03010130CITY OF CUPF,R,rINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION: t
BUILDING ADDRESS:
JUST WATER HEATERS INC
PERM1TNo.
1101 KENTWOOD AV
oWNER'SNAM17:
1764 NATIONAL AVE
APPLICATION SUB DATE
SUSAN LEE
01/23/2003
IONE:
(510)293-9901
SANITARY NO. CONTROL NO.
ARCHITECf/ENGINBER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 o
LICENSED CONTRACTORS P oviCons Of CON
1 hereby under provisions of Chapter Y (commencing
that I am Iiche
stall
Job DCSCr}I(��
(t of Bu
Division 3af the Business and Profcatinre CnJe.aNmyliccnm is
withSectionhired
j1,1� mil
and
Lchmi,rca s efm°L
REPLACE WATER HEATER
License Clore L.C.N
Dale eanDEC
- 18 2003
(4 0 GALLON GAS) R, 1
ARCHITECTSshallaDECLARATION
1 understand my plans shall M used as public ra'ordt
ILp11VG
Licensed Prolcssinnal
OWNERBUILDER DECLARATION
S V
1 hereby al firm lam 1 our cBusin from the Contractors License Law for the
lection ](I31.S. Business and Profcssinns CNG: Any city or county
whicwingn es st
welch rets a pmmil It,e <onswn, alter, impmwc or repair any svucturc
requiresh Kurt t
Poor its owedissuance. also pursuant tothe the
(hat provisions of for such pcemil Lice no signed matemcnt
thcofDvsioof the Ww(Chapter
Sq. Ft. Floor Arca Valuation
comme cmnsedPurstion7 the and
essanJ on. Any, blow. or
ode)or
W,
W, he isc ompwith theclion ]IMNd deU osis n 3 of the Alleged
li and Ne hatis for alleged exemption. Any P of
is exempt Zany
$653
Section be
applicantit malty
p
not mo]f131.5be any icollars apomnil subjects the applicant to acivil penally of
not more than five hundred aanars teem).
APN Number
Occupancy Type
35930018.00
1, as owner of the property, ar my employees with wages m their sole compensation,
will do the wark, and the swmurc is not intended or offered for sale (Sec. HNA, Business
and Professions Cade: The Conuacmr's License Law does not apply to an owner of
502 - FINAL I�Qle�QRGY
property who builds or improves thereon, and who docs such work himself or through his
own employees. provided that such improvements are not intended or offered for sale. IL
506 — GAS TEST
however. the building or improvement is mid within one year of completion, the owner-
builder will have the burden of proving i he did not Wild or improve for famprow of
507 - FINAL PLUMBING
sale.).
❑ 1, as owner of the property, am exclusively convecting with licensed contractors to
Construct Ne project (Sec. 7060, Business and Professions Code:) The Cunvanor's Li-
.se Law does not apply to an owner of property who Wilds or improves Neuron, and
who conmeu for such pmjecB with a Cement licensed pursuant to the Convamor's
License Law.
❑ I sm exempt under Sec. ,B III PC for Nis maton
Owner Date
WORKERS COMPENSATION DECLARATION
1 hcmby, aRrm under penalty of perjury one of the fallowing declarations:
I have and will maintain a Certificate of Consent to self-imere for Worker's Compen-
sation, as pmvlded for by Section 37011 of the Lobar Cede, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
37M of the Lavnr Cede, for the performance of the work for which this permit is issued.
My Workers Com retention Insurance carrier and Policy number am:
Comer: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section need not Ne completed OW pmmil is frond hundred dollars (5110)
or less.)
1 certify that in the performance of the work for which this permit is issued. I shall not
employ any person in any manner su as to become subject to the Workers Compensation
Laws of California Date
Applicant
NOTICE TO APPLICANT: IL after making this Cci iliea, of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Core, you must
forthwith comply with such Provisions or this Permit shall M deemed revoked.
CONSTRUCTION LENDING AGENCY
1herebyich thi Nm Nerc isamm(See Constructionlendingagency for IM1c pcelirtmanec of
the work for which this Pcrmi, is istued (See 3lyd]. Co, C.)
ss
Lender's Nae
Lem
r
LCNcrs Address
I comity Nal l have read this application and slate that the move inlinmution is
Correct. I agree to comply with all city and county ordinances and sum laws relating m
building eonswnion, and hereby autheriaa representatives of thi.t city m enter Upon the
properly lint inspection purposes.
(We) agree m save, indemnify ana keep harmless the City of Cupeninn again,,
ffiConseq
liabilitice judgmen a, costs and expenses which may in any way acerae against said City
once o
in ttmseyuence of the granting of this permit.k6f
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by:�Vp
SOURCE REGULATIONS.
Date
Re-roofs
srsta,nm nrAprbeanvcnntmemr umc
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building Occupant store or handle haaardous material
as defined by the CuPeninn Municipal Cede. Chapter 9.12. and the IIcaW and Safety
cede. Sermon 25532fa)?
OYen 0N
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant nr wmrc building roccupant use equipment mdevieex which
If a roof is installed without first obtaining an inspection, I agree to remove
Imil hamrdnas air contaminants as defined by lbe Bay Area Air Quality Management
District?
all new materials for inspection.
❑Yes No
I have read Nc Catarrhal materials raluircmentt under Clor mr 6.95 of the Califor-
nia IleaW,& Safety CNG. Scctiont 25S)5,25533 and 25534.1 undetmand Nm deet am,ding
duet not currently have a tenant. Nal i, is my respmuibility m Coaly the sa'culanl of Ne
mqummucnts which mum M mel prior to ismance of a Cef ificam of Occupancy
Signature of Applicant
Date
All roof coverings to be Class "B" or better
Owner (or mlNon edagen, Date