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CITY LDI G DIV SSIIONNOPERMIT
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CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
1192 ELMSFORD DR
JUST WATER HEATERS INC
02060099
OWNER'S NAME:
APPLICATION SUB DATE
KENNY TUNG / LIH TUNG
1764 NATIONAL AVE
06/17/2002
I PHONE:
(510)293-9901
SANITARY NO. CONTROL NO. -
ARCHITEC IENGI,NEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I= u u o
7 LICENSED CONTRACTOR'S DECLARATION
I hereby
Job Description
p
aRrm that I am licensed under provisions of Chapter 9 (commencing
with Section 7")of Division 3 of the Business and Professions Cale. and my license
REPLACE WATER HEATER
istolasso. and cRcn.
License Clazs Lic. x
(50 GALLON GAS)
Date tor
ARCHITEeuse DECLARATION
S DELLA
i I understand my plans mall be used as public mcoms
i Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from he Convacmr's License Law for the
following mason. (Section 7031.5, Business and Professions CWe: Any city or county
i which requires a permit m mnnrvct, nlmo improve, demolish, or repair any nm mare.
-prior to its issuaace..lso mWim, Ncipplicam for such peromm fit e..timed sursou t.
Nat hG 19rlican t pu(su0nl to tNM1�e peasisiom of the Continences License law (Chapter 9
(cotmm�neing with Section 70001 of Division J of the Profgssioas Code)�S
q'". t'a)']OOr A, iCat�.1,T p•y-�0. �i.
t"`� 1 ° s` c 4.M i\ I'\ti 44 ➢➢
Valuation
�uFines?pgd
or Naf he id item f Nskfmm and the bask [or the allm tr,np Any via
P gip oge. Lvion
t., . .1 11 :. G
'annA
-ofseotiune he.ri hundred dol1for apmnit ubjecnrhe epplicanuoacivil penaey'
Meat vmm Nan five.hurWrcd dollars (5500).
1`11"I
umber
�P=; \;;, :,.. Occupancy Type
El 1. as owpu,.fNepropcnY or on, empty thalm s their sole cim,en f
_
--will do the work and the nrocmre iz nm intend d'or offered for sale (Sm: 70Sf-'
--' -- - - - - - - - ---- --- -- -- - __-._._.
1Bnsrneas trial Professions Code The Cant n Limme, law does ant appy to an
506 - GAS TESTRequired Inspections!;, r
ow f prupert, Who Wild, mp ov th e d who does such work himself
or throghn ply provided that suchimprovements rtendedor
507 - FINAL PLUMBING �
-offred. for -..r Jr, haIn taking" p vem"nt la N oaynaro(
'prix
___.. _. _. __ .__... _._ _.___ _ _ __. .__ .......
_
�''' "t •-r � ''
inn. the owner W Ider will have the burden of proving that he dad not Wild or
� '
improve for purpose of sale.).
INepp.,am lyco tct g NT nnorsis
_ _.. _.__._... .___..
" 'f
costumier the project (Stt 76w, Business d Professions Cadc:)Th Contractor's
1'
f
- License Law doe., not apply manownerof, pony %hobvilds or improves thereon.
"' '- y'
:., and_htcontracts for such.projnu svN tinctr(s)Ic sed.putent. ut Ne
_._ ._.__...______ _. �.tl t�a�
C nnacmes License law. ,.,
❑ I am "am under Sec:, ,,. ,'B•ffi PCfonhix mason
�eJ1� _ .. _ _ . _ _ ..__ _ ...
,:•!.:,, i-A;n(
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D
JUN 2, 5 2002
WORKER S COMPENSATION DECLARATION
�)'" Ihcmby affirm under pcnaly of perjury nhs,of Ne following declarminns: -
BUILDING
❑ 1 have;Kd will`maintein'e C�nlfirte'o(Consent to'self.insum for Worker's
Compevmion,-m, pmvidcd for by Section 37M of be labor Code: for the
performance of the work for which this permit is ixmed.
