02030149TINO
CITYBUILDING GDIVIiSSIiONPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
20927 ALVES DR
JUST WATER HEATERS INC
02030149
OWNER'S NAME:
DEVRIES DOUGLAS H AND KAYE M
1764 NATIONAL AVE
APPLICATION SUB DATE
03/26/2002
PHONE:
(510)293-9901
SANITARY NO. CONTROL NO
IM
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
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LDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
lob Description
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1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
withSenion 7000) of Division 3ofthe Business and Rofessions Code, and myhccnu
REPLACE WATER HEATER.
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uLivense
is in full force and effect.
Claw Luc, g
(4 0 GALLON GAS)
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Dae Contractor
ON
ARCHITECT DECLARATION
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I undenund my plans shall he osed as public records
Licensed Professional
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OWNER DECLARATION
I hereby ,(Stat that 1 train
atIam exempt License Law for the
exempt from the Conions
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following m n. (Section ]OJLS, Businessand
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Professions CMc: Any can mcounty
13x Po-Anon
va. dr
whmM1 requi�a permit m alma; t a, pplicaimprove, demolish, fie pair any srmmutt
its issuance Isorequree VPI' t for mchperm Oofleasigned ant
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pr hC1AIX
co ¢e licensed with -ion 70nepro of the Contractor's LrcenseLaw
(commencing
(comate B with Section ]000)-f Division3of the Business and Profejaons Cade)
ons Code)
1, s Seq. Ft. Floor Area Y,
Ia \,
._ _- -_flo__
Valuation
or that he ,s exempt themfmm and the baso for the alleged cxinumbod. Any v,olm
j�•, x,, t.FaW L.'+P.'S i1rI eY I:.��':
on
-of Section 1031,5 by anympplicant for a pemdr subjecu the applicant to a civil Penalry-
:of not maretmnrr<hundreddnnars(s500L
APN Number
:'dr -ro Occupancy Type
ml, as Owner of the Inamemy, or my anploy"s with wages az their sale compensation,
502 _
' will do the work: and Ne si ucture is not intended or offeredfor sale (SAO. 70,40,-
'Bushess and Pioressiom Code: The Conwcmr's License Law docs nm apply to an
506 - GAS TESTequired Inspections t i
owner of propeny Who builds or improves thereon, and who does such work himself
or Ihrougn his own employees. provided that such improvements Are not intended or
L Plw'vl. If, a wever, rhe Wedin -----
g or ,mprovcmcm is sold within one year aro-
'compleriun,
507 - FINAL PLUMBING
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the owns -Wilder will have the burden of proving that he did not build or
pr cf rpurpwe (salt)
n rote property. am exclusivelycontracting ',h licensed contractors to
;7, ] p'
cotet t the project Ie7044 Business and Professions Code) The C t cis
License Law does not apply r ow pentwho builds or imp ,her
rsd who contracts for each projects -with acowa rt 7 lie rsed p , m Nue,
Contractors License Law.
0 1 am exempt under Sc B&PCfor this reason
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' WORKER'S COMPON DECLARATION
1 hereby affirm under p<wl,gof perjury one ohne following dedannons. '
° 1 have and will maintain a Ccnificam of Cim,am woself-insure for Worker's
Compensation, .,-pvided
Comro far by Section 37M
me
of Labor Code, for ,he
perfommaca of the work for which this permit is issued.
111 have send will risainim. Workers Comperisaliov Insurance, as requiredby, Section
_
37:W f the IaWr Code, for the w1finrnwnce o(the work for which I penrJ, is
issami. My Worker's Compensation lnsurancecarrierand Policy numMare:' -
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Came t - t: ..f r O 1, ..pEMPT - I r'.'
1 fERTIF]CATION OF E WORKERS
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_ i. a l \ i�. : t T'ne l i t +, s, 1 l'• .; . •'.� 1, I. :It
.COMPENSATION INSURANCE �
TION I SURANC
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(Th s sectio need oat be comPlheB if the Permit is for one hundred dollars
r •` �: L :'• r .1: [ 0', ] s "r.
($100) orless.)
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r 1 ten fy'that in ,he Performance of thework for which this Permit is sued l
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shall no, employ any 'Person in any manner so az m become subject m the Workers
Compensation Laws of California: Data
.. Applicant .. :. .. . ..
: NOTCETOAP TIf Aftermaking this C fE<pt y Amid
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femme subject ile,WaCo pe pro,maaohhc Latin,CM urt
forthwith comply With such pr sonsorth s permit shall bed anted revked.
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CONSTRUCTION LENDING AGENCY
I hereby R Jut Nere o wn o lending agency Ardor perfo once
of the rk fo M1 n ih t ed (S 309]' C
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Lenders Namc :. , ._,. .., .� :..
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LedcriAddress
I cagey that 1 have read .11a and amm ,nn me above i
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coma. Wld 1 city aduon
laws Mining g
to con tr comply with all city and county ordinances and cine taws relying
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gAgree
aildingcontioned uparty rebyamhonurcposel., v of this ci,y to enter upon
the abovementiened propcny for inspection purposes.
indemnify
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,;
save, and keep harmless Ne City of Capcnirio against
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es judgme is
liabilities, judgments. coati and expenses when may in mY war, att,ue !9s,tm. As
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in Consequence the granting permit' " " " " " "
APP R
APPLICANT UNDERSTANDS AND WILT: COMPLY WITH ALL: NON -POINT'',
D WI
SdIJRCEREGIILAT10N51.•''.." ..•
issued by:
-
Date
Srgnamne of Appluam/Commetor'-;'.^�•^ .. ...•.Date'....
HAZARDOUS MATERIALS DISCLOSURE
/
RC -roofs
isII Ne aPpl cant or future Wilding occ pmt store m.tornado hazvdous mat nal
Type of Roof__
as d f ed by ran C pcni.6 Municipal Code Chapter 9,12,and tha Health Ad Safety
-
Code, Section n 25532(,) r r 17 No - t [l; { I
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All roofs shall,be mspected.pnor to any roofing material being installed.
r: Will 'hem, applicant o f mn bmfi ng Occupant use ea Air cit t Monk wean
emir
mnh J mmamn t azdefined by theBay A aAvQuality M 'gemrnt
If a roof is insialled without first obtainingan ins ection; I agree to"'remove
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Diatri'. -..
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all new materials for inspection. Applicant understands and will with
-sb
.-"all
non-point ,comply _
ore 8 iegulaiions -
1
Phula end the et rd .'mamristq nements undo Chapter695 of
-
the
Califo a Heal 5505,25533 Safety Cade. Sections 25505, 25533 aM 25534 1 undersumd,eat
-
if din Wldig does not cumAnd,have ,term tea itsmY responsibility, notify the
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g=t f in. equ r mtnuirwha,hrAms, be at prim!. issuance of to Cemficam of
_
Signature of A hcant Date
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_
All roof coverings to be Class "B" or better
own,. or mmor;�ea agent • _ Date,„ .,,
OFFICE