02030108.. ..... ._ ....._ _.. .. .vrncE
CITY OF
G DIIVISSIIONNOPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
20052 NORTHCREST SQ
JUST WATER HEATERS INC
02030108
OWNER'S NAME:
APPLICATION SUB DATE
AUDREY VOWELL
1764 NATIONAL AVE
03/21/2002
PHONE:
SANITARYNO. CONTROL NO,
(510)293-9901
O O
ARCHITECIENGINGER:
BUILDING PERMIT INFO
W ❑
BLDG ELECT PLUMB MECH
U
I=J
y i
LICENSED CONTRACTOR'S DECLARATION
Job Descri tion
Fi;
I hunch, affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Seettim7p)(i ofDivision 3 ofthe Busineward Professions Code. and my license
P
REPLACE WATER HEATER.
Lin full fame and effect.
icense Class tie. is
(4 0 GALLON, GAS)
Dam Contractor
a. a
ARCHITECTS DECLARATION
I undersmntl my plans shall be used as Public m,,md,
T
OO
Licensed Profosional
o �
Ow'Nam
Ffrom
exemptthe Law for the
1 hereby affirm that 1 am,Busin from the Commas
?
Co : Any c
following reasna(Sermon]onsum Business and Professions Code: Any city or county
❑
which q Permit t :t t hr eM1 repairan, structure
3aQ
tforsud,mal
PnoS S' l: rry' theapplicantmfm suehpennnmfk signed smamum
-.. __.... .a'ti . _ ...
^t Sq: FC FloorA�ea_)-, ^s
i, `�'y\ 'a1
aluation
thpth licensedip ugthp nsaf of he andPo?cense a .m,Ctck)
Icat ening with Salo o Business' d ons Code)
bet.A
arm andfD basis the Any violation
and She barns for the alleged u<mant
or Sect he is exempt any
p"ye l". L ^�,' 1'. �}.'
to
ID3P.5iv anyaondimfor apemtit subjects the applicant to ocivil punchy
applicant
,or not mare man five hunarea dannrs lssaB.
turn..me
A um er
� Occupancy Type
Ell, as owner of the Property, or my employees with wages us their sole compensation,'nqFTT)JAL
will do the work: and the 'q or tic -is, not intended or offered far vele (Sec. 7004:
Business end Professions Code:Irm Cammcmr's Licensc law docs not apply m an
506 — GAS TE S"Required Inspections:
owner of pou,cny, Who builds o, imprnvm thereon, and who tl«s such work himself
507 — FINAL PLUMBING t
or mrnapn his awn employee, provided that such imp ... emems ore not Intended or
—offered for mile: If, however. the Wildingt is sold within one Y
onmpmof
_.._.. _ -._. _._.... ' —. -. .._ ._ .-- _—. .._.,.... _ _ ............ _
pro ycldo
builder will Haut the burden of proving SM1a he tlitl not build or
theoco,
r_
U 't "
c ��®
inpove for of
mpro.e for purpose ansate.).
FINA
- =
_._._..n----.. y.---'—_-.._,.
❑Las owner of jec P(Sec. 71 ran exclusively d Prommng with lice.) ed The Con eoors m
the project (Sec. Business and Code:) The Cos
MAY 0 7 2002 t, t
-
my.hins
License man owner of who) o, impmvcs licuu ,
License Law does not sou
a corny lice t to du,
and who contractsforsuch Pmjums with a commnm(s7 licensed pursnam So the
r such
.... __.. ___ __. . ___... ... sass_ ... ... r_ .... _ .... _. __ ...._. ...__..__... ...
_
pt unde Law.
❑IamesempS undec Sic.' .BB:PCfor this reasonsl
01 am exempt
-
..
BUILDING `
`
Gwne, Dam
WORKER'S COMPENSATION DECLARATION
I hereby alflrm undef penahy of perjuryone of the following declarations:
❑ I have bid will nwiatuinit Certificate of Consent to self -insure for Worker's
Compensation, asProvidedfor by Section 37W of the Labor Code, for the
perfmarro a of one work far which this permit is issued.
