01110086 INO
CITY ofsDPv SoI iN PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
: 877 LONNA LA HOT WATER INC 01110086
OWNER'S NAME: APPLICATION SUB DATE
WEIGART EVELYN F 2531 GRACELAND AVE 11/19/2001
] PHONE: SANITARY NO. CONTROL NO.
(650) 298-8494
PO O ARCHITECDENGINEER: BUILDING PERMIT INFO
a m G ;, BLDG ELECT P UliMECH
8 O i LICENSED CONTRACTOR'S DECLARATION Job Description
0 I hereby aiBrm that l ore licenud under provisions of Chapmr 9lcommeiming
,4L.as wit Seminn7000)afDivision3oftheBusinesseiidProfessionsCode.andmylianxe REPLACE WATE$.HEATER.
1.OW.UI cc
tcanse Cla �n fall � Lic.p
S3 me Co,Er,LA FINALEW
LL O ARCHITECT'S DGCLARATION
U '_ 1 understand my plans shall be used as public records MAY 2 8 2002
i a p'O LittnseJ Professional
o , OWNER-BUILDER DECLARATION
. 1 hereby affirm that I am exempt from the Contractor's License Law for the
C < following reason(Sat 7031.5,Business and Professions Code:Any city or county'
S o which req permit t wa Iter improve de not sM1 pair any structure BUILDI� $500
Co pno t itissuarce also req res the applicant for such Permit flea signed statement .-__...... _,--___
3 m that hn.fcenud pdesuanl t the P o t tons of the Commnora L c law(Chapter 9 - - -
(com necgwthscto )INN() f D iron 3ofine Business dPrf rens Code) f'; wtd;'1413=ry 7V.5'll'1p�•E'`6sl i�• Valuation
Or that be k exempt thcicfrom'and the basis for the alleged exemption.Any violation
of Section 7031:5 by any applicant fon permit subjects the applicant to a civil penalty A 7� }�,� n p y Typ
-ofnotmomthanfivehundreddollars(s50o). ' 50LPN"TTL PLUMBI G ENERGYccu ane e
❑1,as owner of
the progeny,m my employees with wages as their sole compensation,
wiuidas'the work:and the Code:
The C not intended License Law
for snot apply Loan 5 0 7 — FINAL P$A�iIIbgp
Business property Whons Wilds
The Contractor's License law docs not apply m an actions
caner of property Who builds or improves thereon,and who dos such work himself
0
.. or through l�t own employees.provided that such improvements memo ere not intended or
dtleied for sale:If,however:the building or imPmvemeni is card within came-year of' �_.... ...-_..._._- .- . .__..-...._ -._____.._.._._.._. ._. ._ .. ,_ _ _ _ .___ _ _
'completion,the owner-builder will have the burden of proving that he did not Wild or
improve for purpose of sale.). 1
.. _- .._._. of
exclusively_. .. _.._. _ .-..
°L tr ct the of the pmpmy,am Businssa condoning with licensed conmaaon to i,;; M1:.i -License
the does
n(Sec,70aa,Business and Professions CodoB 7M improves
tmrecan, s.,, t.
mad.u1 law data nut apply man owner of progeny who builds seimprovo thereon, ' s
•i s:. an ourson es Livens fLaw. ryojau with a tdntrmods)licensed pursuant to the .. _. .. . _. .. - . _.. .-..-.__-..__._... ......... ...... ._. _ ..
01 metals License Low.. --'
Olam octopi antler Sec: " � ,B'kPC for this rtuan •. ,,:'la'iip7 -
-' Owner'.. . . Dote'. -
�'*;:L 1 WORKER'S COMPENSATION DECLARATION
I hereby afiinn under penalty of perjury one of the following doelermi sma
❑ 1 have and will maintain o'Ccnificac of Consent an selGirtsum for Worker.
Cialor radon. as provided for by Section 37W of the Labor Cade, for the
performance of the work for which thin permit is issued,
n °1 have end will niainuin Wod:er's Compensation Insumnm,as '
pens required by Permit
is
3)00 of the Labor Cade f th pctt ur�m�ance of the work.f h i this pennn rat
Ourd ore/ omlK °tl°�^.P-1 yNomer mtlP �:
RT PI ATION OF EXEMPTION FROM WORKERS+' ' ' r ••• .I� � � T�i, tl- t.1,1'ibO,r' t t' r' LCe
COMPENSATION INSURANCE"
" (Thnsenion rieednol Wcompined if the Permit is for one hundred dollan - _-'i•U �" --._ -^_ ---_ --- 1' --
(SIW)oiless.) F
1 c mfy that,in person
performance n the ark for which this ct to t e issued,' l i y ry
shell nmi intim L airy,person m any manner so as to became subject to the Workers' -
Comicrrt ion laws of Celifomie.Date' '
fault lilt- ply_ the ,g i you
_.. ._ __ - .. _. ...._. __.
Appi cant
NOTICE TO APPLICANT If.Compensation
after making n sCertificate of of Exemption, must a 1
boo - -.m,I Ne,such oComps ret nae s sof theLabor Code y m st
h pm t tons- this action sM1u11 be dttme. ked.
r 0 _._..._ _. . N ..
W Il lm Wd"'CONSTRUCTION consLction AGENCY
Ih reby affirm @ut the - 'a" simci¢m lending agency fonhe performance n
W'..�a of the work for which this permit is issued(Sec 3097.Co,C.) -
p=tQ Lender's Name _... .
U z �L&dcrk Address.
11 certify that 1 has'o rtad this application and state that the above information is
W �Gy lien I.,ran toe reply nh all law,relating
to building c n W motion,and f by a�Bo� p mixt es of thiscity 10 a ter upon
Ne ilio s, nit M pman
(W) g t sae tl m ns Bk prpo l s sheCry fC pen'o egmnst
yliabilities,judgments,m casks d l expenses which y m any way against avid
V.z Cs nmsq mthe gm got Or c
Pf ANT UDDRS AO N'fL COMPLY WITNA NO -POINT " /
AE
�� Issued by: Date 4
Signemre ofgp icoMCantmctor' ', " ':- '7,Da Re-roofs
l,a HAZARDOUS'MATERIALS DISCLOSURE � '", •
Will the applicant or fume balding occupant nae a Handle hautandonas mamriil Type Of Roof _ -.
as def ed by the Cupen no Municipal Cod Chapter 9 1Z and the Health and Safety - -' -
Code S nton SS321a1 4 ..._ 1 • 'r - f 4 "j rpt" ,s t . r _, VW'., _. .
E3 N
All roofs shall be,inspected prior to,any.roofing material being installed. _
I Will the uppltcant o f tort W ilding occupant use equipn nt or de tcea which s
j Y Quality Management If a roof is installed'wiffiout first obtainingan ins tetroti, Iia ree'to'retnove�
ren heard s vi mntunmants as defned b the B Aro A p g
Dishiciall new materials for inspection. Applicant.understands andwill comply with
1� •,
Dyes 1 °No all non-point source regulations., _
t 1
ave readh'Slid
h zardo. mkmnals 505 25533 under Chapter understand
f the
C lmili Hgil &Safety Cdde75eeta a nd.that
and5534.1understand that
'i ebuildinB dos not currtn0y heveamnanL that it is my responsibility to noiify thb"
at of,he rtquircmenn w'h must be ren prior 10 ismaa,,of a Ce"ifdmbf "
,.. n. est' a ., r„ ..
:''''• 4 Signature of Applicant _. _._ _ Date --
nararan0m ate i�i.1 , ape. All roof coverings to be Class "B"or better
OFFICE