01070105 t, 1 CI BU DIN. o: ...
s
CUP,ERTINO -
c olvlScoN.,- PERMIT'.. n ' CONTRACTOR INFORMATION
" t BUILDING ADDRESS;"
I, . .__ . . ,q , ew . PERMIT,NO
0WERHEATERSONLONYHILLSLA107
.1048 '.COL ------
c-rn
APPLICPTION UB DATE
�YI2 NORBERT'`AND HELENA 500 AIRPORT BLV 07'/232001
PHONE:- ` SANITARY NO. CONTROL NO.
(415) 349-3747
O'er Z t ARCHITECT/ENGINEER:, -
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Z o= LICENSED CONTRACTORS DECLARATION,9 noJob DESCTlptlOn
oN_� In by rf NtI r -m d p fen ptrmmenent,ing REPLACE WATER HEATER.
wNS [ VOW nin } fN'B di fes ons Code.vndmye
(40G GAS WATER HEATER. )"
%
XO,U Dan,. • n o Conoacmr
m 3t y' ARCHITECT'S DECLARATION '
CS�O< 1 undersund my pans shall be used as public recoNs
w p O Licensed Professional
°'°' -OWNER-BUILDER DECLARATION'
uai I hereby,affirm that I vin creal from the Comrac[ors License Law for the I -
�?Q' f II gon.(S t 7031L5,BusinessdProfessionsCod Any city pocounty•,
2 m O which requires a parrair[ i [:alter,improve,demo) h or napauran,stromme„
i3 _.that
mm encmgw lho cion] the_ PPI ark ft such Parton is sgnedeta [ 1 - - -
to l Nepfo i. of the shalmli License I_e:v(cM1 pt v Sq. F[ Floor Area ., __: Valuauorc '
+ N ort licensed Imtx,o
r IXM17 of Di s n 3 of the Bushes and Pmfosslon C d) , -, a. .ra• 'I ,7
o N[M1 ,p[,he efmm and Ne -basis for th IlegeJ exemption.Any vI non tl "',
y f s 70315 by ny, ,hi im.,s t bj ca N..... .t.............tr ApN Number _ tl Occupancy e
+ 'l lotht re Nan By has deoi�ors lasoo> j , 1 1 {"',? r ! upyT'P
c.
506»,'- rvGASATESL ':.
L'DI n ofth Pr party,or my employee with g ,auhe re decompcnk i .-.'.• - - BIN .-ENERGY —.- -^-.•.. ---------
-will the work and-the a,Code to is t t dad offered fo ss le apply
]o a '- - � ,Business aha pore, n.coae.The Contractor's License Law does norapply,o an rI]2egwred Inspections • '
maller,ifImpair,Who Solids.,imp es Neen and wh dock,mcla,voirkl if 507 FINAL PLUMBING
o through h' employees.provided that suchimprovementsintended or
7-offired fo,xile7.11,honvocker,me b dd n8 r mpro emmn is Id abotin-one y f ._.._. . .. ._. ..._. .. ..._. t _ - ...�.....
completion,Ne asanmr-milder ill have the burden of provng that be,mairmbuild on3
i p for p tp flat,).. 9
- _ .. h�
11[,-as..herof the p pny clot lycnuvtmg with licensed t t ..
construct th Porkers(Sec]to s B sl ass fe.,on il,o)m, ,Connector's, _
tr t n [apply to an ne kid,h property h h Ido alp es chanson,
111.'
s L L does ns for ch P lees.. N va[ rts7 I c d P ant[u th .,_,_ _. , ... + ., .. _„...._
Contractors❑t e , sc La ... ,,and h c nt a
p, d S i 3 T`� t '-' ' e&PCT far n � .'
WORKERS COMPENSATION DECI ARATION
r Ih by orderon penalty fee7pryo c fthe' II ngde Iv nous
It
❑ Ih n d 11 a mi
mor .'a Ce ife to f Co t[ [elf .sure for Worker's ,.
