01100057 INO
CITYBUILDING nrvERONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7643 BERLAND CT JUST WATER HEATERS INC 01100057
OWNER'S NAME: APPLICATION SUB DATE
Alk GHELICHKHANI SHOMIN 1764 NATIONAL AVE 10/10/2001
PHONE SANITARY NO. CONTROL NO.
p (510) 293-9901
W O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
B m d1.DG ELECT PLUMB MECH
Z I'' I hereby ulprmEiha ED um l coed code•prov.Cres of ChaPecr 9(commencing Job Description
RATION
'yt° with Sen;on]00)ofDivision3efthe BusinessendPrel'e"ped,Corp.add mylicrnse REPLACE WATER HEATER
is Licemal le,,orce d epttti (5 0 GALLON GAS WATER HEATER)
;Wo6 Lice Class Lie.r
1 0 O U Date Contractor
ARCHITECT DECLARATION
I understood my plans shall he used as public records
i �
r 6 p O LicemeJ Pmfessianal
o� Oat I am eUILDE from the RATION
w 1 hereby s(Sect that 11. exempt from the Cocoons Co :Any c law for the
C 3 0
following reason.(Section 703 Construct,
BusinessandProfessions Code:Any city or county
be o which requires n permit m toms h t,alar,improve,h Permit t ore pair any swemre
pat he slicensed
issuance, medtothe meapplicandvismdof The Contractors icenseLw(chgned temetn
a a m
That hers Bee with Season 7000) 1 Division
3 f Contractors sale law ons Code)
S R Floor Area a t •a ..
Rommcneisg'.wen theionma and the basis o the
leged
dexcept on.An vi coag t 't,I x\ , '.9. t '•l v l\ Valuation
or that he is 31.5 ht raenefram and the basis for the Subjects
the
to.Any lineation
or not Section7031.5five
any udreddll ($50nnit suhkns Oreapphcum roacivil penalty Occupancy Type
,if not more man five nananea anaars rsaw). rte e
°1,as owner ofthe property,or my employees with wages as their sole compensation,
will do tlm work;and the strnnure is not intended or opened f r sale(Sec.7044.
Business and Professions Cade:The Contractor's License Law does not apply to an 506 - GAS TES7.Required Inspections
of pperty Who Wilds or improves thcneon,and who noes such work himself
powder through his own employees.Provided mat such improvements ane nor intended or 507 — FINAL PLUMBING .
offered for sale.If,however,the W llding or improvement is sold within one year of -
Iompinlon,the owner-builder will have the hapho of proving that he did oat build or
mprove for purpose of sole.). /� r
co L as owner of the (Sec.
T,oto eosin ivdy d Pmning with I;cense.e C.rdado
mews mo does
(Sec, o, a Business and Professmb Cared rroam es Oc m in,
Little law noes not apply m un owner of pmpeny who build,or improves thereon,
dna who conuans for such pmieas with a ronwnogs)I;anud wnmm to The oe
Conunttors License Low. p _
°1 am exempt under Sec. B&P C for mire moron 9 90�� 1 .
Owner - Dam G
WORKER'S COMPENSATION DECLARATION �I ®
I hereby affirm under penalty of Perjury one of the following declarations: V I I��
❑ I nave and will maintain a Certificate of Consent m sel4insure for Worker's
Compensation. as provided for by Section 37b of the Labor Code, for the
- performance tithe work forwhich this pennit Is issued
111 have and will maintain Worker'sCompensation Insurance,as required by Station
3700 of the Labor Code,for the performance of the work for which this permit is
.:. issued.My Worker's Compemutioa Insuranoe easier unJ Policy number are:
Carric2", t i r t; ' ''Policy No: a .r T'" `'� t a S• ( ,'\,. :t.. ,
CERTIFlC,TION OF EXEMPTION FROM WgRKERS'I -
COMPENSATIONINSURANCli' .
(This section need nm W camplemd i1 the permit is for one hundred dollars _ `-' It, `
(SIO)m Ins')
1 een;fy that in the performance of the work for which this permit i3 issued,I n
shall not employ any person in any manner so as to become subject to the Workers
Compensation Laws of Califomia.Dam
Applicant .
NOTICE.TO APPLICANT:If,afar making this Cenificele of Exemption,you should
became aupcea the Workers Compensation provisions of the Lalmr Code,you as,
z (0 m foMwith comply with such provisions or this permi t shall be deemed revoked.
F 4 CONSTRUCTION LENDING AGENCY ,
as ' 1 hereby affirm that there is a comauclion lending agency for the performance
of The-wark for which,his permit is issued(Sce:3097,Co.C.)
'Q Lender's Name'
z Lender's Address
0 1 certifyagree that 1 have need the application and store that the above maws mins is L /� l / •9 //_ 'r Y� /VI/�t� — O
F" t
correct.l agree to comply with all city and representatives
entatives add state taws relining /l/' U/V•rV�/Y lU(-(-/�l�/ �/
Q V mbaboingeonswai proper herebyrtinspection Tepnscnmrives ofthis cirymenmr upon ////
Cis
the eba(We)ve agree
to property for inspection ad kn purposes // a�r�
En (We))age judgment,me.cost Tiee e,pers swhi hamyinless me Cityof Cupeni.ln.at ins,said //
ti liabilities, equencecose and e g of this
which may in any way aecrve against said
V ` Cry in consequence of the gnm;ng of,his permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOURCE REGULATIONS. Issued by: Date
Signature of ApoicantlComncm, Data Re-roofs '
act
HAZARDOUS MATERIALS DISCLOSURE.
Will the applicant or future building omupant atom arhandle haiaNtms moment Type of Roof
as defined by the Cupcnimi Municipal Code,Chapter 9.12,and the Health and Safety -
Cude,Seined 25532(.)p , l '
❑Ya °No r'' All roofs shall be inspected priocto any-roofing material being installed. _
Will the applicant or man,building occupant use equipment or devices which If a roof is installed)without first obtainingan inspection, Ire pee to'rernove
emir hamNoos air Cambodianantsaz defined by the Bay Ara Air Quality Management I (�'
District°^ all new materials for inspection. Applicant understands and will comply with
YeE °No all non-point source regulations.
1 have read the haurdons mammals requirements under Chapter 595 of the
California Health&Safety Codr,Senions 25505,25533 and 25534.I understand Thai
H1W buiemng does cotcurretnly have amount,mat i,is myresponsibai,y 1.nmrcy the
accidam of the mpainenients which mus,he'ma mm,m;ssumme of a Cedifiam of
Ocsvpancy. Signature of Applicant Date
Owner a,amounted agent Dam All roof coverings to be Class "B" or better
OFFICE
I t ;