02060168 (2) CIeoDNGmy SIONO
BUILDINGSINPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10822 WILKINSON AV JUST WATER HEATERS INC 02060168
OWNER'S NAME: APPLICATION SUIT DATE
LEARN ARTHUR J AND BETTY J 1764 NATIONAL AVE 06/25/2002
PHONE: SANITARY NO. CONTROL NO.
(510) 293-9901
O O zo ARCHITECTIENGINEER: BUILDING PERMIT INFO
u C BLDG ELECT PLUMB MECH
I_
y a i LD L:_J I" .t _I
LICENSED CONTRACTOR'S DECLARATION
o 5 4 m 1 hercb ftirm that 1 um licensed under fCha ter 9(commencing Job Description
y a provisions n p g
°1F-w with Section]Wp)of Division lofthe Business and ProkssioneCNc,and mylicense REPLACE WATER HEATER
rcYf is in full forte and effect.
cxo,a License cross Lie.a (4 0 GALLON GAS)
ca 3 ou O Dam C.mracwr
G ARCHITECT'S DECLARATION
u O; 1 undersand my plans shall be tried as public records
15 Ep O Licensed Professional
°•o u OWNER-BUILDER DECLARATION
=` 1 M1em,m a(Brm Nat 1 m exempt from the Cumrax Crack:
License Law for the
fulavvwhich ing urea is(Section 7031 b, t,Its, andimprove
Professions h.or re ny city or county
iS F o which requires a permit re construct,alter,improve,demolish, file
repair any swcwrt-
c.c.3m -polar mits mmsece.zlsh mgmres the applicator far such perminonleasLiov(am.pboe) xi - -
tharheialicg:Laulpurstrammtheprov,vionsnftheComrxmr'sLicenselatw(Chapter9 (' S Ft. Flo rArea •t t\ auation
(commmcingwith Secaon7000)of Division 3 o(the Buswespand Professions Cade) Fa)'.�"CrLI Sq Ft
E'al pi.t rLP."A.tlV_� .
m mai he 13 exempt Ncurium and the loris for the alldged excmOtmd.Any violation
-of Section 7031.5 by any uptici m fin Is permit subjects he appli.f,in a civil penalty
Iof not more than rose hundred douar,(a5BB), umber Occupancy Type
D 1,as owner of the property.army employees with wages as their sole compensation,
will-do-the work,and the structure isnotimended'or offered for sale(Sect 7044; - - - .`, '-- - -- --- ---
Busbuit,and Professions Code:The Co......,License law does nut apply m ao 506 - GAS TESTRequired Inspections L
owner of propcny Who builds or improves thereon,and who does such work himself
or through his own employee,provided that Such improvements are not intended or 507 - FINAL PLUMBING
-offered'rhrCale.IC however,the building of imyibszmcni ii Som'wimio one yeu or .—__--_
completion,the owner-builder will have the burden of proving that he did not build or
improve fur purpose of.role.).
._ .__..
❑L m owner of the property.
.amexclusively_...._contracting._with.licensed to
consumer the project(Sec.7( Business and ProfCWo:)rte Contract
LicenO,Law J s nmapply .an cnfp peuy who Wilds mpravex thearesm_,
ne ommns fo su h p of as with ommnorts7 licensed PusuanLa the
___.-----
Contractor's
ct License Law.
01mou. p
.r
nJerS "" 0&PCfor this reason . .s L`
Owner Dat
r WORKER SCOMPENSATION DF.CI.ARATION j
Ih by alEnn d Pe shy of pc3 ryo or rhe follwing dmlami ons: - /�
"r• D I havc'.nd will maintain a Ceninsme of Consent to self-insure for Worker's L/
it Compensation, as provided for by Section 3700 of the Labor Code, for Ne
performance of be work for which this pemdt is issued.
D 1 have and will maintain Worker's Compenaminn In,umnce,as required by Section
37W of the Wbor Code,forme performance of the work for which this permit.is
issued.My Workeirs Compensation Insurance carrier and Policy number are `
Csar "t IV C `la{I'N(1•oltcy Na J•r r'S a ( s Y .•.4;' .. �y h.
[t o CERTIFICATION OF E)fEMPIION FROM WORKERS"- v_
COMPENSATION INSURANCE "• '' t f
•'-(Thi,feeion need not be completed it rhe permit is fur one hundred dollar
(SI W)or lean)
___ ... .
1 c n fy that in"the'performance of-tin,xhrk for which thIS re 't is lamed,l- - - I -I r r - - - --
shall nor employ any Person in any manner so as to become subject to the Workers -
Compensation Inws of Cali fornix Date
.Applicant - -
NOTICE TOAYPIf. kinCerin of -Exemption.-
-a -alst
O become
subj^tothe Worker's
ok r.Comps,emtnon pr .tsofthLaborC d,yumlan
Q forth lh m l .with. h o this permt.halbedcore'ked.
_. - -. _._ .. _. .___...._..... _.._.......
`
F'&n '•1 r - rCONSTRUCTION LENDING AGENCY `
7 - I hercbj affirm that thim I,a c insemcr on lending agency fnr the performance
Lvt.O ___ 3097.Co.Cl
ora work Por hick thspermm t .sued(Site
Ort Lend N '.
')_z Lend r AJdrc
1 certify that I hahal city
and d o thath boinformationrc
C E. correct 1 gree to comply N hereby tyatd ry J ' J t t I elerng �J(,
>. W andmim"ala representative,fifth!,ery mepmr upon
y.A. the ubo(We). ram d.m propcny Tor i fy a dt kecurep
p harmle
A. esjdgmentssave,indemnify expense,
whihar a'r iorheCayaumeninoaga ot
aid
Vi liabilities lodgments,cons and expenses wM1.mar in any way accme ngain.a said
U>Z City In APPLICANT
UNDERSTANDS
NDSAgD This WILL
r�
SOURCE REGULATIONS. AND WILL CO\IPLY\\'ITH ALL.NON-POINT" Issued b Date
' SOURCE REGUL\t1UV5. " Y•
_. Signamrcnf APPhc.aVContnnw ' Date' RC-roofs
' HAZARDOUS MATERIALS DISCLOSURE
Will me Pplicam Ton cladding Sa,.t.tore orhmil hvanlhus matenal _.Type of Roof_.
as
dirtied by the Captain Municipal c- Cut Chapin 9 1 ,and the Health and safety s t 's _ _Cede. ❑Ye 25`321x1 s D N n• is r s: 7 r} at i \ ` ! 4�1�. "•. •s, ,
All roofs shall be Inspected prior.t'o any roofing.materlal being.installed,,- -
• n W Ilth . I ttamf turchulding cups tuse egap r e cis which - If a roof is installed without first obtaining an inspection, I agree to remove
m
eRM1 rd irconnrx as defined b5 th Bay Atra� Q Ityam
1negeent
Din clall new materials for inspection. Applicant understands and will comply with
° °N all non-point source regulations:
I,have•rced the ha.dhus romin.ls rcquircmenm under Chapter 6.95 of the
California Health&Safety Cods.Seniuns 25505.25533 and 25534 1 understand that
ifrhe building etas noteurmnd which
no".tax, hat it is my I"tunnnsibilisy rotifica We -
odcupam of IS requircmcnrt which man be me prior to issuance ora Ceninam of
., .^ Occupancy.
_. Signature of Applicant Date
4. o,rner.aroammi:<eagent nam . All roof coverings to be Class "B" or better
. _ _ .. ... .. _ . ... - OFFICE ...