01110037 CIOF
DON
PERTNO
BUILDING PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1212 YORKSHIRI; DR JUST WATER HEATERS INC 01110037
OWNER'S NAME: APPLICATION SUB DATE
GAYLA HIBBERT 1764 NATIONAL AVE 11/06/2001
HONE: (510) 293-9901 SANITARY NO. CONTROL NO.
O O ARCHITECffENGINEER: BUILDING PERMIT INFO
m❑ BLDG ELECT PLUMB MECH
aiW f_I IJ LJ C_J
Z'
S 4 Z LICENSED CONTRACTOR under p DECLARATION lob Description
i Z h It ereby 0)of Division
1 vat licensed sneer provisions of Chapin.and(commencing
with fll force am effect. 3anne eaxinexx and Professions Code.arta my license REPLACE WATER HEATER.
jyy, ince Inn fora a rid eRem. (40 GAL GAS)
;O t U nine
Class Lic,w
Ovid
t LL S DELLA u.I—n ARCHITECT'S DECLARATION
5 I undersmntl my plans shell be used as public records
co
o li
3.rce
i s.co O nsed Profesxional
co OWNER-BUILDER DECLARATION
n I naso aRnn than f am exempt from Ne Cessions res License law for the
C Z< following runs a ISecdon t03L;Business and improve.
de Professions Coda;Any city Stouro e
O ma ha ii lianxd l reconstruct,ober,improve,Jcmnlish,nr repair any strumurc
i3� p�orquirrrapeaw,reefuimltheepplicant for such pemriuofileasigrcd aamrMnb _.. ._. _ _._-._ __.. .._. __.__..__.____ _
which t to
Vets irwance,also
pts to theprovinom°fdreConuoctohLianseLaw(Cheger9 _,f� .,..,.t ,Sq. FFloorr ea- 1', auatlon--
mnmmemm�gwitnseetmn�ogBlnrDivitmn3nnnreag1nevapdPpnrgaxi"�cnee) (.. � t D.r.+..1F.i.k li �`x.4Z�i
or that he is exempt Iherefmm and the basis for mr allkgdl ekempticn.A.,violation I
of Seem.103 1:5 by any applicant far.permit subjects the applicant to a civil penalty-
' of not some man five hundred dollars,(5500). umber �• Occupancy Type
01.as owdo,of the property.or my employees with wages as their sole cmnpa!
enson, 502 -
-
,will'do'the work,andtheis not intended or offered for sale(Sec.704,L r h
Basinai and Professions Code:Thc Contractor's License Law does not apply in an 506 - GAS TES Yequired Inspections
owner of property Who Wilds or improves thereon,and who does such work himself
or through ms own employees,provided tont such improvements are not intended ori
' Wild
.. 507_- FINAL_. PLUMBING
oReM ror
sale.If,however,the Wilding or improvement is sold within one year of 1, t •�t �,
complai°n,the owner-Wilder will have the Widen of proving that he did not W ild or C p� /� ■
improve for puryose°f sv1eJ. F I��1/r"rG las E
_._ ... -. _ G ._. ......._ .. _!._.._____. ...._.. _ .. .. __ _ .. ._ _.
v.'
01:es Dorsi of tW pfopeny.am exclusively contracting with licensed contncmrs to' W.
r.I X ,I L
,. conswm the project(Sec.9pL1.Business artd Rofcssions Codc:)The Contractor's
p ,
License Law does not apply to an owner of property proves thereon,
w"nb"lice°edm F.EB 13 2002
_ -:L• and who contracts for mch.proj I with o conwctorts)licensed pumuentao mr: ...._. . ..___..... __._._ ` .. .. ..
Conuectofs Liccnu Low. r
olameumptunder Sec. � l ' l � .8,4PCfwthisreas°n "sit �- , l,n•
- Owner' Dance BUILDING
cf WORKER'S COMPENSATION DECLARATION
^ I hereby affimn under,[rally of pe juryone of the following dedamtions:
0 1 have'add
will-maintain a Cettificae of Consent to self-insure for Workers
Sompcnsitign, as provided for by Section 3700 of the Labor Code, for the
perfonnai,a of the work for which this permit is issued,
01 have and will maintain Worker's Compensation Isnuonce,as required by Section
iss d M W rk! Cnm sat en Insurance corner and pit try bar arc
_.1 ti 1.1t1� :._ .,,-....—s..._Ynum.. .... - ::-. ._ .-.- . e_..._._................_...._ . -._.. _ ..
