01010051 CITY ILD ry owISIONNOPERMIT CONTRACTOR INFORMATION:
.BUILDINGT\DIIRISS: PERMIT NO.
74r�9 PLUM BLOSSOM HOT WATER INC 01010051
OWNIiR'S NAME;; APPLICATION SUB DATE
2531 GRACELAND AVE 01/12/2001
PHONE.
1/12/'2001
PHONE. SANITARY NO. CONTROL NO.
z Z ARCHITECtENGINI::R; BUILDING PERMITINTO
00 BLUG ELECT PLUMB MF.CH
N z w I—I D I-1 LJ
s�= lob Description
LIat that I a CONIBd under
DECLARATION
1O L_ 1 hereby afnmt rhos 1 an,Ifni,J suer provisions of Chapter Cooler(commencing
F,nf-i: with 5emioree ad)of Divieion lofthe Businessland l'nrlcxrium CNe.and mYliceme
<y—= i.imm�h,meanddme1' REPLACE WATER HEATER
z z c a Licave Clas Lic.a
5 c.0 Date Contractor
nRCHrrEC1"S DECLARATION
c- In 1 underdard troy Alun, tell be used as puhlic records
ca C
o o Licensed rrmcxamn:d
c. OWNIral ex rept b DECe ContrION
o,w o I .,,,aHinn that I ton cscmry limn Inc Cslior,,C%oca:
License Law for the
F Z> but lowing reosnn.(Semon 703 1.5. 1.do,lland 1'n,I'csslo li Cale:trey tory or euutne
whirl,rcyuires n fcrmil u:s nunmr,alma i:npn:m.Ae:nnlinn,err repair any nnucturc
at
a,- prim max nxuana.alru terriers me:ippucam for ouch joermiuo file a.vlgnm ptmcmcin
'bar he isIiecieedpar aal to(lie provikions of the Cmnmmm.ucellLaw(Clai9 Sy. Ft. Floor Area Valuation
(i,tiouncer,un,wilt Seai( 7foxf)n(Div ra3H lheHo,inens and Prote.sionx Code)
ion
or the he ix uxcmpl tco, amt and Thu basis fir the alleged cacmpti,o.Any violation
of rea no 91)1 LS by tiny deed danl fol a Permit nnh,j<srs the applicant 10H civil penalty
err am tome lntllt tree naadred dnuam(a5ou), APN Number Occupancy Type
❑I,s rel the Peeper two sty cmpinyrc wait wages:o,their sole cunpensation.
awns
will do the rind.nnA Tho'recline arc ix nnI lloo', d err,trend roe sale Ism. toJ4. 2GG 113044. OLD
Boom-,and ery Who,as Cod,. in, eves th.rs,and w Law Jne,ton apply rr if Required Inspections
,,w r.ar property wen naudx m bal,rnvcv rhvcmt,and rime and sa,n wink nim.dr _
r though his ,we erepinycd.provided oled nelt itepnoementx are a d intended„ 502 — FINAL PLUMBING ENERGY
nlrered cot sale.It,hnwac:,the bre Jding or Inoprnv,nenl is ,,to within one year of
nipledan.me n,„lcr.buildcr will leave the burden or proving that he did no(builder 506 — GAS TEST
hnprove bur far'ne of snle.l.
507 — FINAL PLUMBING
[11.as owner of project
p(See 7,ton ew9mivdy d Preacing with liccnscde Contractom
kensconvicael the iva n (Sec. it,ai lboowner hx and I rty whinrm ill err The Contareon,
License Law tract nm apply ea on projects
w th a contractual)
who halides improves the.nn.
andCo rano,,mart.Iia wen prokr'u with a onnacuatls)licensed pursuam m Inc
01 our rou License Wen.
❑I ton exenyu under Sm. .H k P C for this meso
Owner hf('[)are Data .2
WORKTiR'S CU1'I(1N UECIARATION
1 hereby nflirmondcr(+rally ofp tri are of the following dedarac
inn ?`
❑ 1 have and will n main a Ccnifcme of Conxm it)se6insurc lar Worker's
Compensation, itprovided lit by Seninn 37011 of the Labor Code. for the
perfmmanm of the work for which this permit is i<wed. J
❑1 have and will maintain Worker'.Compensation Insurance,as reruirc l by Section
3700 of the LuM,r Cale,for the perloraidner of the work liar which this T:ermit is
sued.My Worker'.Cnmpcnwtian Inwmnce currier and Policy number are:
Canis: Policy Nn:
CEWH ICAI'ION Off lbMrrioN FROM WORKERS'
L'OMPENSA'IION INSURANCE
(I lr,aco inn n ed nal he.cu.. uend i1'the permit to tut enc hundred dollars
(5110)or Ido.)
I ecrtlfy that in the If,Jbnnancc nl'tbe work Ibr whleh Chia tier sed.1
shall all employ any......... ny
in
an no. ,, ......
e subject to the Worker'
Com;xn¢dion laws nb Culiromia.Dam w
Alaplicam
NO)ICF 10 APPLICAN'1:IL alfa making chis Ce ntlearc rel Excmluion,you should
become suhjccl to the Wea kei's Compoicalion pmvisiuro of the Isles Yo
Code, u must
Q O lonhwin comply will. nd pn:s'irions err this pennil shall he created revoked.
z .�. CONS'TRUC'TION LENDING AGENCY
1 hereby action turn there is a ann
nuaion leading agency Ln the Isafoneence
Wof the work Gtr which Inie;wnnit ix isaucd(See.3097,Ci,C.)
L Q Lender's Name
;5 z Tender's Address
U Q 1 certify that I have read this application and state that the above informmion is
fes F correct.I agree era comply with all city and county and nences and state lawn coloring
Q U m building corotruction.and hereby authorize reprcuntmives ofiniv city or enter upon
'. W the above mentioned propcny far impection purloses. -
t,,,
A. (Welt agree to exec indemnify end kat cal the City of Cali against
W liabilities,juJgmems,costs and cMxi which may in any won accrue again I said
U z City in conuyucncc of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE:REGULATIONS. Y'
Signature of Apprc:tnVCmnracmr Dare Re-roofs
IIA/ARDOUS MATERIALS DISCLOSURE
Will the opplicum m lure.building accuNnt rine a hurdle hazuJom nedwriA Type of Roof
as defined by the Cu,eninn'Municipal Calc,Chapter 9.12,and the Hoellh and Safety
Calc.Section 25532b6!
0 ye, 0N" All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or device.whin If a roof is installed without first obtaining an inspection, 1 agree to remove
emit nvurJom air cn tlecti ins ledelined by the(lay Arcot Air Quality Muragenmm
D1111110all new materials for inspection. Applicant understands and will comply with
o Ych 0 N all non-point source regulations.
Inine rent he h oardous mmcriaar rcgnircmcnfa under C'hapmr 6x45 of Ila
Culiharnior I ICJIh ar Safety Cale.Seen to 2550.5,25513 and 25514,1 understand the
it the ntdldin'dn,x mar a:n end,hoo,a ,re:n, Ica.,ik ery re.pme.i Addy.n,Iiry Oe .
mctraatn�r
n I the ui. to
n ants which nmri
t be m Povw
r ,,iun,,ole Ccrtifi,a,c of
Oa'apaney,
Signature of Applicant Date
uwneranennma'ed age:tl Dale All roof coverings to be Class"B" or better
OFFICE