01010016 ,t CITY OFNCU)PERTINO CONTRACTOR INFORMATION:
PERMIT
IIU I LDING ADDRESS'. PERMIT NO,
7708 OROGRANDE PL HOT WATER INC 01010016
OWNER'S NAME APPLICAIIDN SUB DAl'E
RUSS FABRIZIO 2531 GRACELAND AVE 01/04/2001
PHONE; SANITARY NO. CONTROL NO.
(650)298-8494
c)aYO ARCHI'J EC IENGINFER'. BUILDING PERMIT INTO
0
w IILUG ELECT' PLUMB MECH
�t� I-1 I� I-1 Ll
ad
R S N G r u 0n Slip CONTRACIDK'S DECLARATION lob DesCl'IpllOn
Oz_G Ition70by effvm thatIn3 of the Il underpnd PoneofCby,ma.and innenense
H v,r J with fall Beer,
and of Division3af the Boniness and l'npliainn,Code.and my licence
rya nmun,raameeffeeLCHANGE OUT OF GAS FURNACE 100K BTUS
a a Licea,e(,lass uc.a t
o d`e Date Contractor
a 3 a N ARCHITECT'S DECLARATION
CO 1 uuch,um od my plan,,hall he used un inhhe record,
>—
c o
[Accused Prof ex,anal
(1WNIam exempt r DECLARA'T'ION
a e I hereby afhm,the I exempt from the C,,ior,r',LiAny ,Law Ina the
F Z d Wriexi ngu ,.fSedinn 70315.tair,ai improve.
Profen, ran h,or Any city" my
wwiort rcyuiusa Penni)also recnnlmel,pplicant mrve.demolish. fiew,irmykiwancu
3 pa"he its iensed i,ter,W Inethe liviocumlm,.such permit la ofien.,e LvcJstammem
(commencing
wit vSectmw,the nrnvi,m%in ffic1.1 anmom.. andP,lelw(clm ter 1)one) _ Sq. FL Floor Area Valuation
(e thathe is exempt
Section LMM)ofhe basis3offine Businessandion.An vi Coded
or thin he is exempt tern,aT,and the ami,for tdj""'he P'H'i iso Any vinlation $4125
ny
of Section ,than by my dr d doll fur o rcrmil suhjnls the vPPlialm m n civil penalty
ar mat mora noon live nanarca adeno Issllln. APN Number Occupancy Type
El 1, caner nl'Ihc prnleny.0 nny nnpinym with wl,Gcxmllrvlr"'a"napnmm tun, 362113039, 00
will Jo the work,and the vructum is not intended or offered for sale(Sec.AOL
Ito uc,s:md r,ofes,ioas Code.The Canlralon"Llcen.a:Law doe,nal v mly to an Required Inspections
r ofm
pPc,ay Who balls or improves thereon.and who does such work himself
orvtnmugh his own employees.Provided that such improvement,am not uncoated ter 502 — FINAL PLUMBING ENERGY
offered for sale.If,hnwevea,the building or in,pnwemcat is solo within one year of
completion.the owner-builder will have the himal of roving that he did not lwild or 506 — GAS TESTimprovefnrpamoseof,me). 507 — FINAL PLUMBING
❑1.as owmm of the I opcely, it,e,cl-issly eomncimg with recused counter ,m
ct,ndmct the project(See.7(44.Bti,mes,sad Rnfc„ion.Codc:)The Comraemr',
lceme I.aw does not apply to an ovine,of prapeny who bolds or imPnrve,thereon.
and x'ho contracts for such projects xith a contractogs)licensed pursuant m de
Conmlctar'u Licence[.a,❑Imo exempt ander See. B Nt P C for this reason
ownte, Dee
WORKER'S C(1MI'GNSA'IION DHCLARA'IION
I hachy chino under plmalty of pori ury n ne of tie Wil—ing declaration,:
❑ 1 have and will Heilman a Cer ilicvm of Conran n,self-insure far Worker'%
Can,Pen,min r, a, Pnrvidul for by Section 37011 at the Lubar Code, lot the
performance of the work for which this Permit is issued.
D have:md will matintain W..km'.,Cnn,va,,tin 1 Ineuri c.as rc,aml by Section
37M of the LaMar Code,for the performance of the work for which this Permit is
,ted.My Worker's Compemation Insurance carrier and Policy,mbar are:
carem: Poke,No.:
CERT IICA'I'ION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(I his w,own need not he aumpleml If the permit is Poore handed delhm
Ed 0 )or less.)
I ecNfy that In the lie rl'amnmce of the walk for winch Nin lemon is i"mud,I
,,dl not employ any person j.any moaner,o vs to become subject to the Wo kcrn'
Commtrnxntion I.aw,of California.Date -
APpbumn
NONCE TO APPLICANT IL afree making Iii,Cenilicate of Exemption,you should
heconm subject m the Worker's Cma,,en,minn provisions of the Labor Cctve,you must
Q fothwith comply will ouch provisions ur Ill,ponnit shall be deemed rcvolaid.
z
F .�.
CONS'emUCfIONLENDING AGENCY
I herrhyadifirin which this them-is v coed(Sec. lc D.Ccvgency for the prlinmance
of the work liar which this p,cnnit is issued(Sec.PIMP.Civ.C.)
L LnJcr's Nnuc
z
n1. Z Lemkr's Address
U I sadly that I have read This iq,plicanion and sum thin tic ets vc inl a.... ion Is
counsel,1 agree to comply with all city and county mdimanee%and state laws relating
U to bondingc. idoaion,and hereby authoaie representative,of this city to enter upon
�y [s] the sh,,e.mentia ed properly lot role,nou I amnsc,.
p. Am (We)ugme a ave.indemnify and love,hanndes,the City of Carman,apemen
rte I"bilifle..judgment.,ends anal expcmo which may in nny way accrue against said
City is con,eyin of the Granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WILL ALL NON-POINT Issued by: Date
SOURCE REGULATIONS, y'
Signature of Applicant/Contractor Date Re-roofs
IIA%AR UOUS MA'l Ii I AILS IIISCLOSU It
Will the Wheem,m intense haildmg«cup m don,tea handle hvmakm,ran,dal Type of Roof
as dcrned by the CoNerion Municipal Code.Charter 1).12,and the Hedth and Safety
Code.Section 25532(W'I
0Ye• EINa All roofs shall be inspected prior to any roofing material being installed.
Wim the applicant or Tulare matchil,occupant tea equipment at devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit boardnus air cnnmminanu a,defined by the Bay Area Air Quality Management
Dbuims all new materials for inspection. Applicant understands and will comply with
f ores 0N all non-point source regulations.
I have reed the htvadoas oletesl1v reymrenemx natter Chapter 695 ter the
CaWomia Health R Snfdy code,Sections 25505.25533 and 25534.1 andenund that
Line building does not cummly have a mount that it is my rcgxmsibility m notify the t
pont of @e rapllremmnv which must he met prior o isnuunce tel'a CunlGemc mf
Occupancy. Signature of Applicant Date
Owner orautho,i,alag,at Date All root'coverings to be Class "B” or better
OFFICE