese the City of Capenino against
h liabilities,jidgmcros,cons and expenses which may in any way accrue against said
I V Z City' conseu
qence of,c gmmir,of this permit. /
AP (CANTUNDER5TA,NDSAN ILL COMPLY WITH ALL NON-P, INT" Issued Date
r. St R v"JItL rrdN . / y
ignawrc of ApphcvnJ'EpyArn(rmr' .." I •,•' " me �' Re-roofs
FV, RDOUS MATERIALS DI..handle
Will the pplicant m f tort ip Il Ca cote pant tree hvtle Health
and Safety Type of Roof
- ate defined by the C gem M 'p I Cod Chapter 9.12.and She Neahh land SektY ., „ i t"!•' ^s n r
Coal
OYcsn•2t55n2(elY .f]Noq.t
_-All,roofs.shall be.inspected prior to.anyroofing.material being installed. _
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection; I agree to remove
mit h urd s 'r nm i s defined by theB y A A Quality Management
Distinct. _ all new materials for inspection. Applicant understands and will comply with
o11 1 n late read me hazardoy. us n all non-point source regulations.
I I q rancrhs under Chapmr 695 of the
Califomia Health Ar Safety Cole;Sc4tions 35505.35533 and 25534:1 undentart that
ifth ilding d«snot cumenll,have extension.that ill,my responsibility to notify the
a paat u�he require ems whir si be,met prior to issuance of'a Certificate of
Signature of Applicant . . . _ _. Date
mroramhaIlzmlB car ,', 't Date All roof coverings to be Class "B" or b'ettei
OFFICE
I