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02030152 � CI sua wc mvEisioNN� CONTRACTOR INFORMATION: � PERMIT � tlUILDINGADDRFSS: PERMITNO. 19645 STEVENS CREEK BLVD JUST WATER HEATERS INC 02030152 OW N8R'S NAME: pPpLICATION SUB DATE AZUMA JAPANESE CUISINE 1764 NATIONAL AVE 03/26/2002 PNONG: � SANITARYNO. CONTROLNO, (510) 293-9901 O 0 ARCHITECT/ENGINEER: BIIILDING PERMIT MFO �U� . ��-.. . BLDG EI,ECf PLUMB MECH �<d u u u r u F N Z ' ' LICENSEU CONTRACT00.'S D[CLARATION Job Description � J hertby aRem ihm 1 nm licenttd undcr pmvisions of Chap¢r 9�commcncing '.„�� wi�h5enion]000)ofDivisinn3of�heBu.�incssnndPrutcssionsCodc.andmylicenu REPLACE WATER HEATER. ' ��r�n roKe o�a�rtKi. :��'< ��«�.�a�... ���.x (10 0 GALLON GAS) ��a V Dutc Commcinr ���G : ARCHITECT'S DECLARATION . � ' 1 undersmnd my plam sM1all bc mcd as public rccorAs ��y� i 6 p O Liccnud Profasionol - OWNER�NUILDfR DECLAftAT10N ��' 1 hcrcby effirm thoi 1+�m en�mpi from ihc ConvAcwr's Licrnsc Lew for Nc v. t'?� lollowing rcamn.(Sa�ion]OJI.S.Businexs enE Professions Codc:Any ci�y or coun�y F�$G wti ch q � pcmii�t a .� ct li r, p dcmol�sh,or rtpa r uny swcmrc 6 3_ _pnw i i uuuc�lw�cq �hc ppLc �f ch pcmm m fle e sisncd iummcm -_ ._...." _ " �hq�h' Icen.edprami Jiepro� nsofihCnvecwrslaccnmlaw�Charycr9 c<om c g 1hSec� �iroo� ro ��� 3 nn e���.,:a�ar�r«.��>a,��� :;'} `7• : S F[.yFloorArea n Valuation or Nai he is cncmp�Nerzfmm and��e bvxis for ihe elle8e0'aem�ion.Any vioheon �t �`�-��`9" t'•i�' �'``�(''�'.t r�(:S�S }���"�: • � of Seniw]OJ P.5 by eny nppliram for a pertni�subjecu Ne applicam io a civil peneliy or��m�rc mn�r��n��a�m aoimR�ssw�. A um er Ocwpancy Type ❑i,o.ow��,�r m�p�oa�ny,��my�mrioy«.w��n wae�.a�m�v,:m<<om��.�ao�, ., wlll'eu ine'woR,ene�he swnuR i:nu�'imm�Jcd'or oltcreJ ror sale(sec.9(W, . a����..���e a�r«��o��cm�: m�co�����o,�u«�:.�w a�,�o�.vv�r�o� 5 0 6 — GAS TESBequired Inspections ' ,,,r o�ovmr wno nwm:o.��np.o��:n,«�o�,���e wno eo�::��n wo�k n���«ir " °`°` � � ������a�ao. 507 — FINAL PLUMBING o��n��sn n�:ow�emvioytt:.vro.��aw mm.��n�m�_��m��.,a�o _ �an-�ard,s�i�:v.n��.d,.mew�m�oso.�mr,���m����s.oia�w��n��o�ar�o,or . . __._. ..-- --- ' ._ ._ . ... . __ . _.. ._.. __ ... . . . _...-. . -- - —'-- -- compleiian.iheawner-builderwillheve�hebuNenofprovin��hmheDidmibuilJor � � � - � � impmve for puryou of saleJ. . .. .. .' .... ......... . .....', ... .. ... _. . ..... . . _'_ ' . _ ' .,._..... .. . . . . ... . . .. . . ..._. . .. .. ..... " ___". ._ _' _ _ _ __ '__' ❑Lasowncrof�M1epropcny,a nclusivclycomraz�ingwiihlicensedcamrenorsio . , „•.