01110034I
"- - OFFICE-,
CITYOF SI
BUILDING DIIVIISIONPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
18790 NEWSOM AVE.
JUST WATER HEATERS INC
01110034
OWNER'S NAME:
APPLICATION SUB DATE
VIOLET MUTLER
1764 NATIONAL AVE
11/06/2001
PHONE:
293-9901
SANITARY NO. CONTROL NO.
O(510)
A O O
ARCHITECT/ENGINEER:
BUR -DING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Ihercby thmlam licensed
Job Description
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affirm under provisions of Chapter (commencingP
REPLACE WATER HEATER.
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isinfllfore00defDiviaion3ofthcBusinessaneProksainmCMa.andmyli<ens
m in tun force ane efrect.
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(4 0 GAL GAS)
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S ARATION
ARCHITECTDECL
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I understand my plans shall M used as puM1bc record.
Licensed Professional
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OWNER BUILDER DECLARATION
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1 hereby efErrn that I am exempt from the Contractor's License law for the
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following reason. (Section 7031.5. Business and Professions Code: Any city or county
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which real a .it t,, c.mmuc. It r nd,mvc, demolish or repair any structure
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t m sal req' the ppl'cam for welt perm uo rile esigrcdstuwncttt_
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�,f}iVll`.il9:A!f'.
Valuation
chat he ii,licerylid imsonnl to thirpricolsoons of the Commicmis Lieanse Law (Chapter 9
(co erg with Seet f D tion3of the Business Professors Code)
me .I7IXpIand
or that hes moi therefrom and the basis for the olliged exemption. Any violation
4:5c\,L\iv1y1f14V�'
- of Section 7031.5 by any applicant for o permit subjects the oppl idem to a civil penalty'
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(of not mom than rive hundred dollars (S500).
APN Number
1 •- '., •.. Occupancy Type
❑ I, as owner of the property, Lir my employees with wages as their sole compensation,
S02 - FINAL PTiITMRTNI
ENERGY
will do the work; and tire structure in not intended or'bRcrad for sale (Sea 7(WI
506 - GAS TESTZequired Inspections'
'Business and Professions Curie; The Contractor's License Law does not apply to an
owner of property Who builds or improves thereon, and who does such work himulf
or throaggn his Two empmmed
y s. pvmthat wen improvements arc not intended or
tef(lcdfor sac If, however, the building or imPov
rcment is sold wiihio one yimr of
507 - FINAL PLUMBING
- ----improve
the owner- will have the buNcn of proving shot M1e gid not build or
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for
improve for purpose nLwle.).
We.).r
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s.. elyco_____._-.
am
OLasawoer oldie p(Sec.
hwmrofessi with lb:)The
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7 Business
construct theproject (Sec. ]In ,, .rte and Professions ono Cade) The Contractor's
Contractor's
t it
lar L d nfI .ply i f p pun) who builds or improves thereon
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contracts such, w tncmrfs) hccnsed
ave hoc p rsuhis to .the..._.
Commerce.License W
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❑ 1 pt der Sec.B&PCfor tars reason
Owner - ..
- 'WORKER'S COMPENSATION DECLARATION
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I hereby aRmi under penalty of perjury one of the following declarations:
Cl 1 have and will maintain a Cenifceie of Cunscm to self -insure for Worker's
Coinpcnwti... as ...sided for by Section-3700-oP the Latour Code, for the
perfmmence of the work for which this permit is issued.
❑ 1 have and will maintain Wmloil s Compens.tiov lmmtince, as rt lmord by Section
3700 of the Labor Code, for thepeifro mnen of the work far which this pcmlit is
issued. My Workers Cdori,a ore on Insurance carrier and Policy number-
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Essf Policy No <
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t I,10ERTIFICATION OF EXEMPTION FROM WORKERS',
COMPENSATIQNINSURANCL:
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mrs'sectioti Beed not be'compined if the permit is for one hundred dollars
(blip) or less.)..
-' I cc nfy ih at in th<Performance of the work for which this 'pemut'i Issued, 1
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stall oat employ any; person in any manner so as m become subject m the Workers
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Compensation Laws of California. Data
Applicant " -.i _._ i .:.
NOTICETOhothe Workers If. this Certificate of Code.
pheeomeh
ompensati Labor you
the Workers isi,os the provisionsll the Labor Code,you mull
forthwith
comfy or
comply with such provisions or this permit shell be decided revoked.
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:":!CONSTRUCTION LENDING' AGENCY'
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''•�'l hernhy6lBmi cost there is a consiholoii lending agencYfor the perftiimence
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ofme work for which this hermit is issued (Sec. 3097, Civ. CJ
Lender's Name" ..'.•._,. ,._�_.___....
'sAdd
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Lenis' t
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1 cerrify th , I h d,ld, ipplimiort andtm mat th base information
correct Lag d reply with b u and a Linty finances d scam laws enter
coWilding iniia dh _11 authorize prem fiomida fm sctyt csna pro
upon
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the alio x mens oned pmpeny for inspection p r,cums
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(Wc)agree msave, indemnify and keep hamdess the city of Cupeninti egantst
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liabilities, judgments, costs and espenses whichmny,in any way acmue against said
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City in consequence of the emoting of diii palmi,. �`'
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APPLICANT UNDERSTANDS AND WILLCOMPLY �NTTH ALt:`NON�POI:.T'
I$$UCdb , Date
SOURCE REGULATIONS.
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Signm mot AIppli,ant(Con�acmr:;. ". -P' ,. :.. , ,D.F _
--Re-roofs ---- - --
HAZARDOUS MATERIALS DISCLOSURE It
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WII die .Plica t or f tuu bidding occupant acme to haMl n.a,idoms m;tenel
.
- TYpe of Roof. - - -- - — -
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as def cd by the Cup,.. no Municipal Cade Chapter 9.12. anal mW N stand
e HSafety
Cdd Section 255321a17 -X,'t -..I
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_All roofs shall be.mspected prior to -any rbofing. material being installed..._
,.Will the applicant or future buildingoc,.....uu aquipmein m devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emiihavrdoui air mnmmirmnm as defined by Ne Bay Arta Air Quality Management
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all new materials for inspection. Applicant understands, and will comply with
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0 ye,all
non -point source regulations;
h(vercad the hawdous'mamiials aquirtmems under Chapter 6.95 of the
California Health & Safety Code, Sections 25505: 25533 and 8534. 1 understand that
if me building does not cumcntly have a tendn6-that itis my asponsibiliry on notify me
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o� rat of thc,rc u'u m rat' which most be t m issuance f a C n'Bcetc of
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P y n " t c
Signature of Applicant Date
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coverings t _ . better _...
All roof cover o be Class "B" or better
Own .or.1an.medteaa8�nt....; .,,, ' �,,: :, nate
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"- - OFFICE-,