03030038CITY OF CUPER'I'INO
BUILDING DIVISION PERMIT
ON�� Akl:Tl7RIN'yy'URMA'TTU
BUILDING ADDRESS: _
99-441 SANTA 244111 A. AAT
JUST WATER HEATERS INC
PERMITNO.
OWNER'S NAME:
TIMOTHY KEATTNn
1764 NATIONAL AVE
Pew4IT Lits E A
NE` -
(510)293-9901
SANITARYNO. OL NO.
ARCHITECDENGINEER:
BUILDINO PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION.
Job Description
I areby stars that i em Iianud under provisions of Chapter Y (commencing
with gareand Bef Divinon Sof the Buainueend Profcsaiom Codamdmylkenu la
pngcp
Y INALEG
in full Ue.a -
REPLACE WATER HEATER
Date Ctutlranor
ARCHITECTSDECLARATION
I� n
(5 0 GALLON GAS) APR
APR '2 ,2 2003„
1 undagmd my plans mall be esu l as public meords
Licensed Professional
OWNER -BUILDER DECLARATION
- BUILDING
I exempt from NC Contractors for
1 ateby .(Sect
Co e: Any c ty o my
following.conn. on 1 Professions Cole:Anyally or county
]ensu Business and
arrodun
improve. or repstr may awnure
which myulru n Pnmit to 1, gkC improve,
h Permit t
prior m in issenunce p esu requlthe to applicant offer such Me inguo'toica sstgatl stskmenl
ui=th
uantcdPunuutlblue.fDM.k ofofMeB.mmw:cuaentlaw(Chapter 9
Sq. Ft. Floor Area
Valuation
(that comae wllhe.ftSection land Division 3 of la B m Code) of
Oise is exempt the t on. AnPentai vi
Oilh s exempt therefrom and Mk bus for the Waged uemplim. Any vielnion of
ed exemption.
8876
APN Number
Occupancy e
�'P
Semon 7031.5 by Any Applicant fore Permit subjects Ne applicant to a civil penally of
net mart Nen five hundred dollen (3500).
P Y
❑ 1. u owner of the properly. a my employees with wages u their suk compensation,
35704066.00
Required Inspections
will do the work and theswnme snot intended or Offered formic (Sec. 7044. Business
and Profudou Code: The Cenuum/a Lt. Law dam not apply k an owner of
property who builds orimprove&Maraon, and whodas aahwork Mmsalfordmugh his
502 — FINAL PLUMBINPG ENERGY
own employee, provided that such Improvements arenninionded oroffmal forule. If.
SO6 —. GAS TEST
however, Ne building or improvement s sold within one year of completion, the mom.
builder will have Ne burden of proving Nu he did nm Wild Or Improve for purpose of
507 - FINAL PLUMBING
❑ ]..a owner of Ne property, em exclusively contracting with licensed conrracmn to
-
construct the project (See. 7044, Business and Profusions Code:) The Connekfs Li.
cense law dots not apply in in owner o'propeny who Wilda or improves thereon, and,
who concocts for such projects with a eonuacmr(s) Earned pursuant to the Comnemfa
Lice. law.
❑ Iameumptunder Sea ,B&PCfor Nsmamn
Owner Date
-
WORKER'S COMPENSATION DECLARATION
I bemby aflsm under penalty of pedury one of Ne following deelstiotu:
1 ban And will maintain. Ccmaeste of Coucntloselr-i-um fa WudcfsCcmpcn-
-iion, u provided for by Section 37n of Mk Labor Coda for Ne performance of she
work for which this Permit Is Issued.
❑ 1 haft and will M.I.Wn Worker's Compensation Ivunnce. as required by Sanson
-
3]nof Ne Jaber Code, for the Performance of the work for which this Farrell Is issued.
My WerkCeS Cnnpenwien Insurance terrier sad Policy number art:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCEor
(This section need not he completed ifthe permit Is fm one hundred dolls (S les)
-
less.)
1 cenify that in the Pcrinnnanco of the work for which this permit is Issued. I sill not
- ^°" " —'-- ""•--•-� - - ^' - - -- -- -- ^-- — - -
employ any Person In any manner en as N become subject to the Worker' Compensation
Laws of California. Data
-
-
_
Applicant
NOTICE TO APPLICANT: If, after making Nis Certificate of Exemption, you should
become subject to Mc Worker's Compensation previsions of Ne "her Code, you mut
forthwith comply with inch provisions or Ibis permit that]be doomed mvekod.
CONSTRUCTION LENDING AGENCY
I haDby which thi the there In construction 0r. lending agency for tik performerkc of
the workforwhich Nim permit Is issued (goo. 31/97. Civ. C.)
Lendcri Nurse
% �-
.
lender'sAddress
I certify that I hen mad this application load sok that the seen Information is
'
corrin. I agree 10 Comply with Ali city and county on inanCes and one laws mining in
lRtiding construction, and hereby autherim mpresurnadves of this City to enter upon Ne
above-mentioned Properly for Inspection PurP=L
(We) .gree to an. indemnify and keep armless Ne City of Cupcnino against
liabilities, judgmcros. cos and expenses which may in my wry accrue against said City
Consequencein of the gounling of I
APPLICANTUNDERSTANDSAND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS,
Re -roofs
Type Of ROOF,
Signuurc of AppllcaDDeanHAZARDOO US MATERIALS DISCLOSURE
HAZARDOUS
WIII the applicant of forum building Occupant store est handle IHealth
u OOOncd by the Cupenin0 Municipal Code, Chapter 9.1], and tits Health end Sefcly
9.1 and
Cede. Seder 25532(p7
All roofs shall be inspected to any roofing material being installed.
Y. ON.
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use, equipment or dcvkes which
Its-rdnueair contaminants udefined bythe Day Area Air QutliyManagement
all new materials for inspection.
istriCli
❑Yea ❑No
1 hive rad the huarNms materials requimments under Chapter 6,95 of the Califer.
ns Hu1N&SsfelyCodc,Sedau75505.25533md75534.1undcnu ifthe Wilding
does not currently ave a tenant. Net it s my responsibility in notify tic meopenl of M e
rcqulmmcoH which mug he mel prior to issuance of. Ccrdfinek of Omopncy.
Signature Of Applicant Date
All roof coverings to be Class "B" or better
Owner
or aulhOdmJ spent new