02090108CITYILOF CrpvEeONxo
CONTRACTOR INFORMATION:
- ' PERMIT
-r
BUILDING ADDRESS:
PERMIT NO.
1005 NOVEMBER DR
JUST WATER HEATERS INC
02090108
OWNS 'S NAME:
BR�WN FRANK E AND LOLA A TRUS
1764 NATIONAL AVE
APPLICATION SUB DATE
09/17/2002
' PHONE:
(510)293-9901
SANITARY NO. CONTROL NO.
zo ARCHITECI'/ENGINEER: g
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
'
O CI I-:I L>
Z LICENSED CONTRACTOR'S DECLARATION
Job Description
E I hereby affirm then lam licensed under provisions of Chapter 9(commeMing
REPLACE WATER HEATER
with Section 7")of Division J m,he Business and Pmfessians Cade, and my license5 is in fall farm and effect.
(7 5 GALLON GAS)
at License Class Lic. g
L'
,
DateContractor
I-i,
• ARCHITECT'S DECLARATION
1 understand my plans shall be used as public retards
OLicensed Professional
- OWNER-BUILDER DECLARATION
I hereby aRtm that I am exempt from the Commetor'e License Law for the
a following mason (Section 703 I.S. Business and Pmfcssimss Cade: Any city or county
0 which requires a permit to conswa, alter, improve, demolish, or repair any structure
- -- --
m .prior tot 'e, vl require,hetpplicium for such ma,m Msignedsmmmem
s v a e., {Sq: Ff. F1Got Area A'4 Tt>
Valuation
- that be A lcimad pun 'fa0the plivosi ns of the Contractors License Ls (Chapter 9�,
Basin, dP r-bns Code)
(comment g„(h Sect 71RM)) fD icon3 1the
or that he A exempt thciefnini and the basis for the aII�gW exnnpti0o. Any violation
tn_1 iSJLS. Pl\ d'= F,'':5+7�.t';:s
-of Stenon 7031.5 by any applicoAi for a permit objects theapplicant to a civil penulty-
APN Number
'1'��r,�:a 'a: Occupancy Type
-of not mor= than five hundred dollarsa WI.
Cl 1. as owner of the Property. or myemployces with wages as their sole compensation,
502 -
- - - 506 - GAS TESTRe aired Inspections,":, ''I
q
-will 'do the work: and the-slructur<is not intended 'or"offered for sale (Sec70aa,
t Busincss'ond' Professions Code: The Contractor's License Law does not apply to an
owner of pro,my Who hadd% or improves thereon, and who does such work himself
507 - FINAL PLUMBING
or through his own employemployms. provided th t such improvements t !ended or
._. _—......_ ... _..._._..__.____... .. _._. .....__.
t offeredfd.l 'If tiu -thhld - min Id tAn.e_ f
build
S,1 \• v Irl
Eompleton the owner-builder will have he Widen of proving that he did not or
'
improve for Pm ,wr 0r sale.l.
xan f vtapru_y.m_dwith d contractors t
diu_s. IYTcgw_lc
Construct the Project (Sec 7044 Business nd Proficisions Cale) The C t t s
Lt W Jas oat apply man owner fp 1 Wilds r P th
fes, ryy, p .I (t ! t '. .
FON LE
perry
i -and, ho. contracts for such pro)nts.with acontractor(s) hmmeLpsmoam. to he-
_ _..._----
_ _. _ _ __.. _ __...---------
Contractor's
- Convectors License Law. „5
Q l am exempt ander Ssr.' ... '.its&PC far thio reason
�'..'-
,,,;is
SEP 3 0 2002 .._ �. s,l,.i(1❑
Owner .,Date,
- WORKER'S COMPENSATION DECLARATION
-1 he
1 1 p'
BUILDING
Ihave 6d will maintain'o'Cinifcdm of Consent to self-moire for Worker's
101
Compemation; unprovided! for- by Section 37M or the Labor Code, for the
_
'p6ifirmanmdf thework for whieh this permit is issued.,
❑ 1 have 6n4'wi11 r aiim6 h Walker's Compensation Ins,imnee, at required bj Se 66n
1700 ofihe Labor Code, for the, peefmrnarc of the work for which this permit is
issued. My W rA r Compensation In. bean, c and Policy number
a -., ..
� ...
