01020087 NO
CITY IL DING DIVEiSIONPERMIT CONTRACTOR INFORMATION:
MALIAN PFkMIT NO. VO
HEATERS INC 01020087
OWNRR'S NAME: APPI.IcAr1ON SUB DA9'E
HAGGARD SABINA ET At 17F-4 NATIONAL AVE 02/15/2001
IONS SANITARY NO. CONI MI,NO
Z O Z° ARCHI'FECI'/ENGINEER: BUILDING PERMIT INFO
y— III.[)(; ELECT' PLUMB MECH
LJ I� LI I__I
ydd
L!CENSfiI)C(IN'I RACrOIZ'S DECLARATION
Iearrly ania„mar la,..lic—ed of Chnplcr9 as ing Job Description
p ao,I..G
F�Cry wish Secfmn Jflfl,p of Divisiun3 of ma Rurinmr and l'mhacrinne gnAe.nnA n,y laenst,
¢ Is in lilll farce and eRcm.
Mae Lmcnsedacs Lie REPLACE 40 GALLON GAS WATER HEATER
°Y° Mae CanlNnlar
w 3 w IV AR IIII L rS )ECI,ARAnoN
G °; undc,',aanA my plum sh.Jl ba asad as pnhhe Icenrds
fwr_
w o o LiaeaFm Prarnssiminl
OWNER-BUILDER... he CtN'ION
o I horehy S...,tam am nxmnpl Gros Iha Cm,trac Cos,Alty I:nv foi Iha
F Z>' fnllax in.all a(Seita,JIDLS,Bus and Pmfcu d Gula Any c'„y a nary
fs0Ill I I ,niu .t rJe I ,Ilsll.(ricipail rally.Irarc
� m arift,to r at, tile ariflWalatf' d fiCrIar, ilea sigaialsit tenon
haat Iprus rt,, lie ir,l oFl Cerfa,wilvs I .L v(Chapero Sy. Ft. Floor Area Valuation
(um.... with SecOan 700rofD's trinoJofthe Hacinecsand Prafasrioas code)
or 111,1 h.,exonPl Iharrfmn,and the brlrix fur,al alleged uemprian.All viollniml
II S¢rmn JID S by.my arldlcunr Iia'ail l a,b]ech dm apptiainl It,a civil penalty
areal IIIaIa d,aa Jilt,h..... nau:Il's(S500) APN Number Occupancy Type
❑I,usownol ofrile pmpmlY,or Inv ampl)yceswin,wal aemdraalar„mPeararan.
will do the k I ll trsl is art illiended offered f -oad see.7044, 369-732101
Bas P-f : Cel n C l .� L d t apply,a as Required Inspections
(,x fn lyW hl p II d a d 1 - AI ,self
r,h for
ail e healasll.. �I I I r l ieAar 502 —' FINAL PLUMBING ENERGY
a0c rd lar 11,owl;l ,w -, he h, l l',6 . „arc w nun a sold w'Ili s Yeol or
"inpmnan.dlaaw ne, lMCr w,Itha”meharden arpa�iad mal he Ali art add ar P.^06 -- GAS TEST
prove lar pa0,rlse A rata.).
❑Laaawnurate.,pmpenY.,mernrlrmClyeal, 507 — FINAL PLUMBING
rtme,,hpt, rjen(Sec.7(94,Baranm
Barnes, ,ad Pfaeriane Cliff,:)Ilse Camarr
mrn
IJmcaast Liw does it rapt,to hu awwr of paps 1,who h,.ai,or fit Proves tlarre ,,
and wha alwes far s mit p jems with a.mnraemiP) facri,f Pw'lana It,me
Canhlw"'O,Licmua Low
❑Ia,n exempt nnd,r Sec, 11&I'C for Ibis roarilriyj
Ow r DatWORKIR SC01111 NS 1110N❑rLLA1tATION
II ly Rt P 'Ila fq.) 11 III Jill yl l"I :
I'll r C 'I C t II K kis
Col p t 1 I by S 391)0 I the Labs, Code, fthe
-
pen In ,uar rnl . I ,to : I.
❑II ,It lardallia Ili I uI I ' dhySction
5]W I11 Iaho,Cal for n InJinn, mkcka whichode if
lit
suad.My WarACrs Colailia oou huwaaee earnertmd Pnllry nnn,M1crum
Carrier Fill,Nr:
CIEWI FICATION OF EXEMPTION FROM WORKERS'
COMPENSADON INSURANCE
('this recut,,aceta nal he erairc¢d a tee permit n tar mit,Inuulred Aullu,'s
(s I00)ar lest.)
I walfy Iha.is,ha perfa"I'a e alma wart:for which mit perm..is isrned,I
.start na,naFl,,y anY Parcaa in an,,inner m as eI haulm,athip"l It,the)VIL",
Canlpear,hion Laws of Caliharria.Date
APPlicnut
N U ICE'r0 APPLICANT:II;after InaAing this Ce,'Iilicnm o[Exuapl.nn,ynu nhnuld
bwon,ro'I'l Io Its Work,”Compensation pravi duns of the Loral Cnde,yaa man
Q fanhwile enlnply wit,ran,pmcivinns or thin pclnla rtaull Fa Acemed recahed.
L
ti VJ a
CONSTRUCTION tCTION LDI
ENNG ACIINCV� lnerenr,farm chart,rare iraa„a-rmati.,a ndins aseney lard”Penannani
of,he wurA for whleh olir ponuir it Issned($u.3noJ,Clc.C.7
W ❑� Lial'rN,me' 7 hcndars Address
L) 0 1 ' ify,l",l'IL III':IF'hlari i Istore hal ]or h f 'mmo,is
I IlA,willII red,an 1 D ard' .Ict, I h l laws rel ting
0 V ton Id'nb co,s,a efit, at Ill utahonm,cprcsanmtivax uP,hit it,m mncr upon
>,, rW tile.h frted pro,crylor aspeclic)i
Eli Q,) n, )agree t d 'f)a I A I I :ole City at C p 1
W Pahl Ie L t d , 'in any way acre ara'm:ald
V Z Calf I,, ,meyre¢c It the 6i n' grI III,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-MEW Issnedb
SOURCE REGULATIONS y: Date
sigaa,are of np,li,ant/Canhaetar Dale Re-roofs
HAZARDOUS MAI'I RIALS DISCLOSURE
W'Illlhaappl.camarRattle mfildingaecrg,alII Aare(3r hanAlC haeardaas muerial Type ofRoof
s delimd by rile Col Municipal Cade.Ch Earr 1).12,and the Habil aad safety
rCade,seer i 2552(al/
❑Yes 1:1 No, All roofs Shull be inspected prior to any roofing material being installed.
Will tile appllCam(or Ratio]hamrlag11111,p„mrweCrta'aaaararder,erwm,[, If it roof is installed without first obtaining an inspection, I agree to remove
Pnithaanrdrnl_e an,eaawlni far,,asdonned by ma Bay Area Air of try Mlia,eareal
,,I? all new materials for inspection. Applicant understands and will comply with
El y”' 171 No, all non-point source regulations.
I hula read the hanmloas materials reyuireiiwats nude, Chapter 6,95 of the
Cal i fnmta IIcaI111&Sit ,yOil sellal,25505.25597 and25594.I anaolstan II he,,
if he budding docs nm curconlly have a raanr,,het it is at,respansihlliry h,nn,lfy Ih,
cenpam of rhe rnpurenwnts whice mast he,ae,prier m iswun¢of a Cenuieme If
or"'l ay. Signature of Applicant Date
Gwncr ar aamarivO agent Date All roof coverings to be Class "B" or better
OFFICE