01070116CITY
oP c uPERTINO '
CONTRACTOR INFORMATION:
t PERMIT
BUILDING ADDRESS:
PERMIT NO.
19936 BAYWOOD DR
JUST WATER HEATERS INC
01c�0AA701;;UU16
D�I� U"11 M ET AL
1764 NATIONAL AVE
07/24 2001
PHONE:
(510)293-9901
SANITARY NO. CONTROL NO.
ARCHITECTIENGINF,ER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONT'RACTOR'S DECLARATION
Description
Ibrrabyamnn that l um noosed ande, provi,aon= of chapter 9 momn,eneing
,lob
REPLACE WATER HEATER.
with Stains 7000) of Division 3 of the Business and Professions Code, and or, license
I, mall force ad elfecr.
(50 GAL GAS WATER HEATER)
License Clans Lia. #
Date Cmnamo,
ARCI II FECT'S DECLARATION
1 understand my plum shall he, used as public records
L'¢cnced Pmfetsinnal
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
fallowing reason. (Section 7101.5, Butinrss and professions Code: Any city or mnnty.
Which requires.c paten to concwv`L alter, improve, demnfah, or repair any tontine
prior m its iss once, also,eyuires the applleant far such permit hr file a signed dominion
S FL F100C AIea, Valuation
q',
tart herlicensed . ... .11,fl p_ i mfmo C t t , License I' (Chef mr9
( omen 'n6 m S tiondlNHl) of Division 3 ofine Business and profession,Curie)
)
.63
or that he is exempt meo film and the basis for me allegdd exemption. Any violation
31
of Section- 7031.5 by any applica forapermir,ashettsme anchor m a civil penally
of anrmum man five hundred doll ars (s5oo).
APN Number Occupancy Type
❑I, asnwne,ormeprnpestoryemployees With wage,re,wirxuleeampensadan.
502 — FINAL PLUMBIN ENERGY
Y
will do he walk, ,ad me smuetme 1, an, intended or offered for ,ale (San 7044,
e _ d n feu . Code The Cummu-', uerna Lew doe, n, apply to an
5 0 6 — GAS TES Tkequired Inspections . .
ow,e of property who nu'Ids or improves mention. and who due,.mah word, himself
507 — FINAL PLUMBING
or through I.,biI own empwyeesh pm„did that such smear is encs are not mended or
orrererlmr ante: If, nnwnarn me building ._ tis sola ditnn, are f
geimprovf yearo
_._ .... . . . .. ... . .. .. ..� ..... -.... - — -
completion, the owner-balldur will have the harden of proving that he did not build or
pro
-
improve for purpose of sole.).
❑T; a, owner r7i�theprogeny, em exdu 1y contracting withl n. J tacmrs to
-'"'" '"'
construct the prefect (See 70s4i Business and Professions Coale) The Cnnba tors
,
License Law does not apply to an owner of pmpcny who builds or improves thereon,
and who contracts for such prolette with a conrcacmr(c) licensedpaauant to the
Commemr's License Law. - ,
❑ I am exempt under Ser. '• „ 118 P C barinis leucon
_.1;.....
Date Dwr oinS
WORKER'S
�'WORKER'S CONIIIITNSAI ION DECLARATION
I hereby affirm ..it,., penalty of penurynae of the following declarations:
❑ I have and will maintain a Certificate of Conwor to ,elf-inarre lot Workers
AUG 0 9 2001
Cmnpen.soner, as -provided for by Section 37(18 of me Lawn code, for tire
perforamee of ma wa,k for when Itis permit is issued.
O I have arta will dwinmin Worker's Con,peasmi or Insurance, as required by Section
BUILDING
370(1 of ,he Labor Code, for the pedisr mane of the work for which this permit Is
Issued:.My Worker's Compensation lnsPo
.. .. urrnce carrier and lisY nal Liber are:
-
.._ .._.. . ..
Carrier:' L. ..: .. Fall, No.:
.. .. ......
i..,-- .. .
M,WORKERSs
CF,kTIPICACO N OFCOMPENSATION
CO>1PENSATION INSURANCE. -
ATION INSURANCE
's t rrhis Set uiorr need not be completed if it,, permit is Barone hundred dollars
(SI W)or levo.)
I cerRty that in the yerfootance of the work for which this permit Is Issued. I
-
shall no, employ any person in any manner so Its to become subject to the Workers'
Co ..... ovim Laws of CuI,f, ie. Date
Applicant.. ' ' _'... ...
NOR 'ICE '10 APPLICANT: It, ager making ,hit Certificute of Exen,print , you should
become subject to the Workers Compensation provisions of the IaborCamle, you matt
forthwith canny with wen provkim., or this permit shall he deemed revokxd.
l CONSTRUCTION LENDING AGENCY
affmn Blow leading agency for perfunnance
Lhrk ntted
of the wink for which this pemtitsis issued (Sec. 3097. Civ. C.)
for is menu (See.
Nam{ -�
' -
- - - - - - - - -
Uder.,
Under'.,
dcrkAddmss-'
I sentry Thal 1 have read this application and score thin the vbave'mfetmmmn is
ea. 1 agree to comply with all city and county andirons, and 91ate lava relining
vn hulidingconstnation, and hereby afflomi ,re,mountinivcs of this citym enter upon
the aba(We) agrnedee 1. prolmny fn, iry and keep
p harmle the City of
oVo agree to save, indemnify and keep hm ua
liabilities, partners, core and expenses which mry in any wary uccme againa said
mayin crueni di said
City inconseq nous this permit. '
RSTAe,antingD
SOURCEREGUL GIONS'. SAND WILL COMPLY N'ITHALL NON -POINT
SOURCE k2GULATIONS'. �.
Issuedb y. Date
Signaturefir Applilm Crmwcmr Date
Re -roofs
It ' HAZARDOUS MATERIALS DISCLOSURE
,
wlltheapplicant or faun building occupant sore nrhaterelVecamasmmedA
Type of Roof_ .. ... ..
he defined by the Capenino Munieipal Code. Chapter9.l2, and the Health and Safe,,
Coal, Section 25532m) _ -
❑r: ;, 6 N -
All roofs.shall prior to. r
ll boofing_material being_ installed._._._
-. Will rneappl _ n r tnrbniid' g e p luseel 1 t - swhich;
-,n ,l
if a roof is installed' without first obtaining an inspection; I agree to remove
e sarr r ams as der el by me Bay AmaAr Quality nrarogement,
Dishier'
all new materials for inspection. Applicant understands and will comply
oY ' noNn -
with _
all non -point source regulations.
I have rend the haunt is matedols mquinnorm, under Chapter 695 of the
California Imahh S, Safety Csxle. Se,rom 25505. 25533 and 25534. 1 understand that
it[ lie building does not currently have atenant, that i, is my recponalahly In nmify the-
hecomm,
commonof'he'myro menu whim 6,1 be met goof 11 .,.moor of Crnifuvm of,
Signature of Applicant Date
Occupancy. "
-
_
All roof coverings to be Class "B” or better
Owner or amnd: e agent Date
` -- OFFICE