❑ 1 have and rill maintain Worker's Compensation Insurance," required by Section
37W of the L bar Cade, for the peiormance of the work for which this permit is
-
issued. My Worker., Compensation Insurance carrier and Policy number art: '
.' _.. .. ..__
_r-'•
...
Come 'r s.s s s"#' 'PoIIcYNo.
I.
t\ -'.15 ,•^.. tB
{,
:. CERTIFICATION, OFEKEMPfION FROM. WORKERS 't
. COMPENSATION INSURANCE _: -'.: •"'t-.
----------- .._.—__.__..___....___._.__._......
Iit '
'(This uciion riied not be mmpia'ed if the permit is for one hundred dollars
I$ IN) or less.)
I eemry that in s issueWerke 1
- of She stork for wn ch Ih6object
t � t, v { r _
ct us t
shall nm employ any person m any manner u as So become sublect So the Workers'
x in
laws or California. Daft
Applicant
t NOTICE TO APPLICA ftm C E..aempdo oust
si onsll themmed Cvokest must
visions f the
Compensationprovisions de. you
becomesubjectme Worker's Corton h
Workers
0
O
ort ispcovi
forthwith tom I with much provisions or this permit shall be dimmed mvokrd.
_
14
''CONSTRUCTION LENDING AGENCY '
"" •
_ 7I
nemby affirm that them is i komtiunion lending itit for the purforiname
'
:r4
orthe hark for which thispermit is i ... oil Sec. 309], Civ. C.)
.Q
Lender's Name..,,,....... :..... .:. ......... .... .. .... ... .:.:.
.. ... .. ._._ ... .. ....... ..sass _.. ._ _.___.._ .. _
. Z
Lender's Address;
I cendy Nut 1 have rend this np,lketkin and spam that the above information is
, (_s
'..rJ
correct. 1 agree m comply with all city and county ordinances and state laws relming
miding ze revresenmtives of this cirywenrer upon
w
the aMmi sc
'he ve enmmed prosmyforhereby s esti
prosmy for•ify
L
to ind keep har hm,MCupctiinoi
esjudgmetumost indemnify and
Me) agree
an,
tel/
Z)
way said
liabilities, jutlgmenu, costs sod apenses which may in tiny way Hecate egaimt said
which
„Z
in consequence the ihms peCO ' " - N
r`
APP
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT
R D
NDS AND
Issued by: Date
Y•
SOURCE REGULATIONS: r - ��
Signature of Appinu uUmatoelor i' t' ,'.. Dam""
'''r t.
Re -roofs
- HAZARDOUS MATERIALS DISCLOSURE
•" will the appl cam or r S "building becuyam mom or handle namit ous material
Type of Roof _ - .. ....
as defined byto, Criterion Municipal Code. Chapter 9.12,and the Hisalth and Seery
Code Section 25532(c) -I
..
-. •i, t ''r•!'^'r:i
r j i, t , 1 -b
ores ❑m'; t _t is
t: .I(
All roofs shall be inspected prior to any roofingmateria] being installed.
Will the app] mean or future building mcupout use equipment or devices which
If a roof is installed without first obtaining an inspection; I agree to remove
emit h r amous air contaminants as defined by the Bay Area Air Quality Management
Distrito
all new materials for inspection., Applicant understands and will comply with
❑Yep • ❑rva .-;'
all non -poi t source regulations.,;;
s>
'I'hav tend he hazaidousrre cri il, reyui,ements' under Chapter 6.95 of the
inia Health A Safety Code. and 25534.1 understand that
a
drive building does not currently have a tenant. Shat it is my responsibility So notify the
drive have tenant, it
.. 1
ccupSm oldie requarcoma s which must be met prim to issuance of a Certificate of
Signature of Applicant - Date _
All roof coverings to be Class "B" or better
Owner orimhmi,ea!sem: Date
.. ..... ._ ....._ _.. .. .vrncE