01080134 y
CITY OF CmoueEBTINo•tu
PERMIT ;CONTRACTOR INFORMATION:
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BUILDING ADDRESS: i it. - PERMIT NO f)YC _ _ - -- ---
1 7481 ".PLUM BLOSSOM :DR. WATER HEATERSo(ONLYr!ns^ r( 01,080134of!
^• OWNERsNAME...•:,���r ^^"'^^T........._,...:_ _,.. __..,_. -- _.._..__ ...__...._._ ..._._ _. ---.___- .APPLIGCf10N'SUR'DATE' ..._.�.._—
HOSHENG; CHIEN'' " 9700Ei"- MAIN _ST; SUITE. 20 08/28/2001
(/PHONE SANITARY NO. CONTROL NO.
(415) 566-2209
Z ARCHITECrIENGINEER:. BUILDING PERMIT INFO
�,O O BLDG ELECT PLUMB MECH
fO LICENSED CONTRACTOR S DECLARATION , ;[ %•rl
nemby afro m t l famed n d p -:- a,or chapter 9 mom nncmg .. ... .Job Description
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With Section 70a)lo'D 3oflheBusiness d ProfessionsCodeandmyraase I REPLACE 50G GAS WATER HEATER
is in full force and effect.;
t ¢ License Class �Lic.,p _... . .__ .. ..
o a 'Dole.f ..: Contractor .
3 n V ARCHITECT'S DECLARATION
O` • i undromad my plans shall he used a,Public hm&d.i _ . .. _ ... ` • -
i sO O ,Licensed Prufessi...I t. •, t „ tf
o LL OWNER-BUILDER DECLARATION' " "•`' "' ''
Pherchy affirm that 1 am exempt from the Contractor's Licame Law for she
?< ;
Jolliuvang reason,(Scvumm 7031.5Business and Professions Cod:Any cry or county - '
Ixp which qi P tt cont s It improve,demolsh. p may.stmctre k:,l " " 1L1 - q.,.. , .. $700
co is .Prwn t alw e4 R ppl'' sf hpermt file -tonna astemem - - - . --- -
.......__..
os.
•thatha Ir dpursuunsmtheprovisions of the C s t L Law.(Chaps 9. Valuation
r(nmvLcrmtpg Jlh suets 7")or Division rU Business d1. hsonn Cod) ! -{±;°. ':f3'�,�'1Fa'.(a ,�t��a "?'I(�"'. ? „ ,
-ooh th pick f mand'sh<bau fo sh 'll ged ke ps e.A Y I( -- _ -- ,.-.. ._. ..._.._._. .......
�mSe Or ]031.36 apenalty !.. ._. ....._._ .. _._... _ ._
y nY ppncam for a perm t'objects she appl n sl
' ;ornotmorennrsenapreaaonars(sso) 5021PNII9ITftrL PLUMBIN 'ENERgpccupanc Type.
lot fineq p tr r- p!Y m ase-aemei r m1.Yai - 5In r 07. :..._ FIN -. . .. o
wi0.a m otk. a.me t t is i;ot tid d. r B ca r r 'm.(Se •]txa'. , __._._.__ Ali P]&[$Q(&iE= p" ._ ..... .. __..
'-Basi ues and Profces to Cade.The Comr¢t Lie sec La does nose I to an S eet10n5-'
wiser f property Who bu Ids,.,imparion,them... ad who does Ioucto work himself
or through his own employms'purvided that such'improvementsre not'intended or ) _
offered f I If,howi,s,ii, he bindle oi improvermit is irald within..a year id
plthe erh Id Ila m hod fp gm theddnot b Id or `/aI
i
in Prove
for
rp..e of )
ca 1; f je P Pent e£I IYcontracting with d i s rs to f t 1.!'('
nus s ol p J t f5 ]M4 B d 1. f - - Cod 1 The C L mr's ;I t,
License Law does not apply to an owner of Front who builds or improves thereon
.andwho contracts for suchrearcns with n ccw.nm(s)lionesed.,hoom.....m the _.____-.....
Com t f cense Lmv.
.a 0 am as ropt made, ..... PC fonhis mason
$ B&
_ Own Data
^ WORKER'S COMPENSATION DECLARATION
I hereby of irm under penalty ofperjury one of the.but lowing declarations: ....
pf ❑ I have d will rc.iMiin a CadfiLm of Corwordilo wB-)mam larwoulmr:.