�. ,.... . �� � onswct the pmjat(Sec.'l041,Business anJ Pmfessiona Code:)lhe Convumr's � , . , , �, , � � License Low docs not apPly m an uwncr n(prnpcny who builds nr impmves ihcrcnn, � ��`:' aM who comreeb for sueh proiu�.witb a conuaeme(s)littnud pursumt�o�Ae . _ .. ..._.. " '_...... __......" " — ...' ' "'- -".. ..._....._. .._.... — ._ _. " Commcmr'sLicrnscLaw.. - plomcncmplundet5ecf � � � � ,B&PCfor�hicrcaon .� . ., .... . ,_ Owncr . . •� �.� .•. Daie , , . � - . . . - ' WORKER'SCOMPENSATIONDCCLARATION �'����� ' IhcrcbyafLrmundcrpenol�yof�ierjuryoneolihefollowingdeclamiions: ' ❑ 1 �ave vnd will-maintein n Ccnifice¢of Conrcm�o eclGinsum far Workcr's O O �oo^ ���/ Comprnsaion, as proviJcd for hy Scnion 3]00 of �hc LaFor Codc, for ihc qpR O � pu(omunce of Jrc work for which�his pnmi�ix issued. O I hoJc�ond will muinuin.Warker's Compenseiion Insurvnce,us rcyuircd by Senion " � c J]00 of�he Labor Code.fm�Fe PeAoemantt of Ne urork for which Nis�,,,„ B U I L�i ivCa �"�' �.' ismeJ.MyWorkelsCompensa�ionlnsurancecaenerondPoli<ynumbernrc: _ ' .. ..". . .,. . .. . .. . ..... . . .. ...." .. . . ..... .. _ .. - _ _ . .... ... _.,; . , ... _ . . .. .. .. .., ,.... � C5m - �Iri i i . '!PuliryN .. ��- � , � ,� ' fi A'r tr � pl[♦.a.. '. i .. . . . . . CERI IIlCAT10N Of,E%LMPI'ION FROM WORKERS � �.. . � '. k...., _ �. , .i, l, Iv �� �� • {�� � ''�� "� ;' COMPIiNSATION.INSORANCE � " '� • -' --:•--.r..._ .. . . . . ..�. .-._ _ '.' "._ '_�"'...,__""_'___._......"_"__....._...__.. ...__._._._ ._...' _'__""'_._._ __._..... _...._.—.__. . _ �. , . �"' . . .. ... �.:'.� (This udiitin neetl noi be mmplc¢a if ibe pennii is for one hundrcd doliurs ' r-.� . � ` ... � . ,..,-.�� . (5100)orlcss.) ... . .. . . . . � „ .. - .. .... . . __" . . .... ._. . . . . . . , . . . .._ . ."" ' . :.. . . .. . .... _, .. . . . ... . ., .. . ._,.. �.... . .. .... . _ . . . '1 certify�hei in Ne perfaimince of�M1e work for whicN ihis pcemii is issued,I _ , , . .. shall na employpny,person in nny manner so o.i io become iubjen m Ne Workeei . ' -' " ' Compcnmiinn l.awi of Cnlifomiu,Dam - -.APPlicmi - ' . " "_ ." _" . . _. . _ —__ . . _ . . .. ... . . .. .. .. . . . ... . ._.. ....._... _._ . .., . . .. .. ��OfICETOAPPLICANT.ICuf¢rmaking�hisCcnifcamofG<mpiion.youshould " . . - � becumc su�ja�m�Le N'oekir's Compensoiiun provisinns oRhe Lnbur Cotle,you must 0 O foMwii�comply wiih such pmvisions or�hi�permit shell be dmmed avokcd. _ ". ..._ .. . . . . .. . _..._ . ..'_ ". . ._ ..... '_ _ . .... . .. . .. .. 1_ _ . . . .... . . . . r..