01020105 CIO
BUILDING i ISIONNDPERMIT CONTRACTOR INFORMATION:
BUILDING ADD19956 BEEKMAN PL WATER HEATERS ONLY PERMITNO_ 01020105
OWNHR'SNANIbRANT DONALD W AND JOAN 500 AIRPORT BLV APPLICNIION sO'2M20/2001
PHONE' ( 415)349-3747 SANITARY NO. CONTROL NO.
7 ARCI I I'IPC'CENCINEER BUILDINGPHRMI'I'INFO
O O IILDG EI.1?CT PLUMBA1ECH
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NIf CNSI'D CONI'KACI OIYS DPCI ARATION 7� n,enn>,n r, n.l l an,ru,,c]. daprr,-Aon m'Chal tr,lro,,,e,e,g .lob Description
w'mSeelnn7onfnnrD, ,,3nrmelal n.,.mlalfl ,�nd,..,d,yad,, REPLACE 40 GALLON N GAS WATER HEATER
in an bei ndall"
'y y�� Liccnm Clao u hic M
ay5 0 Y Date Con,roclur
ll n+ a c,i, ARCHI'I'EC'I"S DECLAIj ION
undannmd m 1 d helmet Mie r emeis
J YPan,s,u us pu
Y
z a Llrcn.ud Pmfwsiumhl
xX O N OA4NIil1-HUILDER DECLARATION
ed o m I hcrohy nl'lirn,than 1 c stn rronn the Connactor's Lunate L mo or the
K7<
following Olson sc,tion 703 L5,13rou.111 rdI r:' Code Ail, 'ty u, ry
f�O whl P tl Icl 'I p LI Y'I-elm
thril
p13 m ern I l L I Ih .fit p ,, t L Tai ,col
L (lou It,im rer yet II,m(Pr If the t laeln- I 1 tCl me o Sq. FL Floor-Area Valuati9rY00
(u bw he is c wish,therm 7fIIH Oil he bia is 30 the 1i inens cold P nfArt, i Cndq
s mal he is eaenhph they inph and he basic pec(m the alleged caenpalon.Any vidwion
' of Secaiun 711315 by unY uppllcam for.,pennil euhleem nc nppllcvut tnucivil pe,ally
ul not onus man hue banded dollars(S5(10) APN�W,16114. 00 Occupancy Type
01,mn1111Iof in,properly.urul,employee, olh wages;Is their,ole conTengaio,
loin]do the work,and tm slrocmro Is non ourbird of churned it,, sale IS'ec.7044,
Ensine"and P,le Ca is The Corn,toy,License Lew duel ant ply to:t' 502 — FI�PfJL'Ir �.'19 t19V� ENERGY
at phopony Who haddv or In,pnn,,vn,tureeand who doe inwor
cl, k hbn,clf
Orinhl,own emNo,re, ported 11141,adl Ihnpruvemenu are nut intruded on • 506 — GAS TEST
upend Ito,ole IL how r.the building o ,nproant is,old within u e ym, ere
Iinpleton,the ownenhnilderwid have t he mento Thr ern 416 mN lie did 1101 build 507 — FINAL PLUMBING
hnprovo ror papnno or sale),
❑1, o owner of the properly,cut eabloorly conlmet,ng w'n11 licensed cono-aclor,Io
I on I Ill proper(S .7044 H d l f.. Cade The C I l 's
-c 1 I a,Ny1 I; Iy ld i P fl c'iedr,
and sho coattails, lot such1 ejects with H coro aur 4s) llecroal utrancort In d o
Cal t 'I- 1
❑Ian a cost under See. ,It kl C turn his anion 1
Owner Iamc \ /
WORKER SCOMPENSAI ION DI.CLARA'I'ION / [�
Ihachy alllrin under lmnalry nrp jury one oC the followingAuluraton,'.
