02060118 IIIIN
BUILLDING DIVISIONN0 CONTRACTOR 14U MATIONd-
PERMIT
BUILDING ADDRESS: PERMIT NO.
7955 SUNDERLAND DR JUST WATER HEATERS INC 02060118
OWNER'S NAME: . APPLICATION SUB DATE
KIRTLAND HENRY H AND ERIKA H 1764 NATIONAL AVE 06/18/2002
PHONE:. SANITARY NO. CONTROL NO.
(510) 293-9901„
00 ARCHITECT/ENGINEER: ':`.;- r.r s.: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Z m Z LICENSED CONI)OACfOR'S DECLARATION Job Description
O a— 1 hereby affirm that 1 um licensed under provisions of Chapter (commencing
F: 0t0 w1+BSection]000)of Division3ofthe BmincssamdProfessionsCoda.and mylicense REPLACE WATER HEATER
`d
is in full force.nd effect.'s < Liernse Class Lic.a (4 0 GALLON GAS)
a O Date Coatmctm
g 0 _—ARCH= DECLARATION
I undemrad my plans shall be used as public records
ed
ch 6 a Licensed Professional
nv ore
^ OWNER-exempt R m the Contractor's
1 mrshou.(firm.. I am aline from the Comrr.Cos License Law fomy
t'?Q followinguiresa(Semon]O3L5,Business and Professor.de ion Co de:Any city st county
F O which requires a perm.m contact,alter,impmve,demolish,or repair any swment
d 3 m _poor to i6Icimle ce,alt.requires Nq,#pip caof thear Ci h punnet Lt..W file is Laved smmnrent
tq'at Nu is,Ii«ntetl pu�sunm lq_ pryVisiom o(d,c Cpnrrncm/s Li«nu low(Chapmr9 ('•! n� [ c!�Oprr-��qqAA��yy��,� tt ^^ff !! `` j aluation
(cammen'a lS'ith Sedim'n(7, f Division 3 of they ine.55s and W7priiom Cade) a..•t.I:Y�1- •.'� L�P• 1..i PlJlC d:1[3\�.5:
or Chef Ee le!emir themTrinWvnd the basis for the aIIFllGd dtcmp(ioh.Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant on a civil Penalty 362ki Dof ma room than Eve,hundred dollars S500), PN Number _ ;PO::'FIT No Occupancy Type
01,es owner of the pu'luoo,ur my employees with wages as their sole cma,mminn.
(Bill'dvthewmrk:'shamodeThe Compactornded'ere Lawdoe'ande
our'apply 1.an
+Bmin2is'nnd'Professions Cade:The Compactor's License low deco no[apply m an 506 - GAS TESTRequired Inspections'Q`'-,'a t>°�'-
owner of property Who builds or improves thereon,and who does such work himself 1
5 0 7 - FINAL PLUMBING
or through his own employees.provided that such Improvement arc not intended or i
—offcrcd'for'salc'IL however;the building or improvement ii-sold-within one year of
ht the ownerbuilder will have burden of that he did not build or
omp c cpm, proving
impmve for purpox of sale.). L
cm a fjthe ecp(Ser.
1 ly t t g- IhlmcnsTh cmntacmrsm --------- -_._..i L: r 1 . ;a' - ---
on.i tt Ih PmJect(S ]06. Business d Pr f s ons Code)The Cpn[mnor'sqe,vf� s,. \+F: r
Lic Law d«s not apply to n mane,of property who builds onmpmves thereon `g-P `
e and ho.cp tact.far-hillb.purciects with..conouracto"ficearred.purnatcant wfhe. . pa,a�as
Contractr' L e Lu T q
OI pt d S fa' B&PCI Ih' as
reon -}I;Jas+ l�
Owner`t " ,. L.Date'
'WORKER'S COMPENSATION DECLARATION
+' " �I hereby vRm,undrr pcnahyi f perjury one of the following declarations:-- •f^���('ssa.JIy4�i'�
❑ 1 have Clodwill"mamtdin''e'Certificate of Consent to self-insure for Worker's VY�
Compensation:as provided for by Section 37W of the labor Code.-for-the
- performance of the work for which this permit is issued. .
