02030143i
CITY
t DING DIVIISSIONNOPERMYT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
844 ROSE BLOSSOM DR
JUST WATER HEATERS INC
02030143
OWNER'S NAME:
LE FEVRE STEPHEN R AND REBECCk
1764 NATIONAL AVE
APPLICATION SUB DATE
03/25/2002
PHONE:
(510)293-9901
SANITARY NO. CONTROL NO.
ARCHITECDENGINEER:
BUILDING PERMIT INFO
w C
BLDG ELECT PLUMB MF.CH
f 7l I_J L71 L:3
e,,
y =LICENSED
CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that I am licensed under provisions of Chapter 9lcommcncing
with Senion](Nq)of Division of the Business and Professions Code. vnd my license
REPLACE WATER HEATERS.
f�
is imm�mrceandeffect.
(40 GALLON)
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License Clans Lic a
C Gto
Dale Comment,
ARCHITECT'S DECLARATION
I
1 undersand my pews shall be used as public records
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.o
Licemed Professional
R
OBUILDER DECLARATION
vo
1 hereby affirm that at I am1. exempt from the Contractor's License Law for the
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following mama (Section ID3L5, Businessland Professions Cole: Any city or county
FO
hihreq ape it <oWet Icor impose. mlisp oreipairmysWeturt
3c�
Paapter9
to hractor
Priot ¢issuance,Isrequirespheision
acts.....__..
Sq..Ft.FloorAreaYYf� e !! ��(t
KJ,": VAS IAI iCs-`
Valuation
of Licensegad
Ihmlh, licensedp"'ction700)of6visionNeC loclor'sLiccn"papmascma)
(cont nB wtN Sector ]0001 of Division BuSioess allQ PyVfeFs,ons Code)
or that he Is naempt Therefrom and the basis Tor the alleged' exemption. Any violation
i �1 g.tit"`..)R',
oo
of Section 0031:5 by any applicem fora permitsubjects he applicamma civil penalty
ofnmtmemthan five hundred donars(s50)).
APN Number
4rr;.::".,: Occupancy Type
pl, as owner of the proMltYur my employee wish wages as lhcir sole cumpensmion,502
— FINAL PT.TTMRTN�
ENERGY
- -
506 — GAS TE 57RegUlred Inspections I' "' • -
will'do'thework: and the structure ' is not intended or offered for side (Sec: 704,1.-
Business and Professions Code: The Contractors License Law does not apply to an
owner of property Who builds or improves thereon, and who does such work himself
507 — FINAL PLUMBING 1
of Ihmugh his own employees. rounded Nal such impmmments are not intended or
___
If, bowber, the building or urden anent n sold within
build of
me
completion, the awn co builder will have the burden of proving thin he did not build or
completion,
improve fm purpose of sale.).
6ai�
Flp���■ C®_
acts ,w _ _tracting wi_.-_ ...._-__. ..
O L as owner oojec property, am licensed contractors to
._tract tract ... sacs. _sacs. _. ,Vr _ .,. _.__..______._.
I C t `: — - -
1
ns
Business a d Professions
construct project (Sec. ]OLL Business and Pmfcasions Code) The Contractor's
9002
- [-
c
ow
Licenu co docs not apply man owner of property who builds seimproves Hereon,
License
„and rano. contracts for such,projectn.with.u cOnvncmgs).licensed pursuant to.Ne
Y/- 0 Q
_._ _ _ .. acts_.._sacs .. tract. ..... H1 -O .L. ._ .....r._ ..... _.-...sacs _ _.._.___..... _.
MAY-
`%•'
Contractor's License Law.--
❑Ivmaumquendd Sec:",t '• --" '" B&'P C fourth rtaun
Owner .. Dom.. . ,..
-
BUILDING
' WORKER'S COMPENSATION DECLARATION
1 hereby affirm undo Irr or perjury one of Ne following dalarmions:-
❑ 1 have and will maintain a Cer ifcate of Consent to self -insure for Workcr's
Compensation, os provided for by Section 3700 of the Labor Coda. for the
r
perfortnnnca of the work for which this permit is issued.