.\
Compensation, as provided for by Section 3700 of the Labor Code, for she
performance of the work for which this perp t is issued.,,
❑1 haveand will maintain W k ComperisImin 1 'wee,'a�brobuired by Section
:37W of the Lahor Cddc for the performance of the work,for'which this perm t is It
ded My W k ' Compen ion Insurance c e and Po1h Y umer b +, t T -
C¢ihe I N ,. "i Yk l.v Policy Nb t sr. 1 st .�✓". t l �l. ' 1 4 t.dr t 4 s t.se _ V/Us t^.h s1.._ _
,y M ION p CERTIFlC N OF EXE
COO PENSAT?ON(INSURANCE OR ERS ',;, s' "
l ... .---
rptition need nothe completed ifthe pedour isfo hu ndmd dollars
J 1 Y -V . 1 . ._.._... _ _... ._. ..-.:�.. is v. . ._..___.._. ..-
Ie<n fY thio in 0e,pert d e hM1c ork�fr hictt tM1 pcorm,'. I; ,',! _.,:e j s,., ; iei•,
a
shall falsification pluy'any pe n y o_ m baome bled t �M1 Work -
o
liforrU
ben bjc W or she W oke Cnmpc s p ic `
Appl c s uonSof@ L Iw Cal y
O.0 forth ih comply with h
shall bed d evoked
>. ", provisions or m s parrit 1,.. „must
NOTICL TO APPLICANT If M k this C n fc s pfExemption,y should
Z t� - - .. 1i IIJ ,
"^`Vi I: I CONSTRUCTION a IONLENDINCAGENCY'
p.'o-. at
l l' b firm thath .s s o lending agency f 0peri nn5nce f t`
a"� of the work for whichm t 'cd lSec,3U9] C'-,C) - .,_•v.
.r�;tr ..11cisder's Naive, �..•,. ..... _ ..t .. _. .. .. _ _ ... .... ._-.. . .. .. ._...
V O
he f nlfyA that dsh ppl d sh t
v t ,
I B mpl) th all city p J d t t 1 velour,
g
OU thlJg
construction.a
ot i pndh by tM1 p est fthtyt topen I
she av sJ p n finspectionPurposes
`-"�--
�.t y (W) 6 u.ae mdemnlfy dkeep h sth City of Cupenn duct rat
Gr (n Iias 1man.judgment,costs and expenses,which yam any ay am
cce against said
Ui',Z my n
n segnce ohne s r g anis Permit
APPLICANT UNpBRSTANDS qND WILL COA1DLYPITH ALL'NON:POINT Issued by: Date '
SOURCE REGULATIONS.,.•_r.-• ,. y'
S'Bnt tAppbcaht/C t t Dhe
" ,,. Re-roofs . ,..• ,.
y. ,1 ., 'HAZARDOUS MATERIALS DISCLOSURE s
'„ Will beapplicanto f mrcbu'IdnBpcc P t.w nal nazard mat 1 Type of Roof.. ...__ ._ ...._.
a,d.fined by the Catera.Mari ipal Codle,Chapter 9.12. ad the Health and Safety, t •n t le , It xjt r, v 1
Code 5 Lon 25532(a)7
j,, ❑ .,.:', -<1'uf hYeyAll` roofs.shall.beins ecteld. rior,.tof .'any roofing material-being installed:.
,
,'Will theapplicant future building re, pa t use equ p t devices which Ifs
'to ins[alledl'without first obtaining an itispectil''I!agree'to remove
District'. - all new materials.for'I'tispecuon Applicant understands and w_ ill comply with
ith d 1 A OItyManagement
,
❑iwvc reatl she hazardoametenak re wremems)un - i --
m
r all non pomhsource'regulahons'
.,.
y der 4.,l un 6.95 of the
Ca Ubebuilding
ing due&SoMy Code ave.IIs2ESOEid I,I,
ymsp.3q:b.understandoardif thio _
lrthe bmMingdnesnmcufrensw hmeaitba thatis myraponsibilitymnflume of � .r
•2up m f the' quire s 'hcnmuii be met poor o its f Cen Rcatn of
'-- °c•`p' y • •" Signature of-Applicant Date
-
. All roof coverings to be Class"B" or better'.
ownernr aadmn.ed ae m��' . . ome� , .
07 OFFICE
;�', 't : �, ..... '. t . • .. - .. t,,. ..x., ,,,.fit _ . .