01080049 CITY DIGmERoNo
NPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20202 RODRIGUES AV HOT WATER INC 01080049
OWNER'S NAME: APPLICATION SUB DATE
CHI LEUNG 2531 GRACELAND AVE 08/08/2001
PHONE: SANITARY NO, CONTROL NO.
(650) 298-8494
C z i ARCHITECrIENGINEF,R: BUILDING PERMIT INFO
su-w BLDG ELECT PLUMB MECH
a U w
ad
LICENSED CON RACPOR'S DECLARATION
5„? Job Description
I(army affirm that 1 am licenad under r, vi,imv,of Choper 9(commencing
force
„�� withSection]OW)of Division3oftheBusinessandProfessionsCode.andmyliccnse REPLACE WATER HEATER/GE PROFILE PERFORMAN
p m f-i is ca full
Class force and erf<n. SMART/WATER
OW a4 License Class Lic., �®
n O Dae ComanorFINAL
3 u.y ARCHITECTS DECLARATION
=O? I understand my plana shall W used as public reenacts
W as 2002
W
ECC Licensed Professional
ace OWNER BUILDER DECLARATION
List a
y 1 hereby tarn that I um exempt from the Contractor's License Law for the
F?< following arson(Section]onL5.Busimsa andProfession,
vet de io li Code:A y ;o�^il
5-o which rtquirts a p limit to cannmct,aper,improve,demolish,or a9 E NG o
w�Z prior to hz issuance.map requires the applicant for such permiuo file a sign
".___....
dym nets licensed purwam to the lu visions of the Contractors License Law(Chapter 9 S Ft. Floor Area . a uetion.
(cmnmebcing with Scaran•70W)of Di mon 3 of the B,r,jnea..an<l Profession,Code) 7 ; 9 or that he is ei8mpt therefrom'and the basis for the alleged exemption.Any violation
-of Section 7031.5 by any applicam for a pcmtiuubjcas the applicant m a civil finally
•of not more than rive hundred dollars x500) umber 1' ., Occupancy Type
❑1,as owner of the pmpeny,or my empmya,with wages m mar sola compensation,
will do the work:and the structure is not intended m offered far sale(Sec.7141. -
-
Rusin-,and'Pmfessions Coda:The Can......License Law does am apply 1.an 506 - GAS TES1Required Inspections
owner or property Who WaId.%or improves thereon,and who does such work himself
or through his own employees.provided that such improvements am not intended or _ 5.07,-7-. F I NAL., PLUMBING-_____
".bffer2d for sale.IL hiwvevd,the building lir iniptdvemem is sold within one yes of _, _....- -_.... ... ..... ... .
completion.fthe owner-builder will have the burden of proving that he did not(wild or
improve fs
orr purpau of sale.)
..O 1.as owner ofth< - _contracting - -.... .... .. .-.._ . . . ._. _..__ -.. ,..._.. _._ _.._ ...,.._ _ _ — _ .. ..._ ._
property.I 4. ussad with Wc:)Th contrumn to ry ...
icane me project(Sec. to an
owner o and Professions who Codes improves
Contractor's
License Law, not apply man owner of a commands)
who builds se improves Merton.
anJ.who contracts.for sucM1 projeca.with.a rommnodzj IimnseJ pursuant norther
Cnnnactnrs Liecn.ae Law. _
e' _
❑lamcmnr,,under Sec. .B&PCfor this reason �' �- - �• ql
Ow,n _ Due
WORKER'S COMPENSATION DECORATION
. . I nereby affirm under penalty of pe jury one of the following declarations:
❑ 1 have and will maintain a Ccnificac of Consent to elf-imame for Worker's
Compensation, as provided for by Section 37ID of the labor Cale, fm the
_ petfonnance of the work for which this permit is Issued,t.
❑1 hale ondwill maintain Workei i Compensation Insurance,as required by Section
- _ 371(1 of The Labor Cade.for the performance of the work for which this permit is
issued.My Workers Compensation Insurance currier and Policynumber ant
Cartier.' •I l .Policy Nu. q• '+(P: rb:.'in d)
CERTIFICATION.OFEXEMPTIONFRO.MWDRKERS','
_COMPENSATION INSURANCE ... .. ..... .. ... . . .... .. ._-
•flT s section acrid not 4s am plued if the peen t is for one hundred dollars t s t
($IIID)or less.)
I comfy than in the performance f the k t,;,-hch thi pc t issued.l • - - �, ,F' _ -_ _ .. -
tshall not employ any person I.any manner so as to become subject to the Workers '
Compensation Lowe of Califianw:Data
NOTICE TO APPLICANT IL after making this CeExemption.
n B<ac f E pti you should
laccome obactotht such C mwne t p hall a Un Coda,d. most
Q Q
forthwith comply with such Pro -ions or do,fern t.null be remained ked.
CONSTRUCTION LENDING AGENCY "t
a'7 'I hereby aFrm that there is a conxmrn{on leading'N tmay for the Rmfomas e
h h th permits iaued(Sec 3097.Civ.C.)
yC 'Ledrs\ante
1 carmfy tbar Ihave ath PDI i d.ttth th bo f Liam is
curie..I.,me t lily with r1l city and comyordinances d s,,,a laws clai., r
soWilding construction.andh authorizepermpirte.- tt oY
to enterupon
>,:W the ithave-overamed property fpet parrovics.
AW (W)agree tosavc.indemnify
and keep hamle ,ba City f etun axi
liajudgment,.costa and expenses which may many way accrueagmn,,said
Cityailc ofthem"orlihla
CANTUNDERSTANDS'AND WILL COSFLYWITALNONPOI\T
a SOURCE REGULATIONS.
Issuedby: '/a1VM'I���/ � �✓I^k Date
IV,yA�/J.
Signature of Apprcant/Cantmemr > Dam t Re-roofs
HAZARDOUS MATERIALS DISCLOSURE ,,I
Will the, pplic ,.,Estate Wilding mcupamt store,orhandle harvdmrs maeam ..Type of Roof ... .,..-._...- .. ...,...._..,-
as def had by the Caper no MmrCiPrlrCMe Charter 9.12,and he Health and Safetyt„s: ) �. ••
Cole,Section 2553](.). f
0Ye3r ” - 't,^,;pNn', ;' ,:; .;,; .J':o All roofsshall.be.inspected prior.to.any roo6ng.material being.installed. ._ ...
w 11 thethe t f t build occupant u%e a mens o devices which b
pp d Win q p If a roof is installed without first obtaining an inspection;d-agree to remove
Dtri'nkui d vco t r v%detin Jny he Bay ArtaA Quality M1lanagement
Di%nmtr , all new materials for inspection. Applicant understands and will comply with
'pY`a ❑Na all non-point source regulations. ,
1 have mad the h.cardoui mamals mquimnwn¢under Chapter 6.95 of the
Cellfarnid Healthi&Safety Coca,Seniors 25505.25533 and 25534.1 undersand that, _
ifthe building Docs nm cancntly havcamaomnha liisn,Y P Y Y -- - -�
n,inilit mnficam of
bceapam of the tequirtmentz which men W tan pridr to issuance of a Ccnificam of
OccuVancy. 'n
' •� '
Signature ofApplicant _ ._, Date
Owner or authorized agent- tD„< All roof coverings to be Class"B” or better -
t: ..
OFFICE .. . . ._.. . . _- . .. . ..