� ' "� ' '` 'CONSTRUCTION LENDING AGENCY' � ' ' ' ' " ' " ' ' ' � " a'� ' I hcrcby aliimi Nm ihem is a ronswnian Icnding agcncy for Ne perfoimence' , �� ` •� � ' ' � � W.Q of�h' kf hichihvM�� �issued(Sec 309] Civ C1 � ' .... .... .... ... .. . . ... . .. . I.cnd -N me . . ,.. ..._. �. � �:� .. . ..._ .. _ _... _ . _ . . ._. .. . �.z Lend Add� , ... . . , _ . . . . �V � 1 cmify i�nt 1 heve rtaA�his applica�ion and niu¢�hni�he ebove infomn�ion is � P W comen.1 egrcc io wmplY wi�h ell ci�y und<ounrys rdivancca end sma lawe rtln�ing /) i/ „ ' � _ /n�.�_ :0 V wWildin6�onsvuciion,andhcabylmhonxempreemeuJesofNisci�ymrnmrupon � /���(�, V � ;� W Ne ebovcmemioncd pmpcny for inspenion purposes.. _ _ / .�.y� (Wc)�ngrcemsavqinticmnifyunJkccphamless�M1eCirybfCupeninoegoim� tA liabiliiies,jodgmema,cosu enG cnp��us wM1ich muy in eny way ecnuc egvns�eid �,7 ,7a Ciryinconsequenceofthegremingof�Aispermii"" ' " ' n APPUCANTUND6RSTAND�S'ANDWILLCOMPLYWITHALCNON-POIM ` ISSllE(Ib ! DflIB SOUBCEREGUI:ATIONS.. ' ' ' Y� -. SiS�o!ure'nf ApplicnnUConuaaor;i,• . "' ' Y: '� ; "' �Uo¢ ' (ZQ-IOOfS H.VARDOUS MATERIAIS DISCLOSURC ' '.;' W�II�h pp�¢am or f m Fu Idmg wcupant siort or hanJle M1 a ':mamna� .TYpe Of ROOf , _ . , __ . . �- .. -•- ,.-. - -�- � - - ss d f ed by�he Cupen no Muv upal Code Chepar 9 17,end�he H alih and Safay c�a Snon25533(al . � . . .. : ,. ,t .'.� ,f � '...i r�i�t � .�.`..,1;,,,. .... ., . � :. , ❑v�:�_� ^' i ,oN';�; � .�. +, `� , �: . _';pll.roofs shall be mspec[ed_prior to_any roofing materia] being installed. ,._... Wip�hcapplicen�orfmurcbuildingmcupamux<quipmrn�orEeviceswhich If a roof is ins[alled wi[hout first ob[aining an inspection,�I agree to remove cmii hazardous av conmminanis az Acfne�Fy thc Bey Arw Air Queliry Mena6emem ���umn . all new ma[erials for inspectiop. Applican[understands.and will comply wi[h , ' ' °Yo' ' °No ' all non-poirit sou�ce'iegulations. -- J {� . 1 have eaE ihe huaN mmerials rtqmrtmenu unMr C�aPmr 6.93 0(�he �• • �� Califm�nHwlth&SefiyCdc,Sccuons]5505.25533and25534.1unAemenA�hat if Ue buiiEing dws not curten�ly heve u<nam.�he�i�is mY rcxpoiuibiliry ia no�ify Ne . . . . .. ' ".... ... . . .. . . .. .. ..� . .. . . . occupam of i�c rtquir rnu which must bc ma pnor io issvanh of a Ccnifnic of .' o"°"'"". . � •�� . " , � . Signature of Applicant Da[e �r� u Al] roof coverings to be Class "B"or better ' ow��.o,e�mod.w�e�or- . . .. . ����„ . , t.. " � �_ ' .. .� .. .: ,.,., . . . _ . . . _ ._.. .__.. . . . _. . .. . ,_' . . OFFICE `. .. . ,��� ,.��e.; ' . . _--. _ _ .. . , .. . � . . ,