02020127 CITY of cUPESION .;. PERMIT � .' CONTRACTOR INFORMATION:
.,' BUILDING DIVISION. - -- ..
I ,
BUILDING ADDRESS: ,. m �i- a PERMITNO
1529 ASTER, LA: I- JUST WATER ,HEATERS ,'JNC - :;,•,02020127
•' OWNER'S NAME:' ...-._._.._..,..._............r.- _._APPLICATION SUB DATE.......
COWAN%BETTY J :.. ' : 1764`*'NATIONAL AVE -' 02/28'/2002
PHONE:
I SANITARY NO. CONTROL NO.
(510) 293-9901
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
z {{- BLDG ELECT PLUMB MECH
r Z u`i I. 7 I-. 1 L-1 L. 1
LICENSED CONTRACTOR'5 DECLARATION
1 hereb afBlm that 1 sin liccn¢d under, rens I 9 moinmenring - 'Job Description
l provision,o per
mrw isinfatiorceadefDivision3oflheBusinessendPrafcssionsCrvfe.m:dmylittnse REPLACE 40 GALLON GAS WATER' HEATER
is in full force and effect.
c o ,6 Date Class Lie n
time ., S ominwou
DELLA _
p ARCHITECre DECLARATION
� i undecaun my plumkhall he used as public recnrtl,
s p O Licensed Professional •-- _
OWNER:BUILDER DECLARATION
u, i
1 so If In I f exempt,me(lie Co Iran s e cense Law for the
ec filo g .Ie(Section7031.5,caro Buat do f.. or Any cin county
�•
ue F,o or ls s perch re c .I alter, p demolish.or repos any structure I- y 5 21
63� .pnon , issuance,also q thepPl atf such permit flcasisned uemm I. - '.... ._
(,qhe Zing with
itriddle Prov fIh C I muco; mdse Inwcas Cors' �p q�
(cgme g iib, ]na fDlvlemn3rlheBusinessand mpt".AnysiCod)' f.( i".' ir t 1 :< z - - Valuation
of Section
e r he em Pi tnerdmm and the nxs.f srhe cts the apply int Any v a on •'
•s of Sen n]Oi15b an '
Y Y PPI iforapn -"t subjects the apfil'c II civil penalty; A
or not 600 than five hiss dollars,hundred (5500) 5'O LPN-r� FINAL PLUMBI G ENERG�ecupanc y Type
(the,pmperry y.employee,with g.. 't - I ai
on 11'd' the work,and 11c,muci n,is us intended off.d for sale(S 71)44 ,,,.���7,�
.Y. 'Busines, nd'Protessii sCe TheContractor's Lia ,La constant pplyt n -- "' -507-' liPl]'C7LL`0941t9=--FINA " Pection5n
--- - -- ..
owner of prppcny who hoods or improves thereon.and who does such work himself - •. ••.•+• .._..
cur hmuggh Ins own employees,p'" -ded tM1 I u p - intended - - "
offerbd f- 'cmc I or
or sale w hox In will
Idmg or mpro e t s Ii rh one Wild of
completion,im owner bu Ider will nave the burden poising that he did not build of
improve for pugwse of sale J.
.e Easel tied nr Ihe Oroyeny am B.,i.e,el)c I i i lh IiCen Thcommicemm -
nswn Ise does
IS ]apply to a B ass fe ns Cod )Th C Iranor s `
and
Lawtoesnotr.sucI ownerproperty tra buII: p here '<
rid who conuaas for.such'P ojaL iIn I aor(sl LcemW'p m to Nc .. . _._._. ._ . ... ._...
Cnnwaors License Law, -
❑IameecmplunderSee B&PCfee This reason
Owner Daua .. .
WORKERS COMPENSATION DECLARATION
11 hereby affirm under pen It f perjury one of the following declarations:
•1 ❑ I*gave d "II - la Cenifcty f Consent I self - r Worker's
` C mpensal n .p tl tl f by Sectiont]W f the L b Cade the
for
Performance f thek for which thisns:pes ed.