01 h d d dl mai t Wok s Compc t -insurance, s requ and by Section
37W ofth Labor'Cod f the 3effmcnarive of fre work for which this Perini is
'.slued My W rk C pc t finema6cd Policy rrombiir
Camucr eat '. . •U ..f['I•.Pol cy No. +a..r� s{Gt� i Q•' _ S"1 ....\�2,'li,ls,..
„cure ltSCLRTIFICATION OF EXEMPTION FROM WORKERS•• r.-�).tl C1..k1 "J 7tt1_a�S- (-S iu. i�>•. Y. '
A COMPENSATION INSURANCE'1 n s
to •ITrry+.v sect,on need nut be cinplcold,f[he peon t is for one hndre
ud dol tars \ ,..11,1 v ..' 9' .,'.. -• :d^:. 1' >'
(SIM)or less.)
r Loc oft the nihepef my mann the ot6 hi subject
is, dl {� ,t) 1 _ !Ilfl•s'I
dull ar emplmy dry person m my manner sn as io become mb3en_m,thc Workers'
Cnmpe t Lvws of C I' Date'
NOTICETO APPLICANp If,after maki gths Ccmfcam of Exmpuonjou should "••'• � :!
Q Oabecomekilloott 1hmW k r Counkmatiorl provisions or the Labor Code,you most
f6ithwitle e cloy"with'. on innewimmos or thi,pe.if shall be,clecamd pevked,
' CONSTRUCTION LENDING AGENCY 1 - �..k`+ t Ib+n
...y .. 7 d k:.n v .
a.7 j' 1hc¢by hRmi@bnheee isncsued sion lendingagency for��pcRorm + "
an,z
W. and bram `heti lhipemYs'su issued J09]:Civ.Cl
Lenders Name,._:vr_,...
C.1 t1 n ty thatl h
dill,application nd state that Ne Lowe fommuon Is
fss
co ec,I Sme to comply with all city a d county urdimma,3 and state laws relating
m bu ld ng co a cion and htimby'mflhoirise representatives of this city in ¢r upon
W
the h d pispc ty fo n Acct on P +Pm ,fl{'gl/'Vyl
-.F•Cy (We)agmeid'saJc.Indemnify and kap harmless in Ciiy"fCuperonoig.imst
rn
liabilities.ludgmems.Bose d e;q,mes,whi,h ma,in any way.teat..,.lost said
Citync q fNg ( ,or ibsp t.
APPLICANT UNDERSTAND$$A`II)WILL COMPLY WITHALIL NON�P0INT c
SOURCE REOUDATIONS..,.•.p.,-' Issued by: ! Date
�igatrm fAPPlaantC Cram `." :'.J ,Dam ', Re-roofs
Cal Seal ne_.55J HA7ARDOUSMATLft1AL5 DISCLOSURE
pplies, fmrewldgoccupva_mmananarhd].,rd t '1 _Typeof.Roof.
. _ ---
vsdf dbylth Cup rtn htu cp lCal Cryap[c 912 ilii H hh .dotty 1 4 •'
by n 1 4 t�. C i. p f a 'ia AAjY fi;j+ x.
ON rv° ' _All roofs shall be inspected.pnor to any roofing material being installed.
r r_'f �4t a . __
Will the ppl' t f t bindig«cupam use cgmpmrn[or devices which If a roof is installed Without first obtaining an inspection I,agree to`remove
cors hiolirdmiVair comam nam,as defined by the Bay Arta Au Quality Mmagemem
DishriEll all new materials for inspection. Applicant understands_and will comply with
_ _
..,. Yet
,-•5+ oNn,. v -- -, ,_, I all non-point source regulations:, : ,:, - . . .
\
.'if.
l fo a Hcnitfi'&5 f t Cede.Seniors 25505 2551 J
.. 1 have
the harmdous matenals re uirement under Chapkr 6.95 of[he
Q Y J and 255J4. -
-if lAc building J«snot currently havcamnan[Nat it is my responsibility ronodfy the '" "' _....... _ _._. ..__........ .... .__...._..__. __. _.. ._. ..
occupant of Ne rtqu+rcmems which'mun be met prior m coact.(.of a Cenifcase of t
oothiphoic
r Signature of Applicant Date _
—
All roof coverings to be Class B'or better
tlVii: . e,. y -1 ... 1 A. _._OFFICE.. ._._.. _..._. _ ..... . .._..._._ . .. . ..__ . _. .. ._.. ._.._.