01080133 CITY
BUI DING
BUILDING
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMUTING.
10407 COLBY AV WATER HEATERS ONLY 01080133
OWNER'S NAME: APPLICATION SUB DATE
PAULSEN EILEEN F 970 E . MAIN ST, SUITE 20 )08/28/2001
PHONE: (415) 566-2209 SANITARY NO. CONTROL NO.
O m z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
O BLDG ELECT PLUMB MECH
�< r=i LJ I_J GI
LICENSED CONTRACTOR'S DECLARATION
I heab (firm that i am licensed ander f Chat 9(commencing Job Description
ra prvvismnsa per g
=C� is in Jul] on701)(0.4 Division 3.f,be Business and Professions Cale,and my licence REPLACE 40G GAS WATER HEATER
m g is in full I...and cffcm.
f5 Date Clas Lia.B
i 3 a v Date GDECLA
LARCH it be
u e DECLARATION
O g I undemand my plans shall tie nxd as public records
T
Licensed Professional 6M, 1 hereby affirm th
at I amB emDEfromE Comnu�or's License Law for the
I_3 a following reason.(Seaton 7031.5.Business and Professions Code:Any city or county $700
2,x a which q Permit t consumer,al[ p demolish,- r repair any structure,
ne
wap_..pro
e Io m 9cing wit puffs and ld the pro Divi of the C v 1 e V ante Law(ChapterY �$ p rQ t }
(commencing a with Section400anof Division n J of the alleged
and Professions Cmc) f f i"d : '3 1�Ly. QJ�t�V a"�qt f!4.# L -t' S- Valuation
I or that io Is exempt lAny Applicant
lfi and the apes for the subjects
thif eiempdto Any violation - - t
of Section 7031.5 by Any dred deft for a permit sublems Ne applicanno a civil penahy-
:afno,mommanfiseoanareaammrslasoo). 502APNA�i � pLUMBIN ENBRGYOccupancy Type
❑1,as owner ofmc .,ml,Dray employees with wages as theirsole compensation„ rnr _ r. ;
-will do the work,tied the structure is not intended or offered foPsole(See 701- A 2s.
`Business and Prb(essions Cmc n
The Commor's License Law does And opply m nn' 507 - FINAL PI�dT4s6.ectiohss ,
awthr ofh his ow Who builds w improves at Inc m and who doer such wah himself
or through his own employees.provided that such impaveiwnrs art bar intended ye r or
�,b(facd for sale.IL haweveq the buildinglem is sold within one � f
or impmvem yew o
completion,reavthe owner-builder will have the burden o(Pmving shed he did not bode or FINALE D
improve for pomose of sale} ]
�i %ithtimnmdconuwwrsta _'.-.._...,ILL ti _
❑1 a a pe she P(Sm. am Business
vela d professions
S E P 1 D LO O I. l("
..
construct the project(Sm.]1.a Bmmeo,and n, ons Codr)The Commmw i
L L dao net apply m an owner of property won bald or Improve,thereon (
f' _and. M1 commas for such projectswith a commissions)licenud porsoam to the
0ca1 amexe Limnsclsee . BUILDING ... ._ .,.. .. . _ _.
- ❑lam eaemptuma Sec. " •' ',B_&PCfw skis reason
d: �.�.,:, ,':
" WORKER'S COMPENSATION DECLARATION -
I hertby afOrm under IrenaltY of Icryry.ane of she follvvin6 dcdanon
tis.
❑ 1 have And'will mainuin'a CeniGcam of 6.t 1.elf-inwm for Warier,
Compensation, as provided for by-Section J]W of the Labor Code, for the
perfonnmee ohb'e'work,for whish ILis permit is issued..
1 have and xill'ma timin Worke's Campe. dun Inswerince,aslictuired by Scnion
37110 a the Labor Code,far the performence of[he want,far which this probit is
issued MY Worker's Cmna Atam•1.6 mrwe carr ar and,Kolucy,number am.