Eamcr '. F"r, vt Is ..{Pot YN6 -
__ _ _... •__.._. _...._.._... .._ .. r....v�=.._
t,..r(•s, �'[ h+l-j ld tilt i� AA 1 ]P j•, r`a.. .,
`ill!,:,r til'.
s.�l•+Z
' f (=CERTIFICATION OF. EXEMPTION FROM, WORKERS
YS - •:. ..r £`i 1 h a1 s5.
COMPENSATION INSURANCE s•a''r
-- -- 1Ui1!I$'T •'"s;'iT'.t idfl'L'±lil'1:;, t's'
''''nbis'sctlrm ncndnot bu completed if the permit is for one hundred dollars
(SIM)or less.)
I
ha nfy th un the,pef mtai nfth hf hch th Fete tt. issued)
._ ._---� .-.-. �1i'.Cl'tl Cs�{f`}U�t"1(inio�l'x'. ��.
ke
khall noicmploy oby person in any mmnncr +n es in becumc subject to the Won
Co. pcmotionLes .1, n at
NOTICE TO APPLICANT. if, B ask F his Certificate atC folim, You should
lacliniae sab)<n to the Worker S Co nkro p ry s ms iif the Labair Conte:y u ti-t
frth comply inchp-nsnor th Pth 11 bd d....
'-n-
._. .__.
n 1-P s ti WNSTRUCTOC,
° irT-ugenYce
P',%K
1 hTereby s Ih t there i'e nn t m do lend ng Yi f the perfo emu
� bhh kfhM1th pe t ..J JISc Jct➢C CI
-____.._ .._....._ _ __.__,._._ ..... _. _... __.__..
is
1 n fy th t 1 hoe read th i app) til m unJ stem chat the above mlurmmin
}'i}red.
m
1 agate m ro(nply with ull'cilY nnJ cpunty.nNinantts and atom laws alini
ining '
;) tin building cnnsiNction: unJ hcrthy'ambnriee ieprc.vcniative,a of mik chy reenter upon
the aMrvc-,nemimieJ pmpeny for nspcann pwpascs.. .. . .
5:' fwelag •emu d 'fy and\<ep harmless itieCty of Cupen'n,i �gain
fq liab ties, judgments, cops mJ expe Tres wh th may n any way name egmn.a, said
Z Cty bsqucncc fthlgrn ng ofth p n " '
YPPLIC%4T,UAAtiUER51\NDeSAND WILT COMpl,Y WITH ALC N'ON=POLV1'e`
Issued by; Date
'? SUURCB REGULATIONS.
Re-roofs
S galat of Appl,cpm/Cerma,,m ,
'„HA7dRDOUS MATERIALS DISCLOSURE
L '0411th applietm future it in acupant storcr hundlehaloWi mt'1
�• w
Type of Roof_. ._.... ., .. .._... _,-...•.-.. _ ,:,. ,.,,,-._...__....
n Mun c hapter 9.12. and the He IN and Safety,f\
as def eJ by th Cupenhas
r1.a )'I
Code Season?35J�(aj.,i✓A '1 rl't"y
over.' -'• tresis,,,, ,I,_,q�.i >n'`I
1. )riiI
All roofs,shall be inspected prior to.any-roofing. material being .mstalled,_..-
„ N'llth P,” t f t h lhim c'Cupart use equipment or devices huh
If a roof is installed without first obtaining an irispecti6n, Pagree to remove
erm, but nt masdfinehe ByAowAil Qlty hlnagmet
D i' t
I
all new materials for in_specUon Applicant understands and will comply with
.- ,t _ .,.
0?" ° ' - °N°,. 7--all
... r.,'.... ,.-;.
non-point source re ulauons:.
P g
mammals 505.�qu2 the
Chaptererst
I have Safety and
253der
d
California Heahti & Safety Cade, Sccdom'_5303. 33377 and 25534. landersmnd that
rthfo Code. 533
"i(the building does nm currcndYhaveamwmaMtit is my responsibility tonoti(y dc'oou
a:C p t of the icqu t whkh mu t tin t poor m is - ce of a,
:. ate of
-1
Signature of Applicant _. _ , Date_
r - -All
.. _ _.. _
roof coverings to be Class "B" or b6iter,
tb ug't Date...
Ow d
p
_:r ..,:. _�.. .. ..:....... _. .. -OFFICE._.....
-r
_:r ..,:. _�.. .. ..:....... _. .. -OFFICE._.....