02050126CIBUOF PERTNO
G DIVISION PERMIT
CONTRACTOR INFORMATION:
"YON "BRALNUT CL
JUST WATER HEATERS INC
PERMIT NO. 02050126
ON5WPE'LAWRENCE M AND SONIA B
1 1764 NATIONAL AVE
AUgCMnV,1`62
PHONE:
(510)293-9901
SANITARY NO. CONTROL NO.
z ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
EBLDG
ELECT PLUMB MECH
w
C� IUl L" J L7
i LICENSED CONTRACTOR'S DECLARATION
IhercbymTrm that l am licensed under provisions of Chapar9 lcomm<ncing
rlptlon
REPLACE WATER H 'P�
with Section ]000lef Division 3mlhc Business and Protesionn Coeand my license
—< is in full force and cHmt.
(50 GALLON GAS)
Liccnsc Class Lic. M
U Data Cammcmr
ARCHITECTS DECLARATION
1 uml<rsmnd my plans shall M used as Public recom,
2 Licensed Professional
I OWNER -BUILDER DECLARATION
1 hereby offitm that I am exempt front the Contractor's License law for the
< fallowing reason. (Santora ]IHLS, Business and Professions Any city or county
ee which requires h, m
permit re construct. <ImL nforsu. demolish, or repair any swment
$525
n r tofile a
w t t c also requires PDl sant for
- - - - - -
e S-Fh,FloorArea=a• ..y.�.;
Y �s, I f
Val
Valuation
n
Contractoch
- ,ahe
that iCetwe ow (Chapter 9
Smuq ]000) f D 3 the Bus Profess Code)
niece nU tM1'p i nsnfthftheBumors andPredications
rLawonsCor9
(worn<nsi ton of peas and ons
M g
,p{ s {s \
35'/03050-"00
or m,
orther he iexempt Ianyifliand the basis for Ibcallegedcphring t Any vPenalty
anyapplicantforapermit subjects the applicant toaCivil penalty
,nr nm more man five nnnarta salsa ($son).
,of than rive
APN NumberOccupancy
Type
502 - FINAL PLUMBIN
ENERGY
01, as ownerofthe property, ormyemployms with wages ax their sole compensation.
-will do the work: and the s0acum, is not intended or offered' for sale (See: 70 ,
Buxincss'add Professions Code: The Commctar's License Law does not apply to an
Duo fl�'nspections> •'''
owner of,r.,ny Who builds or improves thereon, and who dors such work himself
507 - FINAL P f G
or through his own employees. that such iement is are no, intended or
rthrough
- _........ ....... .... _ _ ... .. ...
buildinded
siA Year
.offered for .ale' It however. the baddi� t Ix sold w mt� oa< _of
gmtmpn
- -._ _ ....
of pro
completion, far the Wer will have the burden of proving that he did not build or
of so
imrrove far pamnx<or soma.
purpose
with enmmnom m
❑has caner of tee prnpeny, a xdiness
.. ,. •yv
Wensd
c Business a d Professions
-_ onawa the project n (Sec. ]OCL Bus and Pmfcsio Code:) The Contractor'sthereon,
,
b
License Law does not apply m an owner of propcny who builds or improves thcmon,
_ commas fonsuch. projects with a commctor(s) licensed pursuam.m the.
.. _..... .. .._ _.... C p� 0ALE® .-. .. _.... _._.. ._ .... .. _. ... _ .
Cmureco Liccnsc Law.
Irl Y
❑lam exempt no, S<c` B'&PC for this mason
01 .. xc
Owner Otte
'
MAY 2 9 2002
WORKER'S COMPENSATION DECLARATION
" Ihereby affirm under Penalty ofperjory ane of, the following declarations:
❑ 1 have and will maintain a Cenifirote of Consem'to self -insure for Worker's
BUILDING
Compensation, as provided for by Section 3700 of the Labor Cade, for the
perforsni nce of the work for which this permit is issued.
