01040081 CITBUOFUPERTNO
INDIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: P17RNIIT No.
2156E MONROVIA ST JUST WATER HEATER INC 01040091
OWNER'S NAME: APPLICATION SUB DATE
LAUMANN JOHNN
PHONE. SANITARY NO. CONE ROI.NO.
❑K Z ARCHII EC(ENGINEER: HUILUING PERMITINFO
O O I11.UG IiLF,CI' It - 1,11 CH
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SH LICENSED CONIRAM OR'S DECLARAHON Job Description
OZ—O hercny ulOnn filial I am licensed under Pmvl%inn+of Chuprer 1 Ics,mntencitg
F41F as with Scaion]IXNB of Division Sol the Nosiness and l'm&scions Cote.unJ mylicenw
< — sh,meandefr t. REPLACE 40 GALLON GAS WATER HEATER.
,.a (.mm,e Class Lica
6 u Date C..imer
LL C lin ARCHI'IEM'S DECLARATION
I mule,cend my Plans snnll h,-used as public records
�r
Edit p ZO Licensed 1}okcional
a c— OW'I am excome In DECLARATION
I hereby x(sent rhes I con exempt trans the Cates Co Any Law far Inc
5-p following tfies. Ivirmil ,9(111 5,continue. er. r, se,l'cssioos h.u, Any ehy m cnunry
whichitsisszne,also reuiresteober,improve,Jcmoliit ,nrrepairanyamcarm
i3m manhos111clance,alxrreyuims the.rums,al fin%stheCchpectninnicense Law
(mineirent,tw,I,Sectio)lo'lieXXpoi Fi-annFnrmUG a lousines Lind del.:lw(e n.,nmr9 Sq. Ft.Floor Area Valuation
(a, Is a with Section]INXp of Div m J done alleged
x and ionfAny vi Code)
or that 31.5 b rhemfmm and the aper,for the alleged caanprino.Any violation
of nor int eth n by any lend antnorapermit,ubjemx the upplicam mxcivil penahy
„rntrrmmemanrabnhdmdd,lw„(x5p). APN Number Occupancy YPe
01,as owner of the respect,,or my amdoyecs with wages as their sole conipenution. Rgrp� Mom
will do the work,and the stricture is not intended or offered for sale(Sec.9194.
Business amfl'rofc,Finn.Code:The Cmanntors license l.aw des no app[,It am Required inspections
ow r of progeny Who build or imrmveh thereon,and who docs such work hiunelf
or through his own noployess.provided that such improvements are not intended or 502 — FINAL PLUMBING ENERGY
offered far sale It.however.Ibe hudding o improventem i,sold within one year of
completion,the owner-builder will have the burden ofproving that lie did not build or 506 — GAS TEST
improve for pugxne nfwlcJ.
❑1.asownerorthe pm,erly.amcscrosively<wmomfir,will,u.rnredem,liaolur .o 507 1:,JjNAL PLUMBING
Lonstcr the„reject(Sec.]W4 Business and Professions Crdep'Um Contractors IMALEC)
icense Law soros not apply to an owner of property who Wilds or furnaces thereon,
and who cmnr:els tor such projects with it contractural licensed Pmsaant it,the p�
Contractor,License i sw.detg
❑I art,escrupt ander See. .B MAY�P e hnr this r-son 8 2001 .
owner Dma
WORKER'S COMPENSATION DECLARATRION BUILDING
I hereby affirm under penalty of perjury one nn the Infesting declarations:
>- I have and will maintain a Canifieute of Consent It self-insure for W'orker's
earrienstien, as provided for by Section 3700 of the Labor Coda For the
pertnnnmiae M the work fir which this pennil is issued.
01 have and will maintain Worker's Compensation Insurance,as required by Section
37W)of the Labor Code,for the herfortrance of the work for which this permit is
sued.MY Waders Compensation InseranCe canter and Policy number are
Camcc Policy No.:
CHRTB'ICAIION OF;EXEMPTION FROM WORKERS'
COMPENSAI JON INSURANCE
ITni%section need riot be eompletcd if the permit is for one hundred dollars
(11100) Is less.)
I certify Nat or the psnom,ance of the sod for which this gamit is issued.1
shall nut employ any persue in:try manner so as In becamo,ubject to the Workers'
Cotnp_a,mion Ln t,of Culdoruia.Dutc
Applicant
NOTICE TO APPLICANT:If,alter making this Certificate Cf Exemption,you s"Id
Z become subject to the Wteker's Coinpemutionpct m IF the Luber Celle,
e,You must
Q O tonhwlth comply with such Pnaisien,o,This pmarl shall be deemed coked
Z
CONSTRUCIION a eflo LENDING AGENCY> I h,cny affirm that there Is n mord uunion IanJing agency for the gcrl'nrmm.cc
of rbc work for which Ilii,permit is issued(Sec.309].Civ.C.)
P. Q lender's Name
7 Z Leede.,Adobes
U 01 cenify that 1 have read this application and state that the above information is
k, E.
correct
I ague m comply with all city fitd cnunry'nNiuree s and.,are lass reaming
Q (� to buildingc'oisirictien,and hereby aohurie mismantatives of this City to enter upon
,he ano—ouentimred pespe t,nn,inspeNm,purpusr<.
M, (We)agree In save.indemnify find kecg haeme,,the City of Cupenim,against
!A liabilities,judgment,eters and c,Nmes which may in.,I,way same against%aid
V Zi Cn,in Cm.Ftgtctm al dg
s mntln,A thl%Pcranit.
APPI.ICANI'UNDERS'TANDS AND WILL COMPLY WITH ALL NON-KANT Issued by: Date
SOURCE REGULATIONS. y'
Signature of AppllcuNCenhuanr UUIC Re-roots
IIAZARINIifS MAI'HR1AL.S DISCLOSURE
Will IN-upplicmm m future building rc,alam sore or handle burardous material Type of Roof
as retroed by the Cupcninn NJ cipal Calc,Chaffer 9.12,and the Humilb cont Safety
Crile, 21531(a),'cn 25532(a) O No
All roofs shall be inspected prior to any roofing material being installed.
Will lie aprheantm In bu'Jding occupant us,1,10piallem de+,iee%'htai If a roof is installed without first obtaining an inspection, 1 agree to remove
.nil naemder,tic a,maminmeF m delini by rbc Bay Acca Air Vualiry Maeogmnent
Districts all new materials for inspection. Applicant understands and will comply with
O Yes [D No all non-point source regulations.
I have read the hawdous materials.,no,ments under Chapter 6,95'If the
California llealih S Safety Cute.Sections 25505,255)3 and 25534 1 under,mnd that
it ere luelding 111111 nm etnaully havcu fennel,tnvhmy csgnmibu
illty ,notify the
weempunt o
f the needuanetes xhick pmt be mel prior b+i.sm:mce of a Cer heave of
Detni,ame” Signature of Applicant Date
Owner or.oil wed agent Dare All roof coverings to be Class `B"or better
OFFICE