01070103 CITYBUILDING
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IPERMIT CONTRACTOR INFORMATION:
B L 'G 1 lit & - PERMIT NO.
��11ITTER OAK ST WATER HEATERS ONLY 01070103
ee03
°�N�NDREW K ET AL 500 AIRPORT BLV A07/23/2001
PHONE: (415) 349-3747 SANITARY NO. - CONTROL NO.
D ARCHITECTIENGINEER: BUILDING PERMIT INFO
�,�— BLDG ELECT PLUMB MECH
��y z LICENSED CONTRACTOR'S DECLARATION
'� Ihereb affirm Nail amlicenscdundcr Tena ter9(commencin Job Description
ozFo wnnseedo 7p)(SPofDivi,mnrnnneeasine„��ne�oir,.mn,codaanam Bcen.,� REPLACE WATER HEATER.
fix= ISmfmlonceandInert' (40G GAS WATER HEATER. )
m w a License Class Lic.k
F L S.y Date Contractor
ARCHITECT'S DECLARATION
1 understand my plans,hull be used as public records
Y'
IF n 0Licensed Professional
i OWNER-BUILDER DECLARATION
u'S 1 hereby affirm Na,1 am exempt from the Contractor's License Law for the ,
following mawn.(Section 7031.5,Business and Professions Code:Any city or county,
o which require.,a permit m eomtrucCalon,improve,demolish,or tepai...swaum
U,3._..prod is iscrame.Jilso requires ling.,litarmf hpcnniu fl l edswtemcnt ,_ _ __
hat Be I scupursuant Ind) P of the Confounds License Law(Chapter 9 mSq: FL FloonArea • , . ) Valuation
(co n8 with Section]000) f D 3 f the Business and Professions Coda e l us
or that he s exempt therefrom and the basis lar the alleged exemption.Any violation r'2
of Section 703 by any applicant for a perdt subjecu the applicant in a civil penalty
.ofno,mare than r.ehundred dollar,Soft APN Number _. ,.. Occupancy Type
0 1.a,owner of dree lorriscay,or my employees with wain:,IS Rui,vote"urper'stmn, 502 — FINAL PLUMBIss
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will do the work;nnd'Ne ntrunure'is not intended'm mf red-for Sale(see.]Bu, 506 — GAS TES --
Busineand'Poriessions Codi,:The m
Corcmr's License Law does not apply to an 'Required Inspec
owner of propeny Who bit o,intio.S.th d whod h work himself 507 — FINAL PLUMBING
m morugh his own employees,Provided that such implov mons mt not' tended or
offered Tor sale:If.hoe he bmildlnig or irufoo,,,.Foru�I, old lin ye ........ .....�— . . _. .. ._.r ....__ _NO,V._ ___ ....
-A.pp
completion.Nc owner builder vitt have the burden of proving that he did not butt or OZ ' •-
improve for purpose of sated,
DI as owner of the Or°Pcny am exclusively contracting with lid contractorsto
construct the proles,(Sea 76w owners and Professions Codi The C nt actors
a; License Law does not apply to an owner of properly who holds°r'mparves thereon. -
' r and who '.License Law.oh Projects wiN a connadnnsl.IicI . pursuant m.the
Contmcmrs License S,u. ..
❑lei cmptuWer Scc:' ,8&P C for this mason ) ). :•t ' ,a;
Ovine F..`Dal' - ,
m WORKER'S COMPENSATION DECLARATION
I hereby St rm under penalty of perjury one of the following declarations:
❑ 1 havc'and will —Irwin a CeniOeme of Conn,to self-inmre for Woker's
_ CotnMnsdion.aa-provided for by Section 37W of the Labor Code, for the,
wrorummic of the work for which this permit is issued_
1 ❑1 have .it will mainmin W°dei,Compan,atmn Insurance.as required by Section
- _ 3700 of the Inbar Code,for the performance of,he work for which this permit is
its u d My Workers Compensation Insumuce carrier Find Policy number
Came 1:r' s '.7 t_ 1 Pol y No. ..
Tt CERIFICATION OF,EXEMPTION FROM �!. 1 S +• a�
,. .,,.
COMPENSATION INSURANCE
tB•c`• (Ths sectiribimcW omit be'nmmpined if dine Permit is for one hundred dollars Vit,.a 1•1'_ s
(SI WI or less.).
"e 1 certify ibar in the pep - ftFe work for win ch tin pe t"issued'1 .�..._•., . ._. ,, .- _ f T ._ _ _
snail t employ any.pe on in any mamner sou to become sublen do the Workeri • -.1�V.•. - -
'
Applicant
ion Laws of Colifnmia.Dam;
Compensat _ t .
'NOTICE TO APPLICANT If,aft k lithe C n r ar or Pr you'Should
z hcc blest t the W kef Comfericution provisions of the Ladfor Code,you mus,
a .
OO fonh tin mply with h pro °m a or N'to t shall bed cd revoked
7.,
a.? `CONSTRUCTION LENDING AGENCY
1 h by !f ,h d m - < q t le din6 n6e y f Ne performance
n. of the work for whwh this permt is issued(Sec 309],Civ.C.)
L"Q L'ender's Nitric-•.• .••. .sy. ... :._..:.,: J... .._ .... __. _ ._... _. f..
-� Z 'Lender's Admevt ... .-. .. ... . ._
1 certify that 1 have read this application and state Nat the above information is
�,of E-: eorect.I agree m comply with all city and e°umy mdina res and xmte laws relating
V .
in building consoucdion.and hereby III repmseindives°1 dhi,citym enterupon
[7] the ab os d d fimpeny ficompectimiP tpn es.,,
(w)ot Save,under 'ry mot k gip ha ml the C ry'tirc.pernim,against
to
liabilities.judgments. is d expenses which y in any y ggm,t said I
U z
City locuru bf din g w g()f thi, ,.I.( -L
-'� APPLICANT UNDERSTANDS AND WILL COMPLY WITHALL NON-POINT
SOURCE REGULATIONS.t'. Issued by: Date
Signature of Applicamicontmctior ."' r•, ;L' 'Dire` Re-roofs
" HALARDOUS'3Lf1'ERIAIS DISCLOSURE
w'u the pplicant o hu w laing«e p „tore ar,n al n iataan,m,mrial ... Type of Roof.. ..
as defined by the CupemnoMunm,pal Cal,Chapter912.and the Health and Safety kn
oY
CodaSectcut 553.(.) - , •s s. i .... :It. . .
i r C1" -All.roofs shall be inspected prior to any.,roofing..material being.installed.
Atsill the applicant or future hudding occupantn,ee9np t or devices which If a roof is installed without first obtaining an ins ecuon,d agree to.remove
ernh bcontaminants- as delimd by the By AreaA Quality Mmupement g P
°° all new materials for,inspection.,Applicant understands and will comply with
.
°No all non-point source regulations, . ,, ,,.1: , - -' --
1
have it the'h v d mmerial tequ end,under Ch ix 6.95'of the t
Cehfom a Health&Safety Code Sections 25505.25533 and 25534,1 i nderstnd that
"cif dine,builJin6!1oe,nod curemly hmedmnanh Nmit is my responsibility to nbtify dins
acupam of the reyuiremend which ruin be tun prior m issuance ofh Certificate of
Occupancy
Signature,ofApplicant Date
t owe o ,Nor da g , D„e All roof coverings to be Class "B” or better
' OFFICE"
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