3To0 f th IoW Cad fo he ormancc o c ww or which this Permit s
Gmv s a.'♦ Policy No' ":,fn
♦ frs -.) t'flk•'t�t,Y . t ) < \ \'8!gsll "I
L,CERTIFICATION OF EXEMPTION FROM WORKERSi l-fie $e �e• - '�-� ` t- �•�tv
-COMPENSATION INSURANCE toe„ __....._ _. __..,_ __ _.__..__�.._.,._
-v- ...-..... .... ..._ _-
t (This sen on sued not rte cempleud d the prmti,is for mu n.
hundred dollars ' .:1 t*` s - i,: . .. t, -'
(S100)w Int.)
1�ccrtdy maiin the performanre of the work for which this permit ix issued,I t3 c.t, l I 1 tr.`tsi; 1 t
shall nm employ any perun in any manner or o to become subject .!he Workers' r
Co morel tion Laws of California.Dau'
..NOTICE ' -.. _ should.. - r ,_..-L ,ts_. ._. - _. .
NOTICE TO APPLICANT:Irs after Commakingmisowsim of the
Exemption,you
become subject,the such
Comprnsation'p.itshop Ithelabor Cade,you must
00 forthwith comply with such provisions or this .it shall be deemed revoked.
.F �"n CONSTRUCtION LENDING AGENCY ' t
"I hereby affirm tots, a commuction lending agency for me pertwmance
:W.sr 'of theork for which this recruit is issued(Sec 3097,Civ C)
0. Q Lenders Name - f -
o z t<nderi Address'• R
,I certify that l have mad this application and state that the abova mfowvtion is'
•-W'E., correct.l More to comply with all city ami county ordinances and state laws relating,'
;Q U m Wilding construction:and hecau byauthorireprcunmtives°(this city to enter upon
; the above-mentioned pmpcny for,inspection purposes., I
i (We)(We)agree iosave,indemnify and keep Wpm1cvsitie City of Cupcm..'egainst
Nliabilities.judgments,casts and expenses whichmay in any way accful.against said.
_U sz City in consequence ofthe granting of this permit. '
.
APPLICANT UNDERSTANDS AND WILLCOMPLYWITH ALL NON'POINT Issued by: Date
'. SOURCE REGULATIONS. , '�' !
.. IV
Signalise,^f ApplirandContractw.:: , :Dae_ Re-roofs
.
HAZARDOUS'MATFRIALSDISCLOSURE - _
W01 me applicant o Nwji build ng occupant stow or h dl hLas usmatl. Type Of Roof .. . , - -
as clefined by the CurpsminoMunicipal Cme,gharpler 9.12 d she Banks aSafety _ r';, ,..i .."I
Code Secoen 25532 ) f l -1 J. d fl llF' (~ ! ' .: t Is
O Yee •'• ❑Nos. s t ,,, p. ., J •. -. _All roofs shall.be inspected,prior to.any.roofing material..being installed._
•Winm<applicant:rfuture'Wilding«cup:nlasrAFrgofpmemordevices which; If a roof is in'stall`ed-without first obtaining an inspection;•]'agree to remove
emit hazardous air contaminants as defined by the Bay ca Air Quality Management
District? ;. . all new materials for inspection. Applicant understands.and will comply with .
Oyes o ! '
y , X. 0N.. . . •...,: .. .. all non-point source re ulahons..., ,.: i .,,,. : I •'
•./ I have card the hesardous mali6sh requirements under Chkpur 6.95 of they
,California Health&Safety Cale.Sections 25505,25533 and 25534.1 undctaandthin
Witte building does not currently have'......IJhvt it is my mxponsibility to ramify the y
6�culaxnt of me requirements which must be met prior m issuance a ii Cenificar
Occupancy. of 1
ap"`y' - Signature of Applicant - , .- 4 Date
All roof coverings to be Class "B"or beiler '
Owner or i mhwissd agent 1 ,
OFFICE