01080119 OF
CUPE
CI BUILD NC DIIVIISIOrvNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
7470 TIPTOE LA HOT WATER INC 01080119
OWNER'S NAME: APPLICATION SUB DATE
SARJEANT MARK P AND MAUREEN 1 2531 GRACELAND AVE 08/24/2001
PHONE: SANITARY NO. CONTROL NO.
(650) 298-8494
u O O ARCHITECUENGINEER: BUILDING PERMIT INFO
x w BLDG ELECT PLUMB MECH
N< I_—I LJ I_J IUJ
LICENSED CONTRACTOR'S DECLARATION
;Z L z 1 hemby alfino that I am IiccnsN under provisions of Chapru 9leommcncing Job Descryption
L:e' wnh Scc6on7W111af Doision3al'theBmineswnd Professions Code,nnd my license GE PROFILE SMART WATER WATER HEATER REPLA
acfJ
Is in full force xml effort.
a Date E.u ate Clozs Lic.x
i LL LL N DaCimarron,
ARCHITECT'SSDECLARATION'RATION
] O g 1 understand my plans shall be used as public records
T
m p O LIc[Rcd Professional
'x a i am
DECLARATION
1 hereby.(Sell that mat I am exempt from the Contractor'srCast Liana tatty for the
z< following masa.Permit
t consumer.
Business and improve.
d tions Code:Any tiny or county $500
F-O wish t, pc l t t calter,'mpm c de of sh Pa Y trio mrt
Inn i Loreq ' tl ppl rf lire ors t Law
dCha eat .._.
a (commenngwithScu�17000)ofDvisi fIofflue ne9;in<adPrefic,on,coei t ' 'i'dq'i3§:�. ( ,r: 'i,r ` Valuatyon
or that he is exempt therefrom and the basis for the alleged Giempo. .Any vmlanim
-of section 7031.5 tryany applicant for a permit subjects the applicant to a civil Penalty
tafeel moreian Ove hundred dull...S500). 502�PN ftL PLUMBIN ENERGYOccupancy Type
01,m owner of me Moperry,sx mY ernplwem with wage+es then sole nnripcmation, _
will do the work,and the structure is nor intended or offered for sale(Sec.76 . - -
Busineia orad Profcasiaas Core:The Contmnor i License Law does not apply in an 507 - FINAL P1131W&N111spections • ')p
owner of,r opcny Who Wilds or improves thereon,and who does such work himself
or through his own employees,provided that such improvements art not intended or _
offered for talc.If,hawevec the W ddine or improvement is sold within we year of
inmpletion.the owner-Wilder will have the Wrden of proving thin M did not Wild or I-
i
mprove for m rpose of sale.).
- °L f the groitory.am exclusively contracting th licensed contactors to --crawmac, he pr) t(Sec.7fkt4 Havoc,,and Profiessimm,Core)The Contractor's , ,
License Lavv does not ippl,t of p pery who Wilds - r s thereon. '
and th c ctf h project,was r ucmos)licca..d P nt.o the.
Cont t License Lv
°I mpt underS .B&PCBothnia maun
_-_ Oxrrci Dam .. t .
WORKER'S COMPENSATION DECLARATION
I hereby inform under Penalty of perjury one of the following declarations:
° 1 have and will maintain a Cenifirme of Consent to self-insure for Worker's 2//
Cmnpcntation, as-pms;ded for by section 37W of the Labor Cada for the (7
performance of the work fm which this"I is w.w.
°1 have end will maintain Worker's Cdin"nvri6o Instrec.as ocuirml by Section LL//
37W of the Labor Code,for the pertoimance of the work for which this Permit is
i ued.My Wm1a's,Compcn.ik, Insurance cattier and Policy aumbe,mc: _ - -
- _Policy No ' - 0'f-f'^. )•Tf,f(i-...i i..< '4i1F�'ra l ti3 ii")v0 - •t- .
- Ice t CERTIFICATION OF EXEMPTION FROM,WORKERrSg" -
mtizunion oe d nd beenmldncdN INSURANCE o
" 0
e if the l is for ane hundred dollen `�„ -� "C:t:11 nI:
p.it
(Sl00)or Ica.)
.. v
1certify that in ei performance of the work f which alit pe 1 o issued,1 ;�e t, I r.l 7. s . ,• - - -
shall hot employ any reran ra any mannu,.o as to become sub)ut to @c Workcra'
Compensation Laws o'California.Dene' ""
Applicant 1 .. r. ,C
NOTICE TO APPLICANT.If.atter making Jhizoilrou If fLxemptiosde,you shodd s '
z Ohcumc mbjmpweh Worker's Camp:or tics Permits iofthe Lard.CWe,You must
(onhwirh comply with such provisions or this Permit shall- deemed molted.
H (4 t!CONSTRUCTION LENDING AGENCY "
04,x7 1h re'm Riot thio Chert o.r-cto-le dng agency( di per(nn
ncc
ollM1e work lor'xhih tM1apermn .seurd,( 3(N,iCi1.C) .. ... .. .. ..... ` .,.
d.Q 'I<nderName"
Z LenJS'r's nacre:.' ... .. .. .• Lt . ,+;Il,t
V.� 1 certify that I have adth' oplificarima it state thin he bo -anfoarmation is
caincret.1 agree to comply with all city and county ordinances and t t laws refining
V toe Wilding o.wct on and hereby authorize representatives of this city to enter upon
,7,.Lal Ih<oba r dp penYf P, li np rpp. - ,t In'I7 t nn/� �1. _ IV�
(wo)aee w grsure:indemn fy and kapmt
halus the City of Cupenino against
rp liabilities,judgments,costs and expenses which may in any way creme against said
U_Z City in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALLNON-POINT
Issued by: Dale
_ SOURCE REGULATIONS.i Y-
SigdaturelpfAPprcam/Commoto •-' - Date .. Re-roofs '
' HAZARDOUS MATERIALS DISCLOSURE '
W11 the pplicam or furame Wilding occupant store or handle hruerdkouax material Type of Roof - - -
as defined by the Columbia i Municipal Code and re Health and Chapter 9 12 the S ,r
Cad Seento 1 f. ; . . -._ ..
f ..
°Y °" All roofs-shall.be inspected.prior.to.any.roofing.material.being.installed.
`:-Will heapPOcaa,fair,.wildingaccu,noare eIuimmentntdeshttewhich If a roof is installed without first obtaining an inspection, l agree'to remove
emitvu
hardous air conminann a defined by the Bay Area Air Quality Management
rnnner?Ye.
❑Na
' ' . all new materials for inspection..Applicantunderstands and will comply with -
E al(non-point source regulations.,. ,.
'I have read he wziardodnoitiarmlsy temurn,neither Costa,6.95 of the
646mii Health&'Safuy Code.Sections 25505.25533 and 25514.1 undcrsmnd that
ifrhe wilding does our cunemly have a¢nam,the,it is my respomibiliry to naifytha x .
occupant of the iequiremnns which must be met Inform issuance of a Certhicate'of
y
QncupsncI. „ r
p. Signature of Applicant Date
Owncror amhonzed agent Wm All roof coverings to be Class"B"or bets&
OFFICE