❑ 1 haws vad will maintain Workers Comper�sitian'In radar, as required by Section
'
3]00, of the LoMr Code, for the pcRoniuncc of the work fos which this penrm is
Issued My W A Cnmpensulion Iniuan ce comer and Pol y he e: ' -'
- __...... �, .., ..
acts
_...
s• i ( �i_ I F t. 1 T' �A ..I, f %C
;CL'RTIIgCAT10N OF,EXGMPI ION FROM W jtKERS
"'
.a -f , ., x , . ,
COMPENSATION INSURANCE'S
tract_ _._ _
(Thrs aacl on need no, be ci mplemd if the permit is for One hundred dollars
^ k Its -
IS100)orlcsxJ, s -
..
1 can that pert myna of the k f th s permit a iave0 1
B'n me
at employ any, person n any ma ex m become subhect m the Workers
l er
Compensation ion tows of California: Uele '
..Applicant .. .. .. ..
i
NOTICE TOOAPPLICANTotheWo:IL aRcrmaking CMinsof OfE ould
•' `
tionthis
bccomch atter Code, you most
Workers Coimi, his provisions ocatef theLatterCoda yod must
) 0
it or
forthwith comply wilh'such provisions onhis permit shall be Deemed rtvoked.
comply . .sacs ,acts _ ...
_...._.__........ .. _ ._ -.- .
V)
it.' CONSTRUCHON LENDING AGENCY'
s ;
1 h by whiim that th s i
Civ.
(Sec. lending agency for Ne perfoimAnceoptic
a -
)Q
s issued
for thismmnSixiued l5" 3119]. C), o.
ain6-hich .._'S,.
Iz ticr'e Nkv ,�... nr.i..:... ............
... ._"___ .. -_ acts _._ .._...._ .._ ------- --_
Z
. Lender's Address'+" "",
-I n.
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I certify that I have Rad this application and stale Nat the above information Is
i H
uort<cia agree m comply.wilh all city and county ordinances and stale laws relating
)_,
. caT
to Wilding construction. and tiemby amhorire representatives of this city!o enter upon
propcny forinspection -
the ebo(We) ke portraits.
x.pe'
ajioned
and harmle.
IWe)agrce to sale: indemnify end keep harmlasthbCity of Cuycnino against am
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W
liabilities, judgments, costs and expenses which may in any way areme egalnst said
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City in consequence of Ne gaming of Nis pemdt. ' - '-'
APPLICANT UNDERSTANDS AND WILE COMPLY WITH ALC NON:POINI''
''
ISslledb ! Date
SOURCE REGULATIONS:'' "" ..
'DIS-
Y'
-plicHAPARDOUSMATERI-'•
Signature fAp t .Dole ",
Re -roofs
A LS CLOSURE
hsears nomene
's Will ter ppbcam orfutme timldmgnive pat mie or handl doo
.'type: of Roof_ _ - ...; . •._-_, ,— - ._ - .
asdcfndbythCpen oM cpal Cod Ch.ptar9.12, and ith, Hatilthrund Salary
Code 255320
`,1I a V1 !
I ❑N I''`tr ht\1 i
Ott
.V prior to any„^'t)
All roofs shall be inspected roofing material being installed._
.."Win the applicant or future building oacupam use equipment at d-'ceswhich
- If a roof is installed without first obtaining an inspectiob;'I agree to remove
anal haiardras aircontaminants as defined by Ne Bay Ali. An Qoelity Management
District?'-._
'..
all new materials for inspection Applicant -understands and will comply with
- ..
.0yes CN. : WI , . '.., ,.
.. .. .. -. ... _
all non -point source regulations r'
•.I'nave' read the hazardous mvienak”rtgoimments ander Chapter'6.95'oI'tAe
.. ,
California Health & Safety Code. Sections 25505x35533 and 25534. 1 and ersund that
-if the building does not currently have a tenant NP it is my nopOnsibilityto hotifythe
...... _ _. _ _. ... ... `.... ....... ..
occup5m or the re ante I which mus, be,met pnono issuance of a Certificate of
'_` - " ' _
Signature of Applicant Date
'!I
All roof coverings to be Class "B" or better
owne,nraulnod,eaagmr, .Date
.sits_OFFICE