01080054 CIBUDINmy RoNO
BUILDING NPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20612 CHERYL DR JUST WATER HEATERS INC 01080054
OWNER'S NAME: APPLICATION SUB DATE
MAXWELL RODERICK W AND HAMN-VA 1764 NATIONAL AVE 08/09/2001
NONE: SANITARY NO. CONTROL NO.
(510) 293-9901
Q g0 Z❑ ARCHITECT(ENGINEER: BUILDING PERMIT INFO
'u b BLDG ELECT PLUMB MECH
5'i LICENSED CONTRACTOR'S DECLARATION
Z vJob Description
O z- I hereby affirm that t am licensed under provisions of Chapter 9(commencing P
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FhhSecron7D00)orDivuioa3ofineBusinessandPraressfona, my Code, REPLACE WATER HEATER.
ec m s is into and effect,
(4 0 GALLON GAS WATER HEATER)
o v
License Class lazs Lic.p
O EC A '
3 a Dam ARCHRECT'S DECLARATION
F LL TION w
g I understand my plans shall be used as public records ri 1i ^}g if C_ 6 E
o Lmenaed Pmfrissinnal a H Y 1 2002
OWNER-BUILDER DECLARATION
u�= I heresy a(frm that 1 1. exempt from the Commas Cur License Law for the
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following reuma(Section 7onstru Business add Professions Curb:Any city or county,
E s O which requites a permit A timnrun,aper,improve,demolish,or repair any structure
Poor
ol ante.al req sth PPLcam for such
prism-, flsigned summand.
a is -- that he is licensed pars t to me pm inions of me Contmcro! License Law(Chapter 9 _
(c g ithSecti -7") fDivision 3ofineBusin dProfxson,Code)
nation
or that he is cscmpt therefrom and the basis for the alleged exemption.Any violation
-of Section 7031:5 byany.,,heart for ape.it object,rhe zpeicam m a civil penalty
;of not more than re hundred dollars aSW). Tdb , •s<',. :-o Occupancy Type
❑1,as owner of the Property,or my employees wpb wages a their sole compenmulon, '
will do[be work;'aral the structure is not intended or offered for sale Sce.70.13, 5192
Buslucxfand'Professions Code:The Commaor's License Law does not apply to an 506 - GAS TES'IRequlred nspechons i, "
ow
r of properly Who Wilds or improves the...and who does such work himself
or through n' own employees,p a d mar such improvements
- - - - ' tmpmaemenl. ae not e aor ^EIbR d for ''I '1(hth bu Idng or improvemem is soldwithin One year of _ 5 _y.?
completion,the owner bs'Ider will have the burden ofpmtng that he did not Wild or i "� LUMB I NG.
----- --
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improve for purpose of sale.),
—
. wecIYsf7lnsnnecnfhi;amsfiong with contas t r -u
oovus the pmyct(Sec7044 Bun< d
Profession,Codes)The Convectors •"
- License law does not apply to an owner of propcny who builds or improves thereon. "" r -add -
). who comracts f c_h Poleos„wth'a saturation.)licensed pursuant mth .....Cmmmsors LccnscLaw
- ❑1 am exempt under Sec PCfnhisreon . ........-Bu'LDING __
0
t- wrer Date _
....... ..... ... . ........
-
” WORKER'S COMPENSATION DECLARATION
st
1 hereby affirm under Pe Try of pi�rpiy mu,of the following dal rations.
❑ 1 ha ti and will maintisima Cenific re of Consent to elf-inssure elf-insfor Worker'x
fi
" . rteanni iti-, 'ded f by Section 37W of theLabor Code, for the
ce oftheworkforwhichthis p cout is issued.
❑1 have and will m ur ain Workers Com6sprop ori Ineumnes,as squired by Section
37W of the tabor Code.for the Perfo}mence of the work for which this permit is
isidetl.My Worker'i Coinpensatibn Insunnbe carrier and Policy ndmber am: "
Policy No: t - a . . . .�..,.- - __ ........,...
tr ;CERTIFICATION OFC%EMPTION FROM WORKERS"
CONIPENSATION INSURANCE I 1 1. 01
}(Th. non nreti not be rntnvlcaW one Permit is for on hundred sonars .' !it7 '(
ISI WI or lcss.l -
.� of the kf h2hth-pc 'us irsucd.l •. •• ••� �• •.•
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shall hot employ any ismon in any manner so as to become subject to to Workers •`- t s is t)•
Compensbtion Lows of Califomia,Dam
._Applicant . .,,rn' .....0 ... . . .-....
"NOTICE TO
APPLtI =king m Certificate f'E oop
z subject W ter C pni p sio-ofthLabor yu mainQ z st
_ .rl
C -fdnbwunrnmply such pmv stens or thvperms shall be drT .-- ok--
CONSTRUCTION LENDING AGENCY "--"'-
Ci, 1 h byaffirm this there ici which ' e n.swo 1 drag Hcy for the peror ante thtprims island(Sic 307'Civ.Cj
Lcmd Nhu -- . I -: _ .
-
a.na .
Z,
)`D' .1 trinity that 1 have read this applicmioo and .in that the above information is
I agree to comply-,with at city and county ordinances and state laws relating
O.LUs7 to Wilding
t!ionitou dp andhl bYsautho ze p ft rte city to upon /1
-Ire. P hWe.
F.t-Cn (Wel B t - Jen fyand keep harmless'th CtyorC pert' gains-,
V1 Cit Ice jdg est t d. ptoses which taY'n any y cage again."said
V Z
City n c. '
yuencdoP the 1p t g of th sacroL'
(APP(ICA WUNDERSTANDSAND WILL COMPLY WITH ALL NON-POINT s'
SOURCE REGULATIONS. i4 it rIssued by: ci Date
S,gnamre ofAPplicanUCommcmr ..,'',...L .... .. Dmf,-. ' 0,S
HAZARDOUSMATERIALS DISCLOSURE'Wn mepprcam rtrebuilding.p t reorn dl 'hasvd us rmtomil of Roofas d f ed by th Cupen n Mu m frI Code Ch pt 9,12,a d th H lth and Safety1 } "it lr p .j! t r ,1,Ox `oofs shall beinspected,priorto.any roofing.materialbeing installed.___- .
Worn rt co t t w b ld Bot a myArs. v ao a i mm, oof is installed without first obtamiDg an`inspectlon,'bagree to remove
mth rdcont t dfinnd nYth &yAreaA Q Iryhlani estDi" w materials,for ins ection. A Ilcant understands andwill comply withNp r P PPlit ',. . '.,: on-point source regulations. -
1 havviildbc hared aoinal- iq - t. poor,Chapter 695 of the
Cel I m a Health&Safety Code.Sections 25505 25533an 125534 1 understand that
if the bddding dust,sat currently haves imam.mar it is myresponsibildt to notify the
dccuyampf the nquimmems whic'in uu be opt prior m issuance of a Cenifnm of
' 'Occupancy '
Signof Appli _ Date
y Signature cant
._ .. - . _ .. _ _ . .---
sownriroranmonudagent Dam All roof coverings to be Class`xB" or better'
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-, i.,.. .•r... ' ,..: . . . _ OFFICE..- . . ... _. - . _._ .. . . .. _.. _