❑ 1 W and will lnifiredn WorkdsrCompensmiW Insuiibam. az rcquirM by, Section
37M of the Lalsor Cdde, foFt a pmforfrmnce of the work for which this permit is
slued. My Workeli Compcnsmion Insuinnse currier end Policy number arc: '
kl CERTIFICATION OF EXEMPTION MRM WORKERS"
f•f tl�5i •3.3Q,-yt �:1'., Ft i1'iiaV",i'rx; }4j)t'4: •'U,1"'•
COMPENSATION INSURANCE') 'p• t''
. ... .. .. .. .. ....
1
_..�..._ L.__..
.. ''(Th s secbmi need not be completed if the
p prate is for one M1undrcd dollen
., ...... _. _..__
-, r '.t __ _. __ ..�_�_. _._�.-I.fir`. r, •- _ ,'i•..•
(51001 ori .sJ
.; Ic¢fYNii
shall t employ any person to aby'manne so as on become object te Ne Workers'
... ,.';', , ; I -r ,,
Compenulion Laws of California: Date
_.APpllcanit e. ....., ,.. -. s.. .-.r -..
. NOIf. after making OnT
bscomisucttotheWar es Compensation provisions of st Lbtior de,you must
fbN comply-wuh such provisions of his pemit shall be deemed revoked.
_. ._ _. ...
11 s CONSTRUCnY ons LENDING AGENC
........ .. ...._..__ .._ _.... .... ___. .. .. ._..._
,: •_ - , -
nn
aRrm that them -is a construction lending agency for N performance
1
Ne work for wh¢h lh s permit rs rssucd (Sec JCN7. Civ. CJ ' " - ;
Lender's
Lender i Address' ...-. ... . .., .... .,, . .
I cert fY cost I have read histip1lijanim, ad state that he oom information is
correct -91. t comply wilh all ply'nd c1ml, d me d law, rel rng
toWilding Wastraction.andhesbY authorize rmpmralrvcsfhis ctyt to pox
\
,J�pA D X0/1
—
rhe above mentioned pro,criyatior in%peetion porpo
/�//i�V LN ✓�/ lJ f'�_
(We) agreeio ims, mill and keep harmless Ns Ory of Cupcoma against
liabilities, judgnuorm cons. and expenses which nmy on tiny way uccnm against said
City n quince of N gmni ng of N person
APPLICANT UNDERSTANDS AND, WILL 20PLY WITH ALLNbN-PONT
^
SOURCE REGULATIONS i j, ',t j
''-
Issued by: Date
&gnamre of APPIianAZARDOU :g' •; '• , S • .. r p Da,,; :.
-
/
Re -roofs -
HAZARDOUS MATERIALS DISCLOSURE s
U
' WillN'applic t fomre Wilding. pant tore orh handle hu mo sat mnzl
-Ssd
Type.Of Roof...
fin dhy,N C Pedn M ¢p"gost Ch pre 912. d1heHealth and Safety
.,_
' -••-^ -- --
C6&.'S x .255] () s t - 1
I[]Ys -1 its} ONo t• t ")4?'q k kt, {,:..
-
f :\ I v
._.. .. ,
,All roofs shall be mspected,pr or to any roofing being Installed.
-
„•, Wil theppl t future bu Idi goccupant use equipment devices which
orrit W,.ojWi air cotmnantsudcfned by the Bay AreaA , qualityM agemem
-material _..
If a roof is in stalled= without first obtaining an inspection, -I � agree to remove
District? _ ,,
all new materials for inspection. Applicant understands and will comply with
'don
a,ad'. r '.t. -
a pomfsoiirce regulations _
h e sad nh bora d s mm d I r q rmmen¢ under Chapter
h pt r 695'bf the
-•'
Cal f mm Health & So (cry Cods, Seceon 25505; 25533 and 2553) 1 understand that
- if the building does not currently have a tenant_ that it is my responsibility m notify he
""' ""''---_-'-"'--- - -_._.. .._ _........._._ _ .. ..
cupodt or Ns mquirememi which'rnust W'met prior m issuance of a Cenificad of
cteimP Y -'
Signature of Applicant i Date
All roof coverings to be Class "'B" or, better ,
O.ne, pyinh.,imd agent ... „ Date
._.OFFICE.._..... ._._.-. .... . _. _. .._ _. _.._.._..-.. ... _... ---
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