02080082 CITY u Ne.BUILDING CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10113 SENATE WY JUST WATER HEATERS INC 02080082
AM19-0 GERALDINE M 1764 NATIONAL AVE APTLICA]Q/lrB?A 002
( PHONE: (510) 293-9901 SANITARY NO.
LCONTROL NO.
O O ARCHITECDENGINEER: ! BUILDING PERMIT INFO
W❑ BLDG ELECT PLUMB MECH
a O L+ I—J t-1
N= LICENSED CONTRACTOR'S DECLARATION ]] crl uon
$zyG hinny(hembfirmNnt I am sion3oftheBsincensed esandprovisions sionsCtee,andmmecense REPLACE WATER HE� '����®
G vtYw ilii fall Section Division laf the Business Professions Code.,end my licnrse
<m y is in full furc<and effect.
�a �< Dole
ix Clea LContractor
ing DEC 0 4 2002
a� +-}_n Dna, ARCHITECT'S DECLARATION
t:a 0 5 1 understand my plans shall be used as politic react
s2oi
or oi
m p Licensed Professional BUILDING
v ty Oat I am exempt
Lo DECLARATION
1 hemby.!fico that I am exempt from the Cocoons Cas License taw for Ne
Z
< following reason.(s<«inn tons.e.ai�aa arta Professions cmc:Any city or county $800
Sas 0 which requires a permit to construct,alter,improve,demolish,or repair any structure
i3� pneno us issuance.also rcy ' s the for such Permit o file asgned statement - - .caa p - - ----- ------ - -
that Ind.licensed pinaati to N .r prow, s of mct
e Contaors License law Chapter •3r2$1�DtQ�lagrtiplpea 1♦a.-.. Valuation
(vmnnmncirll with Season 7")of Division 3 of the Business and Professions Code)
or that he A exempt therefrom and the basis for the allegeL exemption.Any violation k t
•of Section 703 1,5 by o lapplicant for ,tsuM1jenu the opplicanuoacivil penalty
of not
mom
than fivenundreddollars(1500). - 502ARNWbIA& PLUM13INC ENERGY Occupancy Type
Cl 1.as owner of the pmpvd,ser my employees with wages as Neir sole compensation, 506 - GAS TEST
will do the work, ad doe structure is do,intended or offcmd for sole(Sen.7014. -507 - FINAL PLhT ;A(gnspections
Businev end'Profeaions Cale:The Convector's License law docs not apply to an
ownei of property Who holds or improves thereon,ad who does such work himself
or through his an employees.provided char such improvements art not intended or
`offerdfar"'-Icfl:ho'wcver.the boldin ment is "" " - _. _ ._._.._ . _. ......... ... _ .. -.......' ..
g or improve nhid one year of ,
completion,the owner-builder will have the burden of Droving Nat he did not build or
improve for purpose of xnlc.).
_ _ _ . .. ... _ . -
❑err sew ter rf the pr pent'ons ex sines a numrafeing r., liccnsThe Contractors
onti otoro - -'t
conswct he does
(See to so Business and Profusions Codca The improves
donjon. t
License Low docs not r sue to as owner of property who builds se improves thereon,
.contacts for
and,who mch.pmjens.wiN a comracwrts)licensed pursuant to Bar, ._..._.. ...� .__ ..___... ._._....._ ..... _. ._.
Cnmrdno/s License Law.,.
❑I am exempt under Sec:" .�B&PCfor Nix mason
Owner t" Date
'WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of pro one of the following dulaatione;
❑ 1 have and will maintain'a Cenifcau of Consent in self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor,Code. for the
pirformance of the work for which this permit is issued.
Cl 1 have and'will maintain Worker's Compensation Insurance,as Iequlred by Section
37W of the Wbor Cale.fur the pertrmarace of the work for which this permit is -
issued.My WarkefmInsurance s Compensation Ince cano
sooner and Policy mber are: _
. ......I.... _. aa. .. .{ l
KE - — _ _..r... ... .. . .....
Carrier.": - C'_ .,:'T '.PolicyN°. i��IP� : r r__.:_f..ille':-
fls
CERTIFICATION OF EXEMPTION FROM WOR
RSs' '
•' COMPENSATION INSURANCE' -"a ' -
4_ ... .,... _ ., v ..______
mor,vection need nes W compined d the permit is it,,one hundred dollars
(SI W I or lor"A
d 1 certify that a then in anznce of the work forwhichthis permit a issued,l
Cmadiin employ any person in any manner so as m hecnme subject ro the Workers
Comycnsation Laws of CAifomia.Da¢
Applicant
NOTICE TO APPI,ICANr:IL after making Nis Cenificae of Exemption,you should
become subject to the Worker, nm
's Cpenupun provisions of the Labor Code,you mart
Q Q foe6with comply with sudeme
di provisions or this Permit shall be del revoked.
F'.yCONSTRUCTION LENDING AGENCY 7
ai i of the'1 he by'aff res th t therest r lending agency f sr the performance
- k f which thperm t is issued ISee 3097 Civ.C'1 _
Lends Name
7 Z L1 nder s Address ! p
V- l certify that 1 have read Nis application and sure that N
But above information is
cones:1 agree to comply with all city and county ordinances and state laws oaring
<. C:7 to building construction,and hem-by authorize mprtsxmd fives of Nis city to enter upon
r� the above-mentioned property for inspection purposes.. I A
` L
(We)agree to save.indemnify and keep harnlsz the City of Cupcnimu against
liabilities,judgments,costs and eaMaws which may in any way seen against said
U Z City in consequence of the grunting of this permit.
APPCICAA'T,UNDERSTANDS AND WILL COMPLY WITH ALL NON-PO INT ISsuedb ; ASU Date
SOURCE REGULATIONS. Y
Signature cif ApplicanVCommon., Date Re-roofs
✓ HA7ARDOUS MATERIALS DISCLOSURE
.Will the applicant o ft building acnupam st«o cr handle Incitation,maerial TYPe.of Roof �_ - .. .. .. _ ,.. ... .
as defined by the Culsormirro Municipal Code Chapter9 IA and theHealth and Safety 1 !. V t
Ctd< Seeu n2553e_(a). 'ioe.. i . I I'i,.x Jx .... { ash .� ss.� ^s
0v a"' ElN" _. +, ^ - .-All roofs.shall be inspected.prior to any roofing material being.installed. .._ .. ..
will thea applicant or future Wilding occupantuseequipment or devices which
emit hazardous air contaminants as defined by thBay Area Quality Management if a roof is inst5lled without first obtaining an ifispection;1'agree to remove
Distri`oall new materials for inspection. Applicant understands and will comply_With
rea oNm
all non-point source regulations.
- I have read the hamrdum tramnde requirements under Chapter 6.95 of the
California Health&Safety C«le.Sections 25505.25533 and 25534,1 understand that
if Ne Wilding docs not have atwm.that it ism
curcntlY YresWnsibilit t -tify\he. - - - -
_ )'onm
oncupmn of the rcuirc
qmcnu which must be ort poor to azuanc<of a Cenifcav of
°"cop'"`Y - Signature of Applicant _ Date
Oaner or auNorixW agentDae All roof coverings to be Class "B"or better
_,...
-• -.-.,. . . ... .. ... .. .a...,.. _ . .OFFICE ... .. ...... ..... ... ...