❑ 1 have and rill maintain Worker's Compensation Insurance, as required by Section
37W of the Libor Code, for the lierfotmance of the work for which this permit is
.' issued. My Worker's Compensation Iwumnca Cartier and Policy number arc:
.
%1.,! -.'^Policy Nn tt,-
s,tbs i\ ors- t ... ,
r't�•
' 1, CERTIFICATION OF EXEMPTION FROM WORKERS'1
COMPENSATION INSURANCE
'(Th s section need not be complaed if the permit is for one hundred dollars
181007 nr less.) •• , .
roar in nany ce work for which e permit 1
1t
t a, r •� .,, , - -
s;
person n i intoner u a orkerred,
shall not employ ony person m any manner so as to become subject to the workers'
employ
,,,
CDP pcnsarion Laws of Calil'omiDate
,.
- A Iicunt- .
NOTICE TO APPLICANT If, after making this Certificate of Exemption, you should
I become,othyet tonic Workers Compensation provisions sof the Labor Code, you must
forthwith comply with such Provisions or this permit shall be deemed revoked.
'I
y " CONSTRUCTION LENDING AGENCY
-'
cr-
rthat thereis a eonsu9euciion lendinagency for Ise performance•
at
ynfthe work fo, which thispermit issued (S c 3(N] Civ. C.)
-Lenders Name'. .r..,. ...... r,.- '- _... .. ....... : ..
.._. ... "-__.. ... .. _.... .... ._... .... .._ ... __ .._... __ _ .._ ..
Lenders Address""' - _Z -
_ .-
1 ccnify that I have mad this application and state in., the above information is
co en. 1 agree to comply with all city and county, ordinances and state laws miming
Construction:r.ra!operty rcbyamctionpepoisemmiv<s of this city reenter upon
'mi he ifl re-unading
properly for inspection _
p] the abofWm) ke p
Vim// ,V/?_—`•�
agree to and ep hannue. City of Cuica.groagainst
y es,jdgmets. ave.costs and expenses wnommay in any way eccrve against said
0 liabilities, judgments. texts which
im in, of this
City in copse of @e this permit. ''" '
UND 14DS Ag D
APPLICANT UNDERSTANDSAND WILL COMPLY WITH ALL NON -POINT'
'
Issuedb : Date
y
SOURCE REGULATIONS.."
Sigrmma,m Avpreanvcomranor •. - Da)c'•.Re-roofs
/
, ,HAZARDOUS 'MATERIAI S DISCLOSURE , -
wnto ppbe to pa f.buldingocc t Imemn dl laic d.mt 'al
-Type of Roof - :—• --.. -... -- ..
asdef d by the Culamino Municipal Cod Chapter 9,12.and the Health and Safety
Cod 2553211
i ( f?,.0 $t sll Y x Vii;
i.I,..0No s' t .;., as I
0Ys
1 yTl .t
ll,roofsshall be inspected.pnor to any roofing material being installed
W'll the epplicam or fomre build ape -pant L.�ey 'D <nt ae 'eex .xni�n
_A
If a roof is installed without first obtaining an inspection, Pagree to remove
em t ha,milim, air contaminates m defined ray the Be, Arca Air Qoahty Mewgemem
Diselcn
all new materials for inspection. Applicant understands and will comply with
- oyes -• ON. - -,
a ,. _
sma<dals
all non -point source re stations: -
P g
' 1 ha.e4t2ad the haxmdous rcqmrenmmCmmIr, Chapter 695 of the
Callfdmiia Health & Safety Code, Seiomis 25505, 25533 and 25534. 1 understand that
if the building does not currently have a tenant. that it is my responsibility to notify the-
- - oYa Cmifcete of
occupant of the rcquircments wfiich men bc'mci prlono ixsbantt
_%s Q""PgOey '• r'' t �_ _
Signature of ApplicantDate
All roof coverings to be Class, "B" or better'
owner ages, nate,
Pr pntnndxoa ,;
t,a,.._. ... .......... ._..,.,.......:. ,'.,...:.._:r;..,..,,e .-OFFICE ..._ .. _