01100056 TY
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BUILDING DIViSiONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22393 RIVERSIDE DR JUST WATER HEATERS INC 01100056
OWNER'S NAME: APPLICATION SUB DATE
LAI PEICHUNG 1764 NATIONAL AVE 10/10/2001
PHONE: SANITARY NO. CONTROL NO.
(510) 293-9901
G m Z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
P o FoF BLDG ELECT PLUMB MECH
Z<
5
LICENSED CONTRACTOR'S DECLARATION 3
IZ�+q Inereby 00)am ffuthin lam licensed under provisions of Chapter 9lcommcnnng Job Description
=CW with Section 70of Division 3 ofthe Business and Professions Code.and my license REPLACE WATER HEATER
m y if in PoII mice end effect.
:%.< u1m. la, Lie.a (50 GALLON GAS WATER HEATER)
o 10 u Date Contmcmr
:
is.>n ARCHITECT'S DECLARATION
}g 1 understand my plan shall be used as public mwrds
i i o O Licensed Professional
OWNER-BUILDER DECLARATION
6 1 hereby affirm that 1 em exemN from the Cimunim is License Law for the
C?< following reason.(Section 7031.5.Business and Professions Code:Any city or county
E F o which requires a permit to construct,alter.improve.demolish,or repair any vncmm
p�?'3c� -priwwiuiawnce,alsemquim twviii., fdh,cmusrmiuoicenseow(chapter9 _......._ .—___
- that Heli licensed purivahLtoibe pFovisions oftw Commaors License law(Chepmr9 ... , Sq: -'Flo rem '• -•
(commeecis exe hSeNonlUCind the basis
cumpliml.Any viCade) (��'t;\ �']p.-1,•. (s,lft QY\f `• aeration
or Shade i7(DL5 bt therefromant the hPer fnsthectsthe Aplicpbon.a ci violation
of nor.n'1,ban v my applicant rs apfmtit subjects the applicant tea civil perlmry
of nor..,ban five nunama annars fasoBl. Occupancy Type
❑1,as ownerof the property,Of my employees with wages al their self compensation,
will do Ne work,and the structure is not intended or offered for sale(Sac:1000,"'
Business and Professions Code:The Contmcmr's ucena<law does not apply to an 506 - GAS TESTRequired Inspections '
owner of property Who builds or improves thereon,and who does such work himself
or through his Own employee,.provided that such improvements am not intended or. _. .. .. .507 -7 F I NAL. PLUMB I NG--.
offered for'iale.If,however,the building or impiovcmc n is sold within one year of _... _._ . ._ _ ... .. ... .
completion.the owner-builder will have the burden of proving that he did not build or
improve for purpon of ane).
❑1,a owner pr the property,am allusively contracting with Iiansno C.. ors 'a j •. , "t
mn5wct tw presto(5¢.)010,Business and Professions Cade:)The improves
th er o i ,
Lleense Low dna not apply to an owner of property who builds roe impro sio thenen,
_ -end.who coltr,xu for such projects with a cmnnnm(s)licensed purwam m rw. ._.. _.' - FI N-ALE®- _. ... . _ ..
Contractors License law.
❑l ren cacmpt under S«, If P 1.\, "" r. B'&PC forthis moon
Iwine" 'Dora Nov 0 2 2001
- WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following dmluations:'
I lave and will'insu."win a Cenificae of Consent to mlf-insure for Workcrs BUILDING
tav. Compensation, as
provided for by Section 3700 of the labor Code, for the
pirtormance of the work for which this permit is issued,
❑1 have sand will maintain Worker's Compcnsation Inuratrci,a5 required by Section
31X0 of the labor Code.'I.;tw perfotst'aa�fof the work for which this Dermal is
ed.M Worker,Com uOt T Inurtirce conic,.d Policy n- -
ri
Center Polm No.:
'•:, 1:CIiRTIFICATON FEXEMPIION FROM WORKfrRS",l' - 4-(•\ (�-,.'�t•'a Y,J�� = `r'• y.l`:^ k k • -
"' ' COMPENSATION INSURANCE ""_...
rlTrs action need uta he completed if the permit is for one hundred dollars
(51007 ar lea.) r
. -
t I certify thzt in thparfammtc of the od foi whiN this permit is issuW,1
shall not employyoperm y s as to become t jeec(to the We keri
Compebat an La f Cabfomia.Dais'
-Applicant
NOTICB TO APPLICANT:If,after making this Cenificme of Exemption.you should
bece omsubject to the Workers Compensirium provisions of the Labs Code,you most
QItifnnbwith'comply with such provisions or this permit shall M deemed revoked. I
z
ad. . .
"' CONSLENDINGAGENCY 1
"1 hereby am ffirth t them is..is ms stmcton lend' 8 ge y f the"pertnrmana •'
r.t of Ne work for which this.� h u d(Sec 309'!Ci,C) '
Lt Gender a theme . t""^•. ._ . .. _.. ._. . - . ..
.7. -Z' fender's Address" .. r
V'� 1 cedify dam I ban readth ppict and state that the bo information is '
get F•I. correct I agme to comply with all city rod county ordinances am state 1 relating1-
C.3 , roobuilding t t' d, o by th p e. fth .Y to t upon ,-
�,,, ts7 thew i-ed s pend for .pat p,pose �� •%tV/ �^ttYK//k"
Z, (We)agme is a e Indemnify and keep hi hamay in an City f Cupe against
ego oat
Z : Cig'in consequence
orse uences,fdut and'fx ofthisoasta wwchmeymany way scene egamst std
V rte•. Airy goinfing this permit.: `
APPLICANT'UNDERSTANDS AND WILL COMPLY W ani ALL NON-POINT''
= ' SOURCE REGULATIONS. ' t• Issued by: Date
SiRistumof ApplicanUContmetor'r ""'-' ;' Data 'r I Re-roofs
s it' HAZARDOUS MATERIALS DISCLOSURE
W ll the ITnef nt f t w(ging co upant nom r handle hazardous m teem Type of Roof
- - - - - . . --.-^ -- - -.• -. --—.
era,sell lir the caivt M pm cOa @apse 912.``end the Health and Safety i .,.t. 11� .•,r t.,, .. „ ' . I•
tCcde ❑Ya255311)+ Ito l7 Nnls Nt ', a iJ I'' lj f ... ZL. e t +,,. f fl� v ,� raa47f.•. tl ,a,�:
_ t„,Ell t .I',• All roofs shall.be.inspected prior to.any-roofing material.being installed. -
t .tWll the applicant or furore wilding oceupen�use<gpipmem or devices which If a roof is installed'Without first obtaining an'inspeetion;Iagree toremove
emit baaWom,air contnminanu u defined by the Bay Area Air Quality Management
Dlasrifto vea -oNO' - " r all new materials for inspection__Applicant understands and will comply With
r 1 all non-point source regulations:?,
he e,read Ne havrdou,'m
1emriels raiwnmcnu under Chapttt 6.95of'Ne,
California Health&Safety Code,Sections 15505,25573 end 15574.I undfrstend Nat. -. _
if tri building does not cumen0y have a mn'atih thin it is my rasponsibiliry m notify the .
oc vfoom of dna_qu'ucments which muni be m«prior io isiueme of a CeniOatf of
o
lanney
'' Signature of Applicant Date
o .n,.Ytndudogfnt . Dam „ .. All roof coverings to be Class "B"or better
OFFICE