04100109�z
Z'
fkl
1
J
�U
r
F,
V
CITY0FCUPEWI'lN0
BUILDING nlsry PERMIT
TI2- GONAC tOR INFORMATION ., :
.v'i d3.
BUILDING ADDRESS:
JUST WATER HEATERS INC
PERMIT N04100109
1361 COLUMBUS AV
OWNER S NAME:
PERMIT ISSUE DATE
ah
HARRELL BELL
3400 INVESTMENT BLV
10/14/2004
HONE:
-
SANITARY NO. CONTROL N0.
41
(510)293-9901
ARCHITECT/ENGINEER :
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Op
w
LICENSED CONTRACTOR'S DECLARATION
Jobb Iryypp•i444o
U
1 hereby affirm Ilial 1 am Iittnxcd under provisions of Chapter 9 (commencing
hereby of that I a hapten 9 commencing
(�
W
ofcensed nde and Podficxprovisions
with Section of is
in full force and effect'
IIt1Lr.'�' ay�Jga
REPLACE WATER HEATER. tl LED
M o
Nal
a«m class Lie,.
Daly ConDELL
(4 0 GAL GAS)
a
AR CHITF.CTS DECLARATION
TS
1 understand my phos shall k used as politic records
��� /� 2U�4
u U
ot,
Lianud Professional
g
OWNER 5BUILDER DECLARATION
FO
a i
1 hereby affirm Thal 1 am exempt from the Contractor's Licenac Law for the
(,/\Q�
®8
0 o
following reason. (Section 7113 L5, Business anJ Pndeexiuns Cnde: Any city or vnunty
01 U I'�\V(II�I
Q_ �
which rcquires a Permit to construct, alter, improve, domnlch, or repair any structure
Y V v
iy
prionn its issmam. also rcquires the applicant for such permit to Glc a signed statement
that he is licensedpursuanttotheprevisionsoftheContractor3Liecrselaw(Chapter9
Sq. Ft. Floor Area
Valuatll�1921
..0
PQ
section 700(d Diveaan 3 the Business ProfessionsCode)ar
(commencing with of of and
_
that he is exempt mcmfrom and the basis for Ne alleged exemption. Any vinlatian of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
APN Number
Occupancy Type
P Y YP
nos are than( hundred dollar, (SSW).
36204005.00
01, as owner of the property, or my cmployca with wages as their sole compensation.
Required Inspections
will do the work, and the strucmm is not intended or offered for sale (Sec. 7044. Business
and Professions Cade: The Contractors License Law dors not apply to an owner of
p,O,rty who builds or improves thereon, and who docs such work himself ar through his
own employees, provided that such improvements arc not intended or offered for sale. It,
however Ne building or impareverrocal is Sold within one year of completion. one owner-
builder will pave the burden of proving that he did not Wild or improve for purpose of
sale.).
1. as owner of me property, am exclusively militating with licensed imalmnors m
conswct the pmjcct (Sec. 7044, Business and Professions Code:) The Contractor's Li-
.
cove law dices not apply to an owner of progeny who Wilds or improve thcmon. and
who commands for such pmjccu with a contranmf(s) licensed pursuant to d¢ Contractors
Limit. Law,
❑ I am exempt under See. ,B& P C for this reason
Owner Daw
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of Injury one of the following declanidons:
1 have and will maintain a Cenificam of Consent m ne161rrmm for Wmoo'sComlwn-
.,am. as provided for by Section 3700 of the labor Codc. for dm performance of the
work for which this pemmil is issued.
❑ 1 have and will maintain Workers Compensation Insurance, az required by Section
379) of the labor Code, for Ne performance of the work for which this Permit is issued.
My Worker's Compc ordion Insamnce cantor and Policy number art:
Carnot. Policy No.: _
CERTIFICATE OF E%E,MMON FROM WORKERS'
COMPENSATION INSURANCE
(This Section need not k nampmwd if the formil is for one hundred dollars (Slap
Tess.)
I eenifv Nm in the performance or the work par which this permit is named. 1 shall not
employ any person in any manner so As m kerne subject to the Workers Compensation
Law., of California. Date
Applicant
NOTICE TO APPLICANT: IL it,, making this Cor iticate of Exemption, you should
kcome subject to the worker's Comlchathm provisions of the Labor Cask, you must
forthwith comply with such provisions or this form it shall No deemed mvokcd.
O
N"
CONSTRUCTION LENDING AGENCY
^_
l herebywhichaffirm Oat there is alending agency rnr the Performance of
rowLe work for which this permit is issued (Sec. JOY], Civ, C.)
0
Name
Under's
lender's Address
Z
0
1 certify that 1 have (cad this application and xtam the about information relating ix
Fbonding
1 agree to comply with all city and coumy ordinances and smm Taws relating to
ces
Wildingconswcuopoand this to Ne
esu( city corer upon
about- forcbyantboriacrposeuntati
wy for emnify an
4
(We) Agree 1. s
(We) agree In save, Indemnify and keep harmless the City of Cvpenita against
keep ha
granting aapmncsmit, may in any way creme against mid City
Z
z
in consequence
nce of the of this Permit,
APPLICAN'
^
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
UNDERSTANDS
Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signumrc of ApplicaHAZA DO Dam
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will BICapplicantmserfuture building mcuhaptstoreor handle
sd
dcfincd by he Cut me Municipal Code. Chapter 9.12. and the Health and Sa&ty
HealthSafety
C
code, series zss3xar.
All roofs shall be inspected to an roofing material beim
being installed.
❑vex C3 NO
prior
P P Y S
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupam a. "'Formal at devices which
mil hazardous air contaminants az dcfincd by the Bay Area Air Quality Management
all new materials for inspection.
istrict?
[3 Yea F) No
1,0vocr
I have reed Ne hazardous materials requirements under Chapter 6.95 of the Cali for-
iaHcalNKSatctyCuk,Sccduv 15N15.2553] anJ:5514.iundcrstmd thaifth Wilding
em,whsuncefCeradncycyvimmenrs which muslbemcl Pdunoissumw nfa Certifiau: of 0.cupanrySignature
of Applicant Date
All roof coverings to be Class "B" or better
or amm ittd agent Date