01080111 OF
CI BUILDI c DrvESIONN� PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19986 BEEKMAN PL HOT WATER INC 01080111
OWNER'S NAME: APPLICATION SUB DATE
WILLARD OWYEUNG 2531 GRACELAND AVE 08/21/2001
PHONE: (650) 298-8494 SANITARY NO. CONTROL NO.
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CUzo ARCHITECTIENGINEER: BUILDING PERMIT INFO
s u BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I M1cmb farm that 1 am licensed under fCha: 9(commcncin Job Description
Zv.0 hereby Pmd Pmfca per g p
isnsemdmnstardafect. n3onneBasme+.maProrasie,nace,ae.anamyh<enae GE PROFILE SMARTWATER WATER HEATER
in full force end effect.
O u Date CI>x Lic.p
i 3 u y Due Contractor
ARCHITECT'S S DECLARATION
I unaemaand my plans shall be used as public records '
:Nr
i ec c C Licroscd Professions] OWNER-BUILDER DECLARATION
u� 1 hereby affirm that 1 am exempt from the Contractors License law for the
F z a following reason.(Section]031.5.Business mW Professions Code.Any airy or county
$500
F x e which requires a permit to conn,chrepairwmr
alter.improve,Demolish,or pair any sce
-pro t i Lw requires theapplicant for such perms file signed statement, - - - _ -_ .__. _
ingi ai is laddered ptnomt16 dopirivisions.fila,Commitment,License Li (Chapter 9
(commencing ithS me 17") fD son 3 orthe Busnes. dPrf ns Code) 6, �.P, f.�.
m that he is enempi therefrom and the basis for the alleged exemptmn.Any violin on Valuation
of Section 7031.3 by any applicant for a parmitrobjects the applicant to a civil penalty' ,,q Ntsltu t�h '
rof not more than rive hundred do1leas(5500). 5O24pNri` l it PLUMBINO ENERGPccupancy Type
❑1,as owner of the primary,nr my employees with..,as a their sale compensmion. 506 - GAS
'will'do'the work, ad be nm,mra is not intended or cifned"for sale(Sec:](104] - TEST I
Business nand Professions Cale:The Contractor's License Law does not apply to an 507 - FINAL PIWWUM!spections`' '
ownc
r of pmpcny Who builds or improves,avian,card who docs such work nitmclf
or fired for his own employees.provided that such improvements are nni intended or '
'offered for sale.If,hdwevcn the Wilding t is sold within one
i gorimof,mn year of ,u.:,.r • i'•<.:d.r ._ . .
improvtmn,the owner Wilder will have the burden of proving ilia he did net Wild or 1
improve rw wme,ae of side
Lasowner urine pmpcny.am exclusively mmrefe,i witslicensed e Cvat et to
Lemon,construct the projvi ISv.]014.Business ane art,whops ild,br The ves event, '
awl who
Law does nm apply m as owner of progeny who Wild,or impm.aa to the
: . eM_who its Limen for such pmjuss with a conimmon:)liccnscd.pursuani to ilia .. ._ ... ... .._ _.. _.. ..._..._ __:.. .._. ...._..
" _. Cunmoaors Lienee law. ....__ ...__.._._.-__.. _.._... _ .
❑I am exempt under Sem. " ,B&P C for this reason iL't 1, '.:I .14P
Ownci •' ' Dae
WORKER'S COMPENSATION DECLARATION
1 hereby affrn uMtt penalty of perjury one of the following declarations:
❑ 1 have and'svill maintain a Cerifiemn of Consent to self-insure for Workers
Compensation. . provided for by Section 3700 of the Labor Coad for the
giro rmance of be work for h ch thit,pormil' is.ad
01 have a 'll ma nt W k Camps. t 1 -noic Jb Scr-
3TW of the hither de for tM1 pernuan
f ce f theik.f which ih by t's
'sevil My Wmttt s Co pa i 1 mike caorier and Pot cY be
..
s 7 t
Punic
Coif 'CERTIFICATION OF EKEM�ION FROM.WORKERS li; i < .\+`1 i 'y�ts. "li;_vr3� r.ai i. t "
.
it ,CATION OF EXeON `
.• Cin _ afa a lie ompiehd inns pewit is Tor ane mm�erne dmlnars i: .. 1, — .___._._.-
(EI W)car Ica.)
1 ttm l that tri nae m tri any m f the ink f h ch ci - •. ._ _.
mall not employ say pttwm m any manner so ns ie,hecome sualctu he Workenl t.
Cpcnsmie,n Lews of California.Dam," '}
i
'Applicant
NOTICE
.. ... .. .:, .. ...,-: , ... t-..
i NOTICE TO APPLICANT:If. free Compensation of of Labor io de,y should
-
� Z become subra,lyr it.00,h m Compensation Provisionsrhd oftheCute,you muni `
� fonhwiih comply wish such pnivisinns.,,his permit shall be Deemed rmnked.
Z
.. .. .._. _ ... ._ . ...... _ _ _ .... _ __
CONSTRUCTION LENDING AGENCY -
ai-} I hereby tiffirm that them is a r6hitrumion lending age ey Ai th'peharroance j
yi.a nl ilii work fpr which ih s pennn 5 issued(sec.309].Civ.CJ '' '
z '16nder's Name...
'.z 1rnder's Addre
1 elmly that I have read this applicatiiin and Siwe'hot the above inforancro n is '
1 agree to comply with II city and co ry N mencc. d ,are laws relamng
Q V mWld ng con.waion ndh byimmunize p senmives of this city to mtt upon 1
}.W the idove-mentionedproperty fpectin prpos
p„ (W)"rej t-. demmfy and keep h I 'me Cly ofCpen oagaimt IU+nt�.lUI I� OI/t — I•"'�—_---
(Al liabilities.judgments,cosi d expenses which may,in any waysocame against,said t/
V.Z .City in consequence of the granting of this permit.
r
APPLICANT
UNERSTADS AND WILL COMPLY WRHALL NON-POINT
SOURCE
REGULTIONS: i ]$$sed by: _ _ Date
Signmwe ofAlopoeanvconcraness. .'vr Data ' - Re-roofs
�" " HA9 RDOUS MATERIALS DISCLOSURE'o,. "
%Will the applicant car furore building occupant or handle hezoadmi,material
- asdefinedbytheCapitoline,Munici,.[Code,Chapter 9.12,a'11,Health aadSafety
pe f
•" y o Roof'. .... _ _
Cod Sectin�Yas25532(0l t ❑Ns 1 Tri si i1%�' .
_-All.roofs.shall.be inspected-prior to any roofing material being.mstalled.___._ .
m W dmis.athe pplco t future building rrafbyoccupantyse A .AirQequipment devices which If a roof is insialled'with'out first obtaining an ins ection.1-agree to.remove
smith ab ars,<onam t sd Fncdbc pB yAeaAirQ or deviceswhi h g p
Dinner' - - all new materials for inspection.. Applicant understands and will comply with
❑Y, ❑N �"allnon-point source regulations.,, m
1 hI'aaml the"tes boutreqs remcros urWer Ch pre 695 of the
Califon a Hca1N&Saf ry Cade.Semi ons 25505.25533 nand 25534.1 understand that
iflai pbuilding does not currently have a tenant,that it is my responsibility.notify the
uccuam of the rcyuiiemenG which must be met prior to issmnde of 5 Cenihcate of
Occupancy. . .. .. .- . . .
Signature of Applicant Date
Owner or omhonud
Date All roof coverings to be Class "B - - -
"or better
�t
OFFICE - ._ ...