01110036 CiBUILDING DVSIONO
IiNPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
10183 RIEDEL PL JUST WATER HEATERS INC 01110036
OWNER'S NAMEAPPLICATION SUB DATE
HARRINGTON ROBERT D AND THER S 1764 NATIONAL AVE 11/06/2001
J PHONE, (510) 293-9901 SANITARY NO. CONTROL NO.
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
m BLDG ELECT PLUMB MF.CH
a i CI I'U C"-7 u
Flay
y Z LICENSED CONTRACTOR'S DECLARATION
I hereby )of tier 1 am licensed under provisions of nChI sCode9(commencing lob HEATER.Description
!�C� wird Semiun 70M)of Division 3of the Business and Professions Cade,and my license REPLACE WATER HEATER.
m E 5 is in full farca and effect. (5 0 GAL GAS)
iO i u License Cless Lic,is
i 3 a y Date Canwnor ,
ARCHITECT'S DECLARATION
;2u,
O 1 undersmnd my plans shall be used as public records
I i c O Li«nsed Professional ,
OWNER-BUILDER DECLARATION
ts 1 hereby affirm that I am exempt from the Contractor's License Law for the
C Z< following reason.Section 703 1.5,Business and professions Code:Any city or county
I F O uh h q a perm t r c vua h Doe d< bsh p y structure
63� _pries t t w Is req tae ppli gf uch permitmfu 'grodsur t -
uat hesI sedp runts t6 mall v"I n. once t fur l fen nt 9f / ` Sq:Ft.Floor;q.rea', �• y l ) Valuation
(co g tats eon v000) rD . 3o the
B met de r. h"cesa )' ?.,I lf. � +. t 3.as vA 1F ai Sl Y :
w ding
he is<aemps rherermm and be bests for the el a"atmmpdue Any violet on
of Section 7031.5 by any applicant for n peman mbjecto Ne applice..m a civil petsalty'
of.a.more than five hundred do][.H5W). APN Number � ' Occupancy Type
t
01,as awner of Ne pmpeny,or my employees with wages w their sole compensation, - PLUMBINik
will do the worli,and the structure is not intended orofkred'for wile(Sec 71)114,'
rBm d P'r,cions Code The Conwcmr s License Law daas not apply to an, 506 - GAS TESRequired Inspections
owner of poramy Who Wilds or improves thereon and who does such work h msclf 507 - FINAL PLUMBING
m guestsggh his own wet loy ms provided that such,mpromu
vc <nart not intended or,
7offeWd fesr sale.If,huwevu.the building or improvement is sold within one yew of
omplahon,the owncrbuilder will have the burden of proving that he did not build or
improve for purpose of sale.). j
❑n u owner of the p(Sec.7.em asoBusiness
comrwtctions Code:)ed The meal 1
construct the resect batt.901<,Busineol and Professions Code:)The Conweeon,
❑1 am ex t us fun r such
man owner th pr pony,city who Hailes or improves thereon,
u for such projttu.wiN a commnor(s)Rewound pursuant m.Ne.:
Ownu nde Ll W. _ -
nd.who amp ember Sec., 'B&PC for Nisrt. - t
1 Ccense brew doe �-
0
onwnols Li«
... . Date .., .. ...,, _
WORKER'S COMPENSATION DECLARATION
's Ihereby affirm under penalty M perjury one of the fallowing declarations i.
O I have ird'will .,auto.Ceniftcate'of Consent to self-insum for Workers
J1 Compenspiion, as provided far by Section37Wof the Labor Cade, for her O /
perfor n raze of the wort,for which this permit is issued.
1� ❑1 have atW will mointwo Worker's Compenvtiori IrsurI as required by Section j
13700 of the Labor Code,for nor Ierfortwnce of Ne work for which Nis pemu,is
issued.My Worker's Cm,ar ib 1 su once carrier and Policy number are:
_.timer r i'Itl J .a1 f v"Pohey No .. a y:'t•.pp Yi'y"e`! ft �,ff{�iu � �1u _ n . . .
CERTITICATIONOF,EKEMPTIONFROM WORKERS, c YI to l .�n �.._ �1. ♦1 J_ .1
,COMPENSATION INSURANCE,... _. -.. ........_._. ._._...._
t' (Thr".Certo;maid not he completed if the rather is for ote hundred dollen
(5Halt cr less.)
cl cerdfY Nm in the
perfovnhna of he work for which lois mon I'
isued�h
sliall'nw employ any Person in any manner so ex m became subjem to Ne Workers'
1 A'I t'_.,. fCnlifomia.Dem '
r Nm is TO AYPLIC .. ..
Han o . .. ... .
ANT.IL after
making this C<nificmc of Exemption,you should
irpse
become subj«t to rhe Workets Compensation piovii ons of the Labor Cade,you must
0 O fonhwin'comply with such provisions or Nis permit shall be dame,rtvokW.
-F'
Lon " '`'••"'S^'CONSTRUCTION LENDINGAGENCY,
7 - I Hereby affirm that them is'a construction Ieradmi agency for the performance
==which titch Nsp<rmt .issued fSei 3097,Civ.C.) '
li der N me
'Lenders Address ' _. •s:- „
Wo O 1I amfy taw I bare read alla city
and
eration and ordinances
the above laws
mini
0 W,E., 1.build I ecce to comely d he all airy ati n repimordinances and sum laws relating y f
O :mbatarvegcansonesi pmpony for inspection ize'reprcsemmives ofthis any to enter upon.
Ne above,e)., e_hi propendemnfyandm purposes._,
(We)agments.eost indemnify expenses
hi hamdess they way f eruc.a no st said
h liabilities,judgments,costa end expenus waicn may in my way eccme,aga, said.
'APPLICANT UNDERSTANDS AND WILL COMPLYWITH ALL IJON-POINT Issued Date
SOURCE REGULATIONS.,i-' - . y'
Signatureof ApplicantiCommator . �' t "' ' ';Date .'� Re-roofs
-. HAZARDOUS'MATERIALS DISCI OSURE
vid the tippinent orfumrt W ldmg occupant t w noodle hourdous mwmal �I f Roof' . . - -• -- -•. _. .. ... _ ..
as ned d fibylthe Cupen o Municipal Cad p
Ch t 9.13 d Ne Healthend Sof t S 'l pa o ,
Cod S.fima 55311.1 ,f0 ❑No'' 'f aS'V 111 .t y ,7 if ..• s fTrim. ! .'I
.. _
...-All roofs shall.be.inspected prior.to.any roofing material being Installed.. .
Will the ppGeam est future building«<tsp.hrom equipment est acuate which a roof is installed without first obtaining aIi inspection, I agree toremove
emit hazardous air conmmin res as defined by the Bay Area Air Quality Management'
Dwncl? ,. all new materials for inspection. Applicant•understands and will-comply,with
.uvea, ,,,. ONo - all non-point source regulations.
C 1 f Nee wd'dm h z doui .tenals reyu remenu"tsader CWhrr 6 95 Lf the y
a ve
Ith&Safety Cud ntyeats25505litis yhasp30 Indio nand tthe
ITthe Wildithe!cumm�mnenrlyhaveucns,met ois myt<uance,of.a to notousrafl -
accmWm of the rtquirtmenu which must be mu prior m issuance oLaoCenifcem of
r, Occ, Pagcy.,`s ' g Lure of Applicant Date
„ Si nes
owner or a�tnmi,ed agmu: •!� nate All roof coverings to be Class"B"or better'
.,..,,,.• :. . : :.::...: .. .• 1'";." �. ..,._' �.. , _.. r OFFICE 1