02050131 CITY
1 BBUILLDIIN DIIV�'ISSIIONNOPERMIT CONTRACTOR INFORMATION:
'1 '$`IsADtrAq NHART PL WATER HEATERS ONLY PERMIT NO. 02050131
OrfRh,spApIE:JACK L AND JO A 970 E. MAIN ST, SUITE 20 0'5-f`T1sp2R0I7i2
)PHONE: (415) 566-2209 SANITARY NO. CONTROL NO.
Q0 O ARCHITECr/ENGINEER: BUILDING PERMIT INFO
c u- BLDG ELECT PLUMB MECH
a rLIC
'S = ECLARATIN
IherebyaffirmEa
hEDmfNTRACTOR irmedmde,, vmbr,,sofChapter9lcommcil REPLACE WATER Alki'Mription
�N=o with Section 7000)of Division 3 ofthe Business and Professor,Code,and my license
in an rrree an rc II (5 0 GALLON GAS)
K < Limnse Clasa b Li<.N 3
O a O Da¢ O C."'O'd_
I a u.at ARCHITECT'S DF.CLARA
I understand my plans shall be stud as public amours
i s O O Licensed Professional
'K o, OWNER BUILDER DECLARATION
an_ o I hereby offirm that I am exempt from the Contmaor's I-uum,Law far the
C?a following reason,(Section 7031.5,Business and Professions Code:Any city or county
Wwhich requires a permit to construct.doom impasse,demolish,or repair any nmcmre '�O Q
i3�
-Poor to t e also requires applicant for such pemmiuofl gW mm tme - _. . _
that hins licensed pur;oannoffieprooismas of be Control License L (Chapter 9 S . F[.,F1oorArea..•,
(con g.-thSect 7000) rD ':'on 3,fine BusinessdPor naCods) f.ln.th 1T7� py s a V5 t'�'T b, Valuation
or that he is exempt me efrom and the basis for the alleged tions on Any violation 3 6 b 2 4 0 2 2 . 6 Q
of section 7031.5 by any applicant for a cm it aubjecm the applicant to a civil penalty- Occupancy Type
of not more than lice hundred dollars(SSW). APN Number
Cl,as none,of ore pmpeny.lir my emplryeea with wages as rheb tide compensation, 502 - FINAL PLUMBIN ENERGY
will dr the work.aoil-the'sanned e'is not intended or rrcered In,mile se,7045: 506 C3AS 'E,0
-
Buuiness and Prtifesimer Cads:The Communist's License law does not apply to an �{I��pections" '
owner rf properly Who builds or improves thereon,and who does such work himself 507 - FINAL P 1NU`
or through hisGi son employees,provided that such imment is of are not intended or
'rrccrcd foF.wle.If,howevh,'Ihe'buildin � ��-� � tis sold within otic-� f
gob,men of praying
years
'completion,the owner-builder will have the burden of proving that he did not build or
improve for purpose of sale.),
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RNALSIM. -_.-..._ ........... ... .._._...._.
❑Lasowner ofdhe propenyam exsiness and Professions
witnocenuhe Co enntsto - 'f;•,I,,
c
License
taw Project(Sec,]U44,Business and Professions Code:)improves
ves Contractor's "t',
Liccnu Law macs not reply to an owner of properly who builds se improves t to b, `` -
Cente o.c Linens for such Projecu-wire a contractors)licensed pursuant m the. N V J_-L 3 .2009,--"
Centel m am License Law.
? ( ; ❑I ren<xcmpt under sec."• - �� "' � ,B&PC for mos rwson � r,� � ;��(
Owner Date i
. BUILDING
- WORKER'S COMPENSATION DECLARATION
1 hereby dfmnunder penalty of perjury one of the following declarations
0 I have and wiIZ armando a'Cenificae of Consent in self-insure for Worker's
��� Compensation, as provided for by Section 37M of the Labor Codc, for the
- performance of the work for which this permit is issued. I,
�WL•��have and`will mnimain woikers Compensation Insurance,as required by section
p]W of be Labor Code:for the performance of the work for which this permit is
issued MY Workers Compensation Insurance carimr and Policy.mail art:"
Cam Pnli< N C//_' 2�5��, ' -_-
y } .. .._ . . ._ -.
11 CERTIFLC IONOFEKEMPTIO F O ORKE�-vt RS'. - t ' }sat s. L k I '�� I .d Ems)�`l `:•y,T
COMPENSATIONINSURANCE'""' - =
Y mossectrn-need not be completed if the permit is for one hundred dollars _ ----__- '_ li, .s , 1/
(EI00)arless) '
1 m loyally a performancea of, towhichth pc s issued,1 - - "-'•'" -_" "-"
shall of employ any person m any ma m as to became subject to the Wmkcrs' - rat•' ''
dr
'A bani�' 1'..'California.Dam
Co^pensation laws of ," p
NOTICE TO
T If.after making his C mf can o
should
Znecome subject to be Will C it previsions of the Labor Code,y a must
fohcomply with such psisons or this Permit shall ederned evok .Z x - - -- romr -
i CONSTRUCTION LENDING AGENCY
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1 hereby affirm that them'is a constructionlending agency for the perfoamance
of irka work for which this Permit is rsmed(Sec 3W7'Cy.C) '
Undelr's Name
V
V z Lend Add
W O o,,. 1 r fy that I h d thisapplication tl state thank bo information is
F., ren 1 agree to comply with all city add county ordinances and state laws milifing
U ,Wilding consmai:tiontand Ill finspection
representatives of thisetymenmr upon
W theabUWe)agree 16 propendemify and keplarra g,
�.a Z) IWjudgme m scents indemnify exile seek hi hamay in the City of Cuperoral against against
L Vj liabilities,judgments,costs add expenses which may in any way ac<roe agains said
V'.Z City in ca-im"cc of die gold ing of this pcmdt.""' '^
APPLICANT UNDERSTAILLCOM WITH jiLL NO't0 1'' '
SOURCE REGULATIONS 'XL \tt � C�/�o� Issued by: Date
cn'd' turtrf"Pano aUCrnmmmr "•,---•.. :. . :..::.:./] Dae'
''HAZARDOUS' ATERIALSDISCLOSURE ;, Re-roofs
ik l'dr apphcam or Future Wilding'rccupant store or handle h uv dous real did Type of Roof
as defined by the Cupen Municipal Code Chapter 9 12 and the Health and Safety - -' - - - - -
Code Sc ion 255,Ne1" � � - _
4 \�:. 'If � s..1(
_All roofs shall be_mspected•prior to any_roofing,arena] being installed.
Will to applicant or future building occupant - ----
PP, gayAeaAi trade men If a roof Is installed without first obtaining an inspection;I agree[o�i'emove
emit M1 ado omammam5 as defined by th Bay Area A Coolly Mnagemcm g
°i""" all new materials for inspection. Applicant understands_and will comply with
0yes all-non=point source regulations:
have read the,h zoom s maredals 'qurc cis¢and Chap. 6.95 of the
Califom a Health&Safety Cod,Sect ons 25505-25533 and 25534 1 understand that
if the building does not currently have a mount,that it is my responsibility tin notify the
Oc dooUpon f in requ met h ch n 'st be map or io'ssuanc f Cell'mine of r
w,yy Signature of Applicant Date
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o ami,:e�..get
Date , All roof coverings to be Class or better
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�. -• ;?' tAt. , : . ,. .OFFICE - . . .- .- _... ... .. .... . ..