, .
Com R union. asp d d for by S t 31W,of the Labor Code. for the
f ce
dchowark f whiah lhs pe ,"sued.,.
❑I ha e andwill m W Wo kers,C p ai 1 e c rcgb red by s Tion - -
3700 of die La a n Chile,firrilhe,eank Hhe w6 k t hmh this.Pe it is
_. is u d My Worker's Co P [a imajoinke mmixi and Policy number'
-'Carter . .,.T:,E ,. ' 's; .P hey No, Ji,' I � -1. ,'Til ,.a .»,•,.
'
tWkI CERTIFICATION OF.EXEMPTION FROMWORKERS
COMPENSATION INSURANCE } )
- fill
_
•-.P (Th secwin ea [b'rcompleted' f N forms f n h d d d 11 Y L s qef
`,-. Til t. '`�
II [fyNs e, any
une (i k[becmhNice the ed,l
sh II not employ any p r, n,n dny manner o s m became subJen m the Wmis
C d Lvw f C I Fordmf Ont •” x -
:e Appl m cam... . .. .. -_.. .. ._
! :NOTICE TO
CANT If,after-making[h e Certificate f Exemption,you
should
b subject I. 'Co' et [h Wb Code,you must
fM1thll bed d revokedpy p p
'", ONSTRUanLENDING
CaI hereby w,mcontenc for Ne erfomne
of the k'[ h+hth perm.: 6[ed(Sea 3097 Cie CJ
Leader's Name
w7:z Lender's Address t.- o „it
..,. [. a
1 r,ma Nm 1 read Nis appl nal nd state Nees and
b e infommt of g
., ,�+,F
current.1g cmrrocmply it all<ana mi
countyorNnas ndsalt laws relating
-,Q-V [ building g io t ❑h by huN 'ze representationbf th. sty to eater upon 1 _
'[h b t .l p ndmfor'f ad par,harmless
les s - est -
es,judagree msc d ripen dk i by I sN C a he penino g
4'Wliabilities,1 judgments, is d expenses which may n any way acme aggro t vld
(,1 ,'� City m consequence f the gm,mg of thispe t.'
APPLICANT UMDERSTANDS'AND WILLCOMPLY WITNIALL NON-PONT""
SOURCEREGULATtoNs Issued by: Date '
S Bnatu e'fApplic 'JC CSnor; f l `.�:,.• �Dm Re-roofs ,..•.,
' o s I ,iHAZARDOUS'MATERIALS DISCLOSURE N, I
Wll the,pplc n,o F[reb 0d gm Pott on dlen m , t 1 -Type of Roof- .. ,.,.,.».
a�defnea by,h C pelt. M n tpalC d Ch p� 912 andN H IN rids f,,
�.
Chile
SDy25532 / /. _.
All roofs shall be.Inspected,prior to»any,roofing material being.installed.--, „..__...
• ”' wtu m ppl t r, n'ia g < p t_ q p t dwhichl If a roof is Installed'witfioof first.obtaining an'inspecnon Tagree to,
remove
e th rd t t Jf dbyN ByA A Q ItyM g t
D tr taY ❑No all new materials for inspection- Applicant understands and will comply,with '
all non-pomvsource regulationS.
y' Y 1 M1ov,.TrcaJ:Ne hazardousMu[envlsrequirement under Chepier 695 of Nei 1
+C I f nw Health&S f,y C J 'Sect o 25505 15533 a d 25514 1 u de,land that3
".i buddmgdcm, tmrremlyhaveat m4hht eis my eponsiblity to notify the,
r oc pat of the req ms whi<n'm t be et'prinr m !once 1, a Ceirilmate-of -
Occupancy I r
' Signature of Applicant _ _ Date
Owner amogzea ago t Daly' All roof coverings to be Class "B" or better
_' - 'OFFICE....,