02110038 (2) CITY OF CUPEKVINOIr. '<n` �'
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION ...,
BLq0?64/&UP0AMES TOWN DR JUST WATER HEATERS INC PERMI'TN02110038
ow9t,MMONS CHARLES N AND BARBARA 1764 NATIONAL AVE APPLICATTIISp1U)6TY2002
IN ZONE: 51 0 2 93—9 9 01 SANITARY NO. CONTROL NO.
ARCIIITECTADIrINF.ER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
X00 LICENSED CONTRACTOR'S DECLARATION
�brIberehyanlmrinallamlicensedunderpmvisionsofChapmr9(Commerical, REPLACE WATER 7IhRTffption
with Section 7000)of Division 3 of Ne Business and Professors Code,and my license is
in full force and effect. (5 0 GALLON G PLva
aec,gz License Class Lis.# wool
Data Camracon
¢2 ARCHITECI':SDECLARATION
Oad V I understand my plans shall M used as public records DEO 0 2002
w3w� Licensed Professional
r_ p< OWNER-BUILDER DECLARATION A
eu e p 1 hereby uflirm the,I am exempt from Ne Contractor's License Law for the VILD114
�6pO following reason(Section 703IS.Business and Profeesions Code:Any city or county B
which requires a Permit to cnaswct,altar,improve,demolish,or repair any soulame $898
prior m its issuance,also rcgmree the applicanl for such permit to file a signed.mswrom t
Pill that he is licensed pursuant In the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 7001)of Division 3 of the Business and Professions Code)'
that he u exempt therefrom and Ne baso for the alleged exemption.Any violation of 36610064 . 00
Section 7031.5 by any applicanl fora permit subjects the applicant in a civil penalty of APN Number Occupancy Type
ma are than five hundred dollars($500). 502 — FINAL PLUMBI G ENERGY p y YP
❑Luowner ,the theli=,ur myemntendedwithssagesuthei(Sec.co ,Business
will dr Ne work,and Neswnurt is not intended oroffertdforule(Sec.]INC,Bwineu ®�S Sdjkr��r,�
and Professions Code:The Cnnlnctofs License Law does not apply m an owner of 507 - FINAL tJy�l[$'j"jy[seCt1G0S
Property who builds or improves thereon,and who doessuch work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however.Ne building or improvement is to within one year of completion,the owner-
builder will have the burden of proving Ban he did net build or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
Construct the project(Sec.7W,Business and Professions Code:)The Convector's Li-
cense law does not apply to an owner of property who builds or improves Merton,and
who contracts for such projects with a contractor(s)licensed pursuant o the Contractor's
License Law.
❑ I am exempt under Sec. ,B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby afford under Penalty of perjury one of the following declarations:
1 have and will maintain a Cenificata of Consent o self-insum for Workers Com pen-
satinn,as provided for by Section 3]1X1 of the Labor Cndc,for the performance of the
work for which this Permit is issued.
❑1 have and will maintain Wnrkels Compensation Insurance,m acquired by Section
370(1 of the Labor Code.for Ne performance of the work for which this permit is issued.
My Worker's Compensation Insurance Cartier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not M completed if the parrot is forone hundred dollars(S 100)
or It
I cenify that in the performance of the work for which this permit is issued,I shall not
emptily any past any manner so as In becnma subject it)the Worker,'Compensminn
Laws of Gallfnmla!Dme
Applicant
NOTICE TO APPLICANT:IL after making this Cenifcate of Exemption,you should
become subject to the Worker's Compensation previsions of the Ichor Code,you must
OO forthwith comply with such provisions or this Permit shall be deemed revoked.
z h CONSTRUCTION LENDING AGENCY
(+ I herchyaRren that there is aconsuuarion lending agency forlhe performance of
ai Y the work for which this permit is issued(See.3097.Civ.C.)
C A Lenticri',Name
7 z La dess
rAddre
V 0 1 certify tum 1 have read his apleliembor and state that Ne move information is
wF
correct.l agree to comply with all city and county ordinances and state laws relating to
Q V building conswClion,and hereby authnrim reprearmatives of this city to enter uqm the
ahnvoamnameed progeny for inspection purposes.
(Wal agree In save,indemnify and keep harmless the City of Cupeninr against
N liabililies.judgments,costs and expanses which may in anyway acme against mid City
U z mmnscyucncc ul'thc gmnling of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signaturec of ApplicaR Dow
SMATERIALS DISCLOSURE Type of Roof
Will Ne applicanl or rums building apt score or handle hanNous material
as defined by the Cupeninn Municipal Code,
e,ChChapter H.1$,and the Ilealrh and Safety
Code.section 255331a)7
❑Ye0N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future ba doingocuupam use equipment or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
mit hvardnus air communentsnvdcfncd by the Bay Arca Air Quality Managamem all new materials for inspection.
District?
❑Yes ON.
[have read the haraNnus muarialsreyuircments under Chapter fi.95 of the Califnry
ria Health&Safety Gavle,Sections 255115,25573 sua 35534.1 undersand thatif the boiling
does not currently have a tenant,that it is my responsibility or notify IM occupant of Ne
requirements which mum Wmet prior to issuance oft CondicamofOccupriol Signature of Applicant Date
Owner or authorized agent Data All roof coverings to be Class "B" or better