00090168OFFICE
CITY
CONTRACTOR INFORMATION:
BUILDING IONPERMIT
BUILDING ADDRESS.
WATER HEATERS & MOR
17"PEUMBIN6000901.68
7716 SOUIREHILL CT
OWNER'S NAME'
M 11.63 CHESS DR, SUIT
PI CATIONSIl4j4'.7/ aaa '
W KKI —
SHEEHY PATRICK E AND PAU
HI
PIIONE:
SANITARY NO. CON 'IRol. NO.
(650)525-9287
ARCHITECT/ENGINEER:
BUILDING PEIIMI I'INFO
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BLDG EI ECr PlLUMB MECII
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CON('RACI'OR'S DECLARATION
LICIthatI
Job Description '
.
am fm
I nerehy m)mh that I afialan,ed under pmvi,lorh, of ehapmr n a,rneneing
Ce,
with Scnion7(NI(I)ofUivisinn3oflheBusim,nndProf es,io,Ced,lindmylicenm
WATER HEATER
in full force and dyed.
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License Cl,' Liee
a
Dale Conwcmr
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c fir
ARCHITECT'S DECLARATION
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I underarad fay plans shall he used a, public recoils
Liolort Professional
OWNER -BUILDER DECLARATION
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ur
or 1 hereby a1Tmn that I a untpl han the Clueracr's License law list iso
Business and Pmctxions Code: Any city or cnonly
a following reason, (Section 7031.5
'
Fpwhich require, a purnut is condrua, aper, inymwe, de,unlish, or repair any structure
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3ca prior to its issuance, also require, the applicant for well pemliuo file a signed statement
Sq. Ft. Floor Area
Valu4645
Ihatneisreen.edpnr,trum,,'hepmvlafnft,onheeoatuemrnl.lcen,elaw(Chaper9
(mmmeecing with Section lap) ofGoidon 3 of the Business aad pfofeaiom Code)
or thin he is unapt Ihenct'rom and the hulls for the alleged eve muton. Any violation
of Section 7031.5 by any applicant for a permit subjects the stiff cam ma civil penalty
live Intel dol
APNNt -
Occupancy Type
,if mnnmile than vel an(5500).
3E'?c a3E. as
❑ I, as ower of the ors"cf IA ar fir unhpll, re, ,,It wager a, emir aisle conTro,olion,
lrhI i
will do the work, and the ,tmctum is not intended or offered four sale (Sec. 7 W.
havinlass unit ('miss. or' Old':'I'he Coutrumor, License law dna all at , an
of papery Who Wild, or mail thereon. and who duan such work himself
ownerR
502 — F I NM_r'W1VYW ENERGY
mugh his own mnpleyrr,, provided ntat,nen imprn.•emem, are urn intended our
�aF — GAS TEST
offered for sale. If, however. the building or Inhpmverecnt is sold within one year of
5 �
completi,"'r the ownerfbuiildr, will have the burden of pnwing mm he did not hold our
Sal — FINAL PLUMBING
hnpmse parlo
❑ 1, as owner of the nopeny, am exclusively contracting with licensed contmcton to
construct the pmjeci (See. 7044, (theins, and Professions CminU The Contractor',
,
License law Jrcs sol apply a an owner of property xhn builds ar imprnce, Iherenn.
.all who mrnaets for shun nrnjecn with a countleons) licervmd ...strata Rs he
Courtroom, LLicenseLaw.
El i exeng& ,f under See. . II P C forms reason
(hwnur Date
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WORKER COh1Pr:NSA'I'[ON IlEC1,ARA1'[ON
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thereby under penalty of Rluof -se ofdue Je<lfor
W..
nself-int
will el m f Workers
❑Iia and ill maintain C
Sec f
L
provided 1 by Sar lisp of IM1e Label C dc, for the
out t y 3
f
pert 4 I In k 1 I'ch flas pc I'is issued.
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❑ I have and will memmn Wo,ken', Clanalwalume Insurance. rBuredby Section
37N) of the Lahor Cosa, or the performance of the work for which this permit is
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issued. My Workers Compensation Insurance carrier and Policy number are:
Carries Polley No.:
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C17RI'IFICATION Oil EXISIFTION FROM WORKERS'
COMPHNSAI']ON INSURANCE
(['his Saban need nod W euro, ed it'thelvmdl lx for one handfed dollar,
($ 100) or less
I certify that in the Ivrtbnn:mce of the work for which this permit i, issued. I
shall not employ any psrson in any mmaher so as to become subject to the Workers'
C.... ntinn lawsofbdifornis. Date
Applicant
NOTICH TO APPLICANT: If, her making this Ccnilicme of Exemption. no should
become subject to the Worker', Cn rNa,mimf provisinns "Itlm Lahor Coude, you au,l
O fonhwill cmirpl, with ouch provisions our his permit shall W droned revoked
'+ 7 CONSTRUCTION LENDING AGENCI'
clion lending agency for the pedur sec
C iI hereby antran them is a consfnm
of the work for which This permit i, issued (sec. 3TN7, Co.. C.)
Q lander'., Naas
.
J Z Leader's Address
I clarify that 1 have read this application and ,are that the aborti information i,
cancer. 1 agree m O) ly with all cry and manly ordlnumex road date lows relating
(� to holding construction, and hereby ambo wteprewnlalis- of this city to enter toxin
tire abnveaentiort .loosely for iospeetimt purpose,.
/
, hahless the City of Cunia against
. C. (we) agree lo,arc, indemnify and lost, pc
else against raid
m liahillar'. jadgn eat.. cow aad enpen,e, which may an any wry acra
i City in convectional of the graming of this Imrmit.
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APPLICANT' UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
11111
Issued Q,i Date
SOURCE REGULATIONS.
Re -roofs
Signature of Applicanecomrucmr Date
HAZARDOUS MArERUM.S DISCLOSURE
Nil'theapplicant afuture Wildingsccupane,lore or handle haaWae,material
Type of Roof
;is defined by the Caperton Munidpal Cod, Chapter 9.12. and the Health and Safety
Cala, Section2553204'1
0 yes 0 1No
All roofs shall be inspected prior to any roofing material being installed.
VV 11 11 appbeffm out tuffffe billing ecnfp:mt use Cyapfncnt or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit hamdous air communal a, defined by the Bay Area Air Quality Management
all new materials for inspection. Applicant understands and will comply with
D"'tdc(r
o ye, ON.
all non -point source regulations.
I have real he haeadous materials reyuirearnu under Chapter 0.95 of the
td i lonato I lealth k Safety Cadr, Sc,nion, 2550.5, 25533 Oil25534, 1 undersand that
if the building class not currently have a Zeal that it is my resrymsibilily to naily tire
ve"at to he rcyuirrnhans which must he fuel prior to Iswaoce of a Comficate of
Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
owner Date
oramlufdsm agent
OFFICE