01060043 CITY
DINc
IVISONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS'. PERMIT NO.
878 FERNGROVE DR JUST WATER HEATERS INC 01060043
OWNER'S NAME: APPLICATION SUB DATE
BRAEMAN SAMUEL M AND SHIRLEY W 1764 NATIONAL AVE 06/07/2001
PHONE: SANITARY NO. CONTROL NO.
(510) 293-9901
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
<U 5 BLDG ELECT PLUMB MECH
fn a i LJ 1- U 1=1 LJ
Z
vN= LICENSED CONTRACTOR'S DECLARATION Job Description
= with
O Z F1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Section 7000)of Division 3 of the B oxides,and Professions Code,and my license
< ; is in full force and effect.
Mi< LicemvClaxe Lic.M REPLACE 40 GALLON GAS WATER HEATER.
w3 LL U Dam Comment,
ARCHITECT'S DECLARATION
F.
a O or
I understand my plans shall be used as public records
w 6 Licensed Professional
o
esu OWNER-BUILDER DECLARATION
zo 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
F.
Z< following reason.(Section 7031.5,Business and Professions Code:Any city orcounty
FD which requires a permit to construct alter improve,demolish or repairmy stiocture
63M .pr t its issuance,al requires the applicantforsuch it file asgned statement
'hat he is licensed parett the ptvvalo s of the Contractors Lien. La (Chapter 9 S9'--Ft $75 Floor Area ation
(e m owari g uh 5 ci yn 7000)pf Division 3 of the Bushes rod Profession,Cod) + ap • r :
or that he is exempuherefrom and the basis for the alleged.eximpdon.Any violation
of Section 703 F,5 by any applicant for a permit subjects the applicant to a civil faulty
of act more him rive hundred dollars(s5oB). 37561MSM1:60 :„ Occupancy Type
El L as owner of the property,or my employees with wages as dei...le compensation, ,
will do the work,and the structure is notintendedor offered far.Ie(Sec.70,11, -
`Business and'Profeetions Code:The Contractor's License Law does not apply to an 5 0 2 - FINAL PawiiF��4sIl✓'Rtf9RCiY ""l
..rc,of podpea,Who b Id r inproex meomor and who does such work himself t
" through his employees
Provided that
such improvements am not intended or
cople fo I If, the buildingimprovement Id within year of .-5.06
__GAS TEST
completion, owner builder IIthe burden of proving
merest,f P po f 507 FINAL PLUMBING
_ _ ..-__ _ __
__.
� /j�,{ l a..ad, Rh P Penlm nscls IY rtr m ng with licensed dartr r
creamer thejt(S tl ProbationsCaded
cL L d not apply f property M1 bu Idrimproves thereon.
The..and who couracts,fier-such Projectswin,a,commodans).licensed puant to the _.. ._.. . . . ._....._. . . _... _._ Y
Contractor x License W r O
❑I pt under Set.' B&PCT rthisrc , " ! ;" (pr
Onvair Das'
c WORKERS COMPENSATION DECLARATION
Ihereby affirm anderyearally of pemrYmr,of toe.following declarations:
❑ 1 ha,,'and will'msmmn'a Cenifium of Consen(to selFinsure for Worker's
Compensation;as;provided for by Section 37W of the Labor Code, for the
_ _ 'perfannance'of the work furwhich tM1is permit is Issued.,,, .,
ID I have"and will maintain W km.'Conalpensinum Insurance as required by Section -
37N)of tne'Leb,r Code,for be performance of the work for which this Permit is
is.tied.My Work 6 C penset Insurance c er and Pal cy numb,rare:
+,aner Policy No .: ! t. ;.I
G
p "CERTIFICATION OF EXEMPTION FROM ANCE,WORKERS
COMPENSATION INSURANCE„'
" (Th v uetion need not be complex d if the fermi,is for one hundred dollars
(S 1001 or lees.)
1 cert ry,thaa in th pert an o f th work f which thisp mi t issued,1
shall not employ w "don o n any onoer so us m become sables the
Workers `
' Comped ton Laws fCalifornia.Dine m
NOTICE TO APPLICANT 11 after noddingth.Ceo'rv.eL.fE empi you should,
Zbac a bj c[y,heed k .0 pean
forthp ofth Labor'Code you must
0 rM1 c roily wild h Prov s nns o th permit shall b Jsecure d mucked.
7.. ..
F of th kfor wryr
CONSTRUCTIO N LENDING AGENCY r '
5' I
hereby hitm th t pe t t a d gag y f r thep,font lice
-r+. hthstssu d(5 3097 Civ.C) { .,.�
Pr-Q Lenders Name permit _.... _. __ ...._.._.
z
U_ I certify mm I have read this Dill lion and,mm that the above information is
cause.1 ogre,to comply with all city and county PNirunces and some laws relating
to building cmisromi r ad hereby anatomize rapresentutives'rifthis city to enter upon
A. 'the b,e ; eeds partyf .peer (1
y (A (Wlg to s d ndynses keep int heCity'acme against
against _ iV7L-
rr N Cub judgments,costs and expenses which y- any y cent again.)said !lIUUU
C.7 y Cily n y EAof ST arming fm p t
;APPLICANT REGULATIONS
AND WILL COMPLY WITH ALL NON POINT" Date
_
SOURCE REGULATIONS t I't'' Issued by:
'Sign t of Applitum/C t''roi ,'Date' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicanturrtrebuildingcap t urdare.,handle haddrrdme,material .. ..Type.of Roof - ..
vstl finedby ion2 CuPert M hie palC d Chapte 9.1 ad the Hahh and Safety -..I f x ) a - - ' "`•
Cale Section 2553 f 1 ' - - 1' v
if ❑Y ElNo'
All roofs.shall be inspected prior-to-any
' roofing.matena] being
installed-------
!-Will h applicant future budding cmc p lit use d, p t de ices which If a roof is instaled without first obtaining ins ecti&;, arereetp.removeg hazardous as defli d by he Bay Area A Quality Management c,
District? _
_
all new materialsfor inspection..Applicant understands and will comply with
Elves El No- 'all non-point sourceregulations. - - - -
a 1 h d theh d uI qremains d r Chaps
CubfomraHevhh&S fdyCuda.Seaiton 25505 25533a.d2551JImadersonuffira
y issuance
of o e notify of accupam of the reyuirxments whish mon be met friar to ivuance of a'Ceni@me of
•N r!. Oc upancy. -
' . Signature of Applicant Date
owner lir atom-1¢e1 agars ,Date. All roof coverings to be Class B' or better.
.OFFICE. — '-