❑ I ho and will mainfuih a Crudienle nr eofCons 1 sc-onsure lob Wnrkur's
Compenitinn, uv provided rot by Section 370Oor file Labor Code, for [tic
pert...On ,Ili the work ror which this pennil 1, rel
711 have and will On I Worki,C,Compcn.'don in undid'.Is require.)by Sermon
37f1f1 of the Labor Code,Inn the perror meu e nrlhc wm6 Int Mich Iii,pennil i,
,,lets illy Wn1 kern CompenIeli lu Inwlmnce am'icrand Polley nnmbel'in,
Cermet Policy No.'.
CEM IFICAHON OE EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Illi%section need not be wnnplemd it hie perp it Is neon,han,lnxl nkat,
($100)er 1e,,.)
I coney that in(tic perinnnance of the wutk ror which this pennil i;Iss,me.I
,hall nor Imploy tiny nerson in any mann,sit as to heo ne,nbjecl v,the Worhem'
Cmnpauatu I Law,It Culibu ria.Dore
A,,11cnnt
NOTICE TO APPLICANT:II,ala,ort.."lhi,Ccrlillcala ur Exemption,yen should
2 become subject ill the Workers ConpuuvWun provisions nr tire Luhor Code,yah cast
Q C) rull,wllh comply w'ah,uch provisions Orlhis penhaE be deemed t nvokc,i, -
z
CONS I Ris a coNLENUING AGENCY
a hereby alool,that isPenci,aeawu'uS,I. lend,ng agency lathe perfurmtnm
W Lendrck,Nrnr widen the lxrrmilie issuW f5u.3097,CO,C.1
Lcnd,,Nahuc
Lenders AJdnax
I ,,fF,It,,(IL ill' ldi,aitul tod_lu [itsthe1 '1r ,at' h Is
�I Fy
I oi I'6 ill donitil,vdO'lcity'.11111 county orafinadoes And_had laws Fuming
O (,� huh II u gc,4ndo i horehyandhorio,repic,crintlites Oft,cityI tar pun
[i]
the H11-0Tnentoned propany mel nspaaroa pwp,hses.
M. We)Ill V,avq'mdenmlry vud Acep lmunic"l he CRY ue CapenlnL ngoEul
VJ
liabilities, ndghumes,costs and expaucs which may on any way accrue attains,,aid
L.I City's consequcnee d the gemming of this pclnhil.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT IssLICCI b Date
SOURCE REGULATIONS, y
Signawn of APPlicanh/Connaaor Rafe Re-roofs
HALUH)OUS MA]171RIALS DISCLOSURE
Win'lie aPlsicaa Lr fine buildin,decc,ears rel,or hendm hamrdotw n,ana nal Type ofRoof l
ax ecllned by the Cnpurtnn Mwaapal Cod,Clmpmr 1)12,nom the I I afh and Stdety
Code.Stenon 2553200:'
71Yes 0 N All roofs shall he inspected prior to any roofing material being installed.
Will heappheantOrmlaruhaddingncrapanluse eghdphnnl
eut %i
dctu,"both If a roof is installed without first obtaining an inspection, I agree to remove
ih bmanlous air cnmmddnam%a,dunned by me Ray Are:)Air Qcaldy Mnnagen of
Di"hmel^ all new materials for inspection. Applicant understands and will comply with
pe
°Yc' FJ
all non-point source regulations.
Im<c mod the h:vanlou,under als rnryitenroms under Chdpmr 695 of Ibe
Chliburn oIlealth If,Surely Code,Stole n%25505,25533 i 125534.1 undcmmnd mm
Idle building cuts nor tin u nlly hues a tenant,that it Is hay rcepunv Oh"m nobf,the
L. ...ul of the ennui resents alliin,own be amt prior In inru;ma n1'i C....ficate ur
OCeOpanty. Signature of Applicant Date
Owneruraamuri.cai agent Dn1e All roof coverings to be Class `B" or better
OFFICE