-'iIasi,
amer ` -Poky No RT ( i♦
n. (.
tis CERT 1FICATIONOF,EKEMPTIOWORKERSj','•; " •+ G 3- v ,.
lr, COMPENSATION INSURANCE E
'I .1h.9 ,- Q4:' i'.aliCl tilt-
("''(This section need nal tie compicted if she permit is(w one hundred dollars '' ' j
I ISI00)or fess.) I _
shall not em to any
„
I mfy thinny in m in an n is of m s or to which u petit S lssum L l _
P Y nY perwn m any maim ser to become mbJect m the Wohers: ,,1 T``1 „�tA j'sJJil:f.. -
Compeoa6tion of California Dam 1
• -Applicant'::”.. ..::.:.... ..........,
NOTICE TO APPLICANT If.after midnnglhts Certificate of Exem lon.you,houldi
licca bJ l ,the Worker's C ",ere d- pm n ons of the huhor Code,you amt
0 0 forthwith complywnh such provisions or this permit shall be deented revoked. - t
....., -
_._.-,...___, . _-, .- _ . .
",•�L`v" .'d`CONSTRUCTION LENDINGAGENCY;"".. .. -. _.... _. __ .. ._ _ .. ..._. _ _ ._ __ .,i i•P' .. - -_. ___ ._
I hertby oRtm that she names on lending agency for the ferformanm I I r, •I
W, of she wk for wh'ch so perm��I Is.tied ISee'3097-Cie.C)
Cr Lend Add _ _ . : __ ..__-_• _. ... ..
.f, 0
.1,l -ifythnlhavcmadthisWlicationamswet fficabveinformation rsi
correct.I agree to comply with all city and county ordinances and state laws relating _
0 O'
to buildingconstruction,and h by aufficeire,repmaen i5es f this city to enter upon
'[T]
the above-mentioned property f :Pis nP rp
-(Ss agree io save,mdemmfy and keep harmless the of Cupcmno dguinn
(ii!) liabilities.es.judgmcros,costs and expenses which may in any way ocrne Against said
V z City in consul of she gaming of this permit."l-
'�' ,APPLICANT UNDERSTANDSAND WILUCOMPLy WRH ALL'NON-POINT
SOURCE REcut.AnDNs.;;, Issued by: Date
Signowre' fApplican/C vachr,. "' f :Date';: ' Re-roofs
v-•,
HAZARDOUS MATERIALS DISCLOSURE -
.:+ t Rl the it'lieam w furore fat 1. 'occupant vole arhvdle heaaM ted 1 .TYPe Of Roof
;as defined b,,hA Caption.Municipal Code.Chapt r 9,12,and the Health And Safety' --
Cm4 S❑c Yon 25512(e)"' ❑N a 1 It iY.'ti, y f , I"';_YI 1F+` a2i a x �,<:Li IF ..{
All roofs shall_be inspected prior_to any ioofing.material being installed...._
' LW ll the applicant or future baIding w pamuseequpm nt or devices,.nch.. If a roof is installed without first obtaining an inspeetiori;'Pagree''to'remove
em s h Mous a c nw t.as defined by diBay Are.A Quality Management
Milicil _all new materials for inspection Applicant understands and will comply_with-
-ill lf OYes / '' I :`,O No l t '., - s ,. .. all non-point Source regulations
1 have rend,Ne herard a materiels regmremcnu ocher Chapter•6.95 f Neo i,l•.I I-
C.1ili mm Health&Sifny Cme:Sections 25505.255]3 and 25534.1 understand thus i
ifshe buil,ing does nm emrcndy have amnans.Ihn it is my mrs,rsibiliry to not
the -
P 9 Ss an f a Certificate of r
wco tied of, r '
o"ups ay requirements is n h mall e t r w i signature of Applicant Date
....e. Owncrw ausnoriud agrns,i' .„
All roof coverings to be Class "B"tiffDna.. :
better"
OFFICE. . ._ .. __... . . . . . . ._...._. __ .. _