02050130 CITY ofGsONO
l DIV iNPERMIT CONTRACTOR INFORMATION:
Bt2!INn"MICKET HILL RD WATER HEATERS ONLY PERMIT NO. 02050130
O1TMbtXftEL GHOSH 970 E . MAIN ST, SUITE 20 US`/'`n 2'6U`2
PHONE: (415) 566-2209 SANITARY NO. CONTROL NO.
o C ARCHITECT/ENGINEER: BUILDING PERMIT INFO
&u 6 BLDG ELECT PLUMB MECH
y<u _ = I—U CL L_7
LICENSED CONTRACTOR'S DECLARATION
In<reby arfmntnatlam Beensed unser provisiom orehapmr 9lcommencing REPLACE WATER HLF�' ription
with Section 7000)afl1vision Sof@e Businessand Promsor...Code.antlmylicenx
x s= is In full force and,!Sec �� (4 0 GALLON GAS)
License C az C.
O n G
Date 5 DEILm �p
r 3+G ARCHITECTS DECLARATIur
i understand my plans shall be used.as public records
Licensed Professional SUN 't 7
2002
K o that I am
exempBUILDER DECLARATION 1
m-In 1 hereby affirm that 1 vin,Business
from the Cessions o License law for me
F za following n.(Section]alts,Business and Professions Fort:Any city or county
ccF c which requires a permit m conmrveL nlmr,improve,demolish,or repair any swrwrc $700
poor to lesissuance, N theapplicant for such Permit fleasignedtatemem
them lois licensedwith n thcprovisions Division
the he Brame an La C(Chapde) 3 5 Ft',.F:FINAL
e&. r
r 9
(commencing with a ]1x1an The -zonoofthcBusne. dProfessions AnCod<) S'I q' s ; Valuation
or that he is exempt thcicfmm'nnd the burs for,hc alleged demgron Any srolafon '' -3 4 2 3 S 00 o' ' '`
'-of Section 7031.5 by any applicant for a permit subjects the it,hoannn a civil penalty
nrnot.mnre than Eve hundred dollars(ass). APN er .•-n•>� Occupancy Type
❑1.a,monernfine prn ny.nrmyemployees with wagcsasthelr.so],cnmp,....inn 502 — PLUMBIN ENERGY
wiiTdo the work.and the structure is not intended or offered for sale(Sec.]04. _
Business and Professions Coda:The Common,,License Law does not apply to an spectlOns'
owner or property who build.or improves mercmr,and w'ho docs such work himself 507 - F I NAL P �N U
re thmuh his own employees.pmvidW that such improvements are not intended or
offcred or sale.If,however,the building '- '-
or improvement n sold within one year or r -
oinpleeimn the owner-builder ilej.will hove the huMen of proving that he did not build or '
improve for purpose of sale.).
consnsownerofthe property,7 an exclusivelycontractingwithhced Th Conor auto
construct the proles(Sec ]0,t wo,eea d Professions Code)The Contractors
andwho
Law docs not apply man owner of a cony who builds socipumes thereon,
and who 's Livens.for.such projects with a contruaorts)licenud.pursuant.m the
Conuacexe License Law.
_ ❑lam exempt under Sec. ,B&P C far this reason ,
OwnerData -
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of the following declarations
t. ❑ I ham: and will'mainlain a Cinificine of Consent In self-insure for Worker's
?r<J Compensation, as-provided for by Section 37W of the Labor Code, for the
performance of the work for which this permit is issued.
ITPoise dwill nomineirl W k< Cum.Neutron.Insurance,ae rcgmrcd by Strohm
r7110 of the Lator Code,for the performance of the k for which this permit is
issurad.My Worker's Compensation I ice com co,and Policy number arc
carn _.-
CERTIFICATION OF EXEMPTION FROM WORKERS I. .r _. ,,.k•s! 5( N,t, '
• i
COMPENSATION INSURANCE
lis section nerd not be completed if'be permit is for one hundred dollars
(5100)or nr lost,)
shall
I cinfy in.,in the n in nnifof 5. s 1(or become subject
'he isucd l - "� ll Y "" " _"' '- -' •'-
shill t employ Y P< Y r so as is become ubj<cl m the Workers -• ...
' Compemauon laws olC Tfomn.Date
Applicant '. .. .
NOTICE TO APPLICAMI If afar making th' Cellificme of Exe pion,you should
C 0 become subject to the Workers Compensation provisions df me Labor Code,you must
fonhwitti comply with such provisions or this permit shall be deemed revoked.
Z .... .. . _ _ .. ... _ 1..
'CONSTRUCTION LENDING AGENCY
' 1 hereby 'Ifni that themssued(mmn Iendmg agency for the performance -
W r of the work for which furs permu rs issued(Sec 3097.Gv C) -
J.Z.D Z — _
Lender's AJdressI I
Iverif that f have read this. boo .. .. ..' �•::
-moo Y pP(a ion and nine that the above maws cion is
W F., tofu en.1 agree tu comply with all city and county ordinances and nate laws rele,ing
C.1 m iilding o'ermensunsedproodhcminspecby tion purposes. ves of this city mercer upon
"raj the ebo1We).,a to pmpcny for inspection and Int purposes.,
F.:0.s (Wc)agrcemsave.indemnify and keep harmless 0<City of Cuperimin against
V] City in cos.sequence casts and expenses which may in any way accrue egninst said p-
4.) i City in consequence of tM1c greening of this permit. - (/%a
o APPLICANT9NUERSTANDS 'D'm�y COMPI WITH ALL NON POI IT
SOURCE REGULATIOFs/,�`�' y" �•A �L o2 Issued by: Date
5ignmurtof Appbcaral mmLcmr �•'�G`-- Dn, i
' ' HA ROOFS ATERIALS DISCLOSURE Re-rOOfs
an definedWiII the applicant or f num building cocopnt store or handle b"dnus nicammid Type of Roof.. ..-
by the Cupemm Municipal Cod Chapter9 12 and theHealth and Safety - - - - . _.. ._ ..
Cod Scion 25532(.] -. �' --
11 yes
All roofs shall,be inspected prior[o any,roofing ma[ena]-being..installed.
Will
mit hcontaminants
um ircn,am, to r tt rcbuilding d f d by th r t Bay Area
A Q frM p t ee when If a roof is installed without first obtaining an inspection, I'agree to remove
a d c _ii,eey 'gement
p Din` `r all new materials for inspection Applicant understands and will comply with
satyr ov. - -t.. -all non-point source regulations , '" ' -
ha tl the hoard s miner as requirements"der der Chapter 6.95 of the '
Califomta Health&Saf ty Cod.Sections 25505:25533 and 25534:1 understand that
if the Wilding does not currently have.tomm.tho it is myraponsibilitymnodf,hC
occi pit of the rcymre t-which must b t p t is f a Cenificato of
occnp ^ t np ,
1. S/1i/ -7— Signature of Applicant _ Date _
own mon lag , ! - rme
All roof coverings to be Class "B"or better'
I t
OFFICE -.