1011mai II on W ke C pensiu on 1 as y
7]00 f th Lan Cwle f thero
pe ma ce f thek f which this permit
e mit i .,
tied My Wok Corepc satin In m r aynd P I -he f i i
y _
Comer - f Policy No.:
.�•_'... - _ .. ..
_al
'C:L:R.TIFIGTIONOFE _ S
COMPENSATION,INSURANCF'—''d
e....._•... . ..._..._.,.,
" t (The.c tirn need timi be completed if Ih pe n I is for one hundred dollars '
($100)orte
tl:
• Y Pe remit issued I
1 ren f Ih I in Ihe A c r the work f which this -
shall
tint employ any fiction in any manna . Io become subject to the Workers -
. compensation Alie nLaws of California. are . . ... .. ' ._ .. ._..... ...... ._.
.
,• FO __ . ._.. .
NOTICE TO APPLICANT If,after k gnsCertificate of Escimptimi,y
should' -
Z' becom . o uo the Wok C pen'1 provisionsof the eine Code you most -
lonhwnn comply with such p ons m thisperm I shall bed mad revoked.
Z
CONSTRUCTION LENDING AGENCY .,
as I h work for
aff that N.ip,sec I Ion leading C) for the perforins ce , -
'of Leme,*,Namrwh"ch this perrmr sismed(5<ca(3],Civ.C.)
Lender's Name .,:._._.v .._ ,:_.. :• e_r:.: . .._, ... _ .. _... .. .. .._. ..._ '. ..... . ... ...... .- _.
r;D-Z Lender's Address ;
f..) I ccnif,'but I have and this eppliadon and sure then Iha above information is' -
lim (-' correct.I agree to comply with all city and county Ordinances and state laws relating
. .0 t..1 lobWilding
construction:and hp ""man wflh thisenterupon
rzthe aha mentioned property for
inspecl o p rpo
CiaLy//
FUO (We7agrt Lave tlemnpen dkttihamayin m City ofcruen against 11_ -
.I� Vi liabilities,judgments,co I.and expenses which may in any Tway ace against said'
V ti Limy m consequence of the granting D milli,pelma. ':`a ' - -
SOURAPPLICEREGULUNDERSTANDS ANDWILLCOMPLYWITHALLNON-POINT Issuedb 1
SOURCE REGULATIONS.,' ,'! - y: Date•
Signature of Applicam/Conommor Date.
.HAZARDOUS MATERIALS DISCLOSURE - Re-rOOf$
W II the applies.,or future b Idmg a DH I 1 m or Hanel h"
atandmis material Type Of ROOF '
as tlefned by fic CvIxtruirm hfua c pal Code Chapter 9 12and low H lrh.,in caf ry - """ '' ' -
Codd S '25572()^ - _ - - - :
f: oY. IC7N �, t f r t . t Y , .
All roofs shall be inspected,prior to any roofing,material being Installed.
'
Will dour air
fumreWilde,efinedoc panl,use'A.Ai ntnt Mianewnm If a roof is installed without first obtainin an ins ectioni-]'agree to remove
inn ha N s communion,as defined by rh B y A ea A: Quality M nagemcm $ p
"'"` P r inspection. Applicant understands and will comply with
❑v, zty 1 ort + t all new materials for
ulations - -
all non otnfsource _
' 1 nm d Ih hoard mal Is rc u ._ ... . .... .. ._._.. ..
q menu d115 Ch pI r 695 of the _
11the bud Health&Safer Cote Sections 2550St it
y responsibility
1 modeltand that -
ifN'ebuof the no,currently which
bumnanl,tonsil is myaspncerilitymnficat the -:I
ocC:.upecl of rise requirement,which mitis be mei Pring to ixsmnce'of a Certificate
... ;' Occupancy' .'. . "• - '
'•' "' -i Signature of Applicant ,
- Dale '
owns ti�aamanr<a�genl - pa,e All roof coverings to be Class "B"or better
1. _..OFFICE