00050157 CITYBUILDING DIVISION O PERMIT CONTRACTOR INFORMATION:
BUILDING ADD{F0`5 MERRIMAN RD JUST WATER HEATERS I tMITNO.—r - :—
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000501.57
OWNER'SNd4LJA H T AND JESSI.E TRUSTEE 1764 NATIONAL AVE APPLICATION SUR DAI'E
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HONE: SANITARY NO. C R(l.
n O O ARCHITEC'DENGIN ER: BUILDING PFRMIT INFO
I pp (51.0)293-9901 BLDG ELECT PLUMB MECH
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ZO z Lren' IEII C'ON'1'knC'fOR'$DECLARAWN Job Description
5
I hereby allium that 1 am licensed under provision,of Chapmr 9(commencing
F4 1—OW wllh Seatiun 71111@ rel Ilivision t nl'tlm Buxinesx nnA PmPossinm Code,and my license
ue E J is in lull forte and cafear.
irece saj License Clasp Liv.e
63 p w. Dam CuIO
mue,or
+n ARCHITECT'S DECLARATN
C a 1 undcrsmnd my plan.,,hull be toed e,FuNk,mord.,
eco Licensed Penfnslnnal REPLACE 40 GALLON WATER HEATER
°•%o� OWNER-BUILDflR DECLARATION
we_v 1 hereby affirm that 1 am exempt from the Contrxtor's License Law for the
F Z T rollowie,renson.(Section 9031.5,Buvinesa and Protexeimms Rule:Any city Or county
5 F e which requites a permit to consumer.alter,improve,demolish,or repair any structure
i3ct
- prior to its issuance.also royulres the applicant for such permitm file o signed awement
tbathe isteere,ed puFaam to one prr;nmoes of the conumcmnn License law(Chamerq Sq. Ft. Floor Area Valuation
(commencing with Section 7000)Of Division 3 of the Business and Professions Corel $912
or ohm he is exnnpt Ihereannt and ore basis for,he alleged exemption.Any violation
of Section 703 IS by any applicant for a pnmit subjects me applicant o a civil penalty
of Imoremanfivehtaamecddamar,($5om, AAMY ...5. 00 Occupancy Type
01,as owner of the properly,or my employees wim wage,its theirxole compensation,
will do the work,and the swcmre is not intended or ottered for.sale(Sec.70.14,
Business and Professions Cele:The Contmcmr's License law does nm apply to an Required Inspections
owner of propnvy Willi builds m llnpnrves th uiu m,and who does such work hlmddf
or through his oxo employees.provided that.such improvements are not intended or
Offered for laic.If,however,the building ne improvement is sad within one year of
mnpineni.me ownerbooacr will have me burden m proving that Ire did nor nails a`
improve for purlxra ol's�led. 502 — FINAL PLUMBING ENERGY
01,as Owner Othe propery.amcscd.ivaycontracting with licensed contmcmt,m 506 — GAS TEST
msnuael the prance,(Seu.7044,Basinma and PrefcOu.nx CWa:)The Cmammu r'e 507 — FINAL PLUMBING
License law does nal apply to an owner of pmpeny who builds or improves thereon,
and who commas for such projects with a eontrenaris)licensed pursuant to the
Common's License Law.
01 am exempt under See .B k P C for dais reason (�
Owner Date (�
WORKER'S COMPENSATION DECLARATION Vf 44 ��
1 hereby alhmm under penalty of perjury one of the following doelamtioms: .001.0 1 have and will maintain a Cen fleme of Consent to self-insure for Worker's
Compen.aaime, as provided for by Section 37M of the Labor Coda. for the O
performance of the work for which this psrmit is issocd. O
El have and will n rinl is Worker's Coanpenxutlnn Insurance,as required by Section
3700 of the labor Coale.for me performance of the work for which this permit is
sued.My Worker's Compensation Instarance carter and Policy number am:
Currier Policy Na:
CERTIFICATION OF EXUNIPI]ON FROM WORKERS'
CONIP17NSATION INSURANCE
QLis onion need not be completed it he permit is for one hundred dollars
SEX))
1 unify that in the performance of the work file which this permit is issued.1
shall nor comb,any person In any manner so au Io becaane subject to the Workers
Couramolumn Lawn of California.Data
Applicant
N(nICE'ro APPLICANT:If,lifter making this Cenilicale of Exemption.yot should
hecume,olo ect to the Workers Compensation provisions of the Labor Cards. no most
Q O fo,,e h comply won men provioinns nr this permit,hull he dmmcd revoked.
iCONS'TRIM'ION LENDING AGENCY
a ' 1 hereby nation that there is o construction lending agency lin the performance
W rel the work for which this permit is issued(Sec.3097,Civ.C.)
L Q Lender's Name
Q z Under',Address
V 0 I certify that l have mad this application and state that he above information is
W F.. correct.I agiee m comply with all city and county ordinances and state laws relining
Q V m building construction.and hereby million,representatives of miss city ns enter upon
the atawe-memionW properly far irrepection purposes.
CL. (We)ugmeIll xa,c. mentally and keep harmless t he Cryof Cupcnino againaI
V] liabilities,pidgmam,ows and capensa which may in any way accrue againm slid
U z City in conscyucn,c of the gmming of this permit.
APPLICANT UNDERSTANDS OND WILL COMPLY WITH ALI.NON-POINT Issued by: Date
SOURCE RF,GULATIONS.
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Signature ofnpplicantlConwmor Date Re-roofs
1 IAZARIl01J5 MAIBRIALS DISCLOSURE
tun
the npp0cam m future wading oecureat.Tome or handle monallons material Type of Roof
is defined by the Cuperlinn Municipal Code,Chapter 9.12,and the Health and Safety
Code. acx 255320)? 0 N
El All roofs shall be inspected prior to any rooting material being installed.
Will the applicant sir future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
Olt hatardons air conmm antes;is defined by the Bay Amu Aar Quality Management
10co, all new materials for inspection. Applicant understands and will comply with
0 Y'^ 0 N all non-point source regulations.
I have mad the hazardous materials,quirentcnts under Chapter 6.95 of the
Calif u..re Ile,111,h Sufmy Cu ic.Sections 25505,25513 and 25534.1 understand that
if the building dons nom currently have a tenant.that it i,my re,ponomility n,notify the
occupant of the requir menti which must be met prior in issuance of a Cenificam of
Ocetpamy. Signature of Applicant Date
Owneroe surmised agent Dam All roof coverings to be Class `B•' or better
OFFICE