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CITY
l DING, DIVIISSIIONND
PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
8105 PARK VILLA CL
JUST WATER HEATERS INC
01060059
NAME:
APPLICATION SUB DATE
'OWNER'S
DIAZ GLORIA
1764 NATIONAL AVE
06/11/2001
PHONE:
SANITARY NO. CONTROL NO.
(510)293-9901
Z ARCt11TECr/ENGINEER:
BUILDING PERMIT INFO
O
BLIND ELECT PLUMB MECH
CJ
i LICENSED CONTRACTOR'S DECLARATION
Job Description
o I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
to with Section 7000) of Division 3 of the Business and Professions Cade, and my license
LicenseCls.and eBeCL Lic.0
REPLACE 40 GALLON GAS WATER HEATER.
Date Contractor
Or ARCHITECT'S DECLARATION
g 1 understood my plans shall be used as public actuals
OLicensed Professional
4 OWNER -BUILDER DECLARATION
Oc 1 hereby Affum that I am exempt from the Contractor's License Law for the
a followingrcason (Smion ]0315. Bmincss and P,ofcssions Calc: Any city ter aunty
O which requires a permit m construct, alar, improve, demolish, or repair any stractore
q Prion ea its issasam,alsom,masme applicant far such pcmmm Me. signed statement
.- ... _._...__........ .... ...
- 'bid he I ret tip -win on hb ia: ,l C t , a T _ I tunpmrp
loom a ah with Sea 70tNllufUvis laf the Brion' and lmfgsaons Code)
r' ,Sc FL Floph-Area f .,'t' IItt
�'t )�s. j t_4Ll,.�
$49'2lualion
or that he is exempi thcrcfman end the basis forma alleged exemp0on. Any violation
of Sralnn 7031:5 by any applicant fora permit subjects the applicant,. a civil Penalty
of not more than Five hundred dollars 15500).
3 5 6t1b*�, 9r9ft
— 0 f '. t Occupancy Type
❑ T. as owner of he property, or my employees with wages as their sale compensam..
I
502 - FINAL PI�A9Pl4eA (kI1s GY
-will do the walk, and the sbu<ture is no -mended or offered fur sale (Sea 1014.-
Busineis and Professions Code: The Contractor's License Law docs not apply to an
owner of property Who builds or Improves thereon, and who does such work himself
or through his awn cmplaycea. provided that such improvements ase rat intended or
,__ 5,06.. _._GAS _TEST__ .__ _ —_ ___ _ _ __ _ _
- -, - -
_
wo ed for ielc. If, bowevea the building or improvement is said wimia one year of
--� -
-, _ „ ---, . ---
I it
nmpledan,theawaea.mmde,will have the bods.orpmdngthat hedid net Wild or
507 - FINAL PLUMBING
improve for purpose of ar led,
i
OLas ownerof the Pro n--
pc y,aminclusivelyc ,nt ,ingwishlicensed<ontrctasto
___...
L s f'1- ,.
constmn the project IS 7B44Business d Pr f . 'are CW,:) The Camrator's
License Law docs notapplyt Owner f p piny who builds or improves themon,
ED
And who ontmcm.fa h P 1 t ..wthcontractors) licensed. pursuant to the.
FIN
C.ntrwimmfs Lttmc la
cpcmpt anger Sce. ` . B dr Y C far this reason
�0 l k::, n.- r. ;
Owhir Dot
JUN 2 5 2001
WORKER'S COMPENSATION DECLARATION
I hereby affirm under pepahy of perjury one of the fallawimg deal ... firms:gu►LDING
-maintain
❑ 1 have and will a'Cenifif.m of Cassino 1. ai-insum far walker's
Compensation, as provided for by Section 3700 of she Labor Cade, for the
pedormance of the work for which this permit is issued.
° I halt and will mainmid Worker's Compcns itiob insurance. as required by Section
3701 of the 'I,abor Code, for the pcdormance of the work for which this permit is
- issued. My Workers Compensation Insurance carrier and Policv number arc:
Ca e i ,:; t kn<Na.:
'.
t" '�' �: �: 4.t':'4.iii f; ?:"'•:
t CERTIFICATION OF, EXEMPTION FROM,WORKERSl,
`
bIPENSATION INSURANCE
v ' (This sector. need not he completed if the Permit is for am hundred dollars
151001, less.)
-' rkofb h ,h' pens t I'se issues.
1 cempl ,tet th : ped any
ori ori ca
shall not employ any ,p rso in any mann r s x to became object .,the workers
Compensation Laws of California. Dae
vP .'.
.. _ _ ..._ . _____ _.- __..... 1 _ - - _ _ _ _- - --
-
NOTICE TO APPLICANT If aura mak g Certificate on
•"
must
n o inion the Labor Code, you mulct
to the Workers Compensation
>, bcahwith this peau sol the
a
mond itand.
(anhwi,h comply with such provisions or this Penna shell be deemeJ invoked.
comply or
_
O CONSTRUCTION LENDING AGENCY
,
1 hereby affirm that them is a construction _ lending agency for ,he Performance
'
r of ahcwork lin which this Ixrmit is issued (See. J09], Civ, C)
Z-Lender's Name •. •_ _.. .. .. _� ..c_ ,. _- ._... ..... .. _ .
.._ __ ..._ . _. _ _ .... ... _. _....... _ _.. _ _ . ........ . . . ...
G Leneer's Ad d.... 'a _
.. , r • „„
1 mr ify that I have read misapplication and state that the above imona,ittra is
career 1 agree to comply with all city and county ordinances and state laws relating
tm building e.mouaion. and hearty ammirim representatives to this city to enter upon
s7 .the drive mentioned property For inspection purposes. _
(we)agree id save, indemnify and keep harmless the City of Cuperrino against'
n liabilities, judgmenu. casts and expenses which may in any 'say scenic against said
L Co, m consequence of the granting ofthis_pirmu. _ .'
APPLICANT UNDERSTANDS AND WHIT. COMPLY WITH ALL NON POINT
' "1 "".
Issued by: Date
SOURCE REGULATIONS., ..
.Sigmemcrf Applicam/Cmaa.ar: Dae'
Re -roofs
- - H \ZARDOUS MATERIALS DISCLOSURE'
Will N -''Plc tart buildingoccupant same or handle hazaloua material
Type of Roof
xs defined by sea C pen Municipal Cal Chapter 9.12. and the Health and S dray
Code, Section 25532(a)?,s1e •� i
!(
❑vat0N
_aAll.roofs shall be inspected prior_to-any-roofing material being.installed. .._ ....
Will tea ,plc trif mrebu'IJngOccupant `ro p t ducts - which
If a roof is in without first obtaining an inspection,d'agree tti remove
e,h Ju. arc umn.nna, detndby the' Hy Are Air Quality M.mgemea'
D t t
_ all new materials for inspection Applicant understands and will comply with
,.) °Ye":;;,.I °" -
..
all non -point source reggguul�atiions. �//'i---
1 have read the d materials requirements ode Chapter 695. of the,
'if
H dth Safety Ie Sections 25505,25533 and drum d aha
'�-" l,.t_
i the.
ure e responsibility
he s of currentlyhave stt that my pori
ifitis
ifthebbtldmgdmsnotcurren0yich
-
ora Certificate
occupunt6fthe requir mints whish must be ten prior m issuance o(a Certificate of
mu
Occupancy. : "
.,
Signature of Applicant .., _ ,. _.,.- - Date
t All roof coverings to be Class "B" or better .
muri:en agent
.ea...... _.Date
OFFICE'-