02060173 CITYILDING DIVIiSiONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
10865 DRYDEN AV JUST WATER HEATERS INC 02060173
OWNER'S NAME: APPLICATION SUB DATE
PAPPAS LOUIS AND EFFIE 1764 NATIONAL AVE 06/26/2002
PHONE: (510) 293-9901 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER:
p p BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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N= nion LICENSED CONTRACTOR'S DECLARATION
0 Z- Job Descr IIOn
iC 1 hereby athat 1 am licensed under provisions of Chapter 9l commencing
i- with with Section7"O.f Division 3oftne Businew.nd Prom"im•Code and my license REPLACE WATER HEATER
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is in (50 GALLON GAS)
C w a License Class Lic.M
OR!O Date Commaor
ARCHITECT DECLARATION
a.u O g I understand my plans shall be used as public record,
�Y
i 6 p Lrecnxd Professional
OWNER-BUILDER DECLARATION -7/t/
1 hefchy o1Bsm that I 1 exempt from the Contractor's License Law for the // l
C?Z< following reason.(Semon 7031.9.Business and vet de oat COde:Any city structure,aaaCp"'p O which requires a permit re conswet,aper,improve,h Permits file
repair any statement a.3 priortos issuance,rtledp alsort to the the applicant for suchpermitmlite,signed(Chapter
m5ingiyour lini cking wit pSchkaltdshe provisions Of the he Bilmr's License Lawasiorm Car) ,^s t,J .Sq_Ft. Floor-Area ., i aluation
ordoorbaNe,nh8eeiefroolldu of Divilai, 3 o th<BuFincss and ProfessionslioJej <,„�j.U,.A'.9l T';:F��,
or that lie Ie exempi theiefrom-and the bais for the allegcG cximpbbn.Any violation "
of Section]031:5 by any applicant for a permit subjects the applicant to a civil penalty. '
of not more than five hundred dollars(850111 AFW Number Ili•••,• Occupancy Type
01,as owner of the property,or my employees with wage%an their sole compensation, _
' will do'the work,"and the'stmemrc isnot'intended or offered for sale(See:70,14,
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Basidaa and Profession,Code:The Contea<mr,a«me Law does not apply to as 506 - GAS TESTRequired Inspections'
owner of property Who builds car improves thereon,and who docs owh work himself
or through his own lw sweet.pmvided that such improvements meol are not intended or 507 — FINAL PLUMBING
B�r-compel'fon isle ironer-boulder
he buildings burde of proving
one build of --""'----'-_""_. ._-_.._... ._._ __. -------
completion.
___,.,
oprovei far the Owner-builder will hatethe burden of proving tha he did not build or 1• 1 '' T°t "
improve!or putpese of sale).
❑
I.,m f the p mP cnY or a I I I-livelY rmn in,i s c:) d roma m
_ constrvn the prn3cn(Sec ]OJJ,Business and Professions Gds:)The Contractor's _
License Law does not apply man owner of pfopeny who builds or improves thereon, ' - r:
and x'ho.comiccrw tO,such pmjcns with.a conaanor(sj licensed purtuam m.the..
` conuadors License Law.
0I gar exempt udder sec:- -"""` •,B&PCfonhis reason
Owner,.o - res Dom'
WORKER'S COMPENSATION DECLARATION
I heathy aftren under penalty of prjury one of th<following Jedamtions: JUL l 1 12002
11C.Operoutiare.
0 1 have and will'mainmin a Cenificaie-of Consna to self-insure for Worker's L
as pmvided for by section 3]00 of the Lima, Code, for the
performance of the walk for which this,permit is issued.
f7I) eL DINC;
111 have and'will'maimain Woiker's Compcnsaiion a Insumnce,'a, ,o,d by Sermon
3700 of the labor Cadc.for the performance of the work for which this permit is
issued.My Worker's Compensation Insurance Garner and Policy number are:
Ctnier'. tC , k -I FEXEMPNo _ gg f
,'.(;_CERTIFlCACOMP N ATION INSURANCE.,WORKERS'1 S.i` f 5\ + , 71 �, �s I_ �i`:'\t'i tt'..I.j_*A� \ ••
5
' COMPENSATION INSURANCE.'' ' - -
"t IThi£scnion need not he ttunpined R the pertnn is for one hundred dollar, \ '' .. . .� f j '•t.
ISI W)or less.)
r I test t m the cert scan t the walk for which his .it'. .. .-.. - ..._ _.._ .. _ -..... . .
shall of employ any peswn to any manner so as m become subject to the Workcn! - - -Via'. •"
Compensation hxs of Califnmia.Date
_Applicant'.
NOTICE TO APPLICANT If.
O becti b 1 c uOtheW k ,C! pc kt&hi this P Cn ;¢foefEL bptC-od yS .hI:Jt `
--�-
0 forthwith comply with such p 'nw or this p rtnit shall he ifeemed
-
-
revoked `
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CONSTRUCTION LEY DING AGENCY
j1 hemby affimn1hat N cou'untelim,lending agency for tte performance
.•.
Lendof the walk for which this Peit n issued(Sce.309].Civ.C.)
y'C - ds Name ._. Permit,_.... . .. . . . . ... .. .... ... . .. ... . . ___-___._- ... . _._.__. .
cod mIfc gnf,toscm ply hall
al lctyppfnc dcolony
to ry.mi t 'thn iel ,iL1to,,mIi-In'n-g 1. d bui tiinn.and b,arrize tf s fti: t t nponO j the bitIP PnYf cupurposes
.
—
L (W j lire m sa d inn fy and keep haml th C ty f C pen no g n9
[r
'01 liabilities.judgments.costs and expenses which mm in any way score against said
Y City In consequence of the granting Of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH.LLL NON-POINT Issued by: Date
- SOURCE REGULATIONSn,
SIiIrro1 of APPhcanbC tenor •. .. :, Dvtay
HAZARDOUS MATERIALS DISCLOSURE: Re-000fS
` .Will dies licant car future bulldln
al PP g accupion m, handle h a ,(.df ed by the C pen M tcpCsChp913.and!th<Healthnd Safety Type-of Roof._
Cod Sen n 355te) s
- "" "' ..��• -*^ -
n >1 ;N': •' 11 . :
t7 Nn All roofs shall be, inspected poor to.any roofing material,bei ng installed.
Will dt ppc' t f t b 'IJ g p s quip t d s wh M1
D stn d ,nt t , deanedbym-Ba A,_a� Q rt,M alis If a roof is installed without firs[obtaining an inspectroTi; I agree'to`femove
�'.' oy ,all new materials for inspection. Applicant understands and will comply with_.
all non-point source're'-ulanons: "
1 a He'rcad the h zCode. materials requirements under Chapter 695 0l Nc
California Code.Sveatena5505,355A yresw3nJuar notify the
' if building' the not u d ich un.w Ili that it isdo,my rtspo 'b'f 'e,m rata the '"-" -- - - - -- -- - -- -- - - -------
occupant _
f the e9uirc a i. h h mu.a be met Pnnr m iuu' f a Ccnificnm of - -- -
.. Oce pa cY '.
.._ . . Signature of Applicant Date
owner or nmhonaedagem - Date All roof coverings to be Class "B" or better '
"OFFICE. ..'