01030008 CI OFCUP ISIO
BUILDING N PERMIT CONTRACTOR INFORMATION: -
BUILDING ADDRESS'. PERMIT NO.
10341 MANN DR JUST WATER HEATERS INC 01030008
OWNER'S NAME: APPLICATION SUE DAM E
CLEWETT RICHARD A AND R BECCA 1764 NATIONAL AVE 03/01/5001.
FlONE; SANITARY NO. CONTROL NO.
(510) 293-9901
C ecZ ARCHITELTIENGINEER: RUILUING PERMIT INTO
00 BLDG EI.ECr PLUMB MECH
S y E LICI!NS[i1)CONT'RACTOR'S DIiCLARATION x Job Description
Z 5❑ bcrcbv onion that I art licemed under pmv lxinn,of Chaplet 9(amonrectng
vJCw with Semlon700(bof Divixi130 lire Holmes,and l'mfcminn(Cnd,,;I Ory license
< inmllforce,tt !file, REPLACE 50 GALLON GAS WATER HEATER
0 U Liccme Class Lie.R
Done Contractor
a w0 lin ARCHITECTS DECLARxi-TTN
1 understand my plans shall be used as public mcnN,
T
M
O hicen%ml Pmfcs,innhl
OWNER-BUILDER in'he RAl onflo ON
vl 1 hereby sevffirm that 11. exempt fmm the cession, a A.,c law for me
FZS fullin,which'ire mawrt mutt IDn 5,Haxltcrsand improve.
(Roundish.
or AnY city slcounty
5 i which requires u panni,to cnn„mc,,al¢r,improve.Acmolish.or repair any tincture
ne
iL: prior to its issuance,aim)requires the applicant for such permiuo file a signed statement
that be is fiecmet pursuant to the provisions onnc contractor,Lice—Low(Chapter 9 Sq. Ft. Floor Area Valuatiop
(u,nne ing with Selden Withof Diision J of the Hashers and Pn,tbxsion,Cole) 5951
or that be is unapt kelfrn I Intl thu basis for the alleged cxmnptiot,Any violation
of Section 70.11.5 by any applicant fora,emit wnja9,the to"Iieamt in a civil penalty
of no,mom than me hnndrca doHat,(S500). A PN Number Occupancy Type
❑Las owner of th,Impala,m my e,nployce,with wage,a,their.,),compenmtion. 35645059. 00
.it[do the k d thet cum'. Iintended E d f (t 7194.
Horn, a f: "cd I be c I I :License Law does not apply, an Required Inspections
�rfby oowwnil,,, dedOnm„J, laid ° cot,a,.act,
nornci,tm,i`Ir 505 — FINAL PLUMBING ENERGY
throughY,.ss pans mp'ry
mllvrele for,all.IL huwcver,the l Inue g er improvement deosin sold within one year of 506 — GAS TEST
annplaion,me nwnvr W ilAcr will Lave the W Man of pnwing,hm he Aid urn Wild or
improve for parp,neof.ale'). 507 — FINAL PLUMBING
O 1,a,owner of the pmpeay.am caclmsively contracting with licensed contractor,to
consumer project 7094 business and P ❑en ir t t t
rex t'Iply, c ofI p ly ( biddxe P th m,
cal ct r' rur I +. )hu t t :)Iltt: pormenot In the
Tionfra
t ':Liceme Law
O I'mn cxannit umMr S,,. .H&PC mrthis rcv.w
Owner Time
WORKER COMPENSATION DECLARATION
hmchy ullinn under Ixuuhy of,,c,jc,y one of the following declntntioaIs
C 1 have and will maintain a Ceinficata of Consent to%elbinsure for worker's
Compensation, as provided for by Section 3760 of the Labor Gyle. far the
performance of the work for which this,aran,is issucal.
❑1 have and will,maintain Worker'%Compensation Invereave,as required by Section
37H0 of the Lahnr Cd..for the pc,It nmanee al the work for which this pe req is
wed.My Workers Cmnpea,atien Insurance countermal Policy r mMr ata:
Carrier: Policy No.:
CER I HTCATION OI,EXEMPTION FROM WORKERS'
COMIIHN5ATiON INSURANCE.
I This section,cod not W mmmplacd if the permit is Ibr one hundred(vila„
(SI 00)or lea,.)
I c,alfy than In the performance of the work for%Inch thin Permit i,lowed,1
,hall not employ any person in any manner so as m become subject In the Worker)
Compensation Lucas of California.Date me
Applicant
NOTICE TO AI'I'LICANT;IL after making this Certiticme of Exemption,you should
hecome%ubjecuu the Worker',Cnntpenaukm provision Labor the Lua Cole,you most
Q 0 Ilnthwitlt amnply with such Tmvirionn or mi,permit shall is,Jcented nem,kell
F to CONSTRUCT ION LENDING AGENCY
I hereby affimthat there is a construction lending agency for the alfformonce
Ort the work lir which this permit is issued(See.3097.Civ.C.)
LC Lender:Nunn
7 % Lcader',Address
f..H I eel Ily that I have read this al+plicnlinn unA smneolan the obese aeon union Is
Is+ [r nmrom 1 ogre,to ctnnply will,ill city and county ordini aces and ante laws relating
V tbuilding construction.and locality amhore,rcprcsendtives oftnis city In enter upon
} IL
to building
r&m,.mantiolmd property for inspection mr ousel. -
t,,, 6.
(We)ugree m save.unhandy aced keep harmless the City of CupcniW against
W liabilities,judgtnem,,costs and exlanux which may in any way accme against,aid
City m conequence of me gmaing of this permit.
APPLICAM'UNDERSTANDS AND WILL COMPLY WITH ALI.NON-POINT Issued by: Date
SOURCE REGULATIONS,
Signature rel AppHcan aCriu m,mr um, Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
9511 the applicant in future Wilding occupant tion or hamllc br<awm..material Type of Roof
as defined by the Carl o Municipal code,Chapter 9.12.and me health and Safety
Code,Section 25512(a)1
0 yes [2 No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant ar fnmrc buildingswcupam use equipmcntor devices which If a roof is installed without first obtaining an inspection, I agree to remove
ani,hazardous air contuminua,a%defined by the[fay Amo Air Quality Management
District'
eo rot ❑No all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I have read the hamminux materials requirements under Chapter fi 95 of the
Culdomin I Icalth k Safety Cade.Scninns 25505,255?Hund 255]4.I unAcrst;mA that
it the Wilding due,not currently lave a teram,than it Is my rcxlwnibilhy m rntlt'y the
cupsmt of the requiremem,which nmst be met prior In issuance 01 to Cenllica,e of
Occupancy. Signature of Applicant Date
Owner or authorized agent - Date All roof coverings to be Class %B'+or better
OFFICE