02080084 (2) CITY
DVSIONO
IIPERMIT CONTRACTOR INFORMATION:
BUILDING'ADDRESS: PERMIT NO
11592 BRIDGE PARK CT JUST WATER HEATERS INC 02080084
UW AWANG 1764 NATIONAL AVE APPLIC/,]Igblj?�75002
PHONE: SANITARR1Y2N�O//. l / CONTROL NO.
+ (510) 293-9901
qW ZZ ARCHITECT/ENGINEER: I BUR.DING PERMIT INFO
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u BLDG ELECT PLUMB MECH
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H i - LICENSED CONTRACT'OR'S DECLARATION 1 p��
0 ZZyr Iherebyarawtat 1amlicensedunderprovincesofch 9 REPLACE WATER HE$A geription
Codi (commencing
FyFm
with full Section of Division Jn(te Business and Rofessionz Code.and myliccnu
mZ iscense (lase etW effect.
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License Class Contractor
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n' p.O Data S DECLARATION a LLO .Fi ARCHITECT'S DECLARATION
h- � 1 uMemand my plans shall W used as public records
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to a ca Licensed Professional
f�=o, \.,. ., OWNER-BUILDER DECLARATION
1 hereby affirm Our I am exemptexempt from the C Professions
pr's License c Law for to $620
5 Z following rcawn.(Seddon]OJ L5.Business and Pmfessiom Code:Any city or caunry
E x'� which requirts a pewit to construct,alter,improve demolish,or repair any swcture
n 3 m poor to u usushic,also requiresthe applicant for such pemut to file a signed statement,
III rnra,, ...-.. _. ... .. ... .. ....
that 4licensed id, em(tep vi.ons of to Contractor's W (Chapin Y ., c. r3t62,c$'tO.F51'O QLp�pea Valuation
(co a mg it t dab ]OOU) f D' baton J of the Business ❑Pon.Any vi Can.) 1 5 i f r,. �..v.,, d t 4.y r y;r 1'i r]a� 4{E Iv '
m to he is exempt increfrom and the barn for the alleged caempnt t Any violation
-of3or=n than
iv art hundred
am for a pemdt subjects to applicant a Civil prnalty +
.or not more rote,five nanerea dpnars stalk 502APNPVLD3D& PLUMBING ENERGY Occupancy Type
[3 1,as owner of the property.or my employees wit wages as their sole compensation, 506 - GAS TEST
will do the work;and'the uncertain'is'norimmndd]or offered for sale'(Sec:]Ori,,- S 07 - FINAL PL
Dust—'and Professions Cada:The Contractor's License Law does not apply w an ik-194nspeetions,''
owner of property Who builds or improves Laron,and who does such work himself
orthrough h ply provided- Nat such
improvements- If, tintended
lbffaidfoua h the bildngnr mprpvmem Id- lhn ane yo-
upp m
. .... .. __._._._.. ....
6ourplecon.the owner-Wilder will have the burden of proving That he did not mild or '
improve for puq+urofsalc.).e.l.
- •+ w Owner of to property,Seam eusinesslacomrxtssions btenschconwnorsw - -- ---- -- SEP ry 2002- --- -- --- - _-- -- --- -----
conswa to les n Se,ZO41,owner of and Professions CWep The Contractorrmum,
_
License Law Jour not apply wmi owner of property who huilds ser improves tenon. ''''imd.whm -
i U; _Can.,.coMo,,Lt...for_sucb.projtas wit a conwnor(a)licensed poor cam to.te. . __ _ __ _
Conuacmr's Littnu law.. .. rs ._. .. .._. .. .._ .. �p {�� -._ -.._. -.... ..... ......, ... _._
❑lam exempt under Scc. ;Bd2PCfor tis recon w1�DI1yG' IL'.'il
01. t Dare ..
( WncWORKER'S COMPENSATION DECLARATION'
i..•°.."I hereby aflw under permlry.of perjury r ry one of the following declarations
❑ i haw and will'maintain a Cenifica¢of Consent to self insure for Worker's
Compensation,as provided for by Section 3700 of the Labor-Cone, for the
.. - perfowbnce of the'work for which this pewit is issued,
❑1 have and will.main Worke'r's Compensaiiod lnso`mncb,az respired by Settion
37W of the Labor Code,for the performance of to-work for which this pewit is
issued My)xkelt C pe ( sunmocn . Pwly.. herare
. ..v :
- a•
Cams S - +tl t i - (I,"Policy No
of CERTIFICATION OF EXEMPTION FROM WORKEfts l 1- c a hit i AT:'ti a� ;i.5"s't.1`txt I�+.7 E �•3 jri,t�.
COMPENSATION INSURANCE
`-' f](Th !' Inn need nm W compleieJ'1 tp pewit is f ane hunnreJ dollars ' l :t;{' P
(gI00)or lcss) � � •
1vein Q that dim Performance r h fo which INissued;I
shall t ply any p,. y manin to become ubrect to ito Workers ;,.:t: .:;it d-.'r
.., +
Conpensm on Lvws d[C,I'fom'd Dam 'f
...Applicant.-- " ..
NOTICE TO APo line Workers o makmgtirCisions,of Exemption,Youshould
Z b,comea comfy to suchen Compensation provisional(the Labor Crile,you must '
Q forth t ply t h p - t Permit shall be dee d ked.
CONSTRUCTION LEND
IN Ci AGENCY .. _....- ._ .. . .. __._.. .. _ , -.... _._...
hereby affiris tat there is a construction[ending agency for th per(om
W oft k f huh t pemnt eJ(S 709] Civ C) '
r7Isnde Add i
V:
(,; y,-1 orrifify to c I holt read all city
adapplication and state thatthea anavcsuit paws relai s
0 [r t owain g coon to coon.and he all city and coupon ordinances and stem laws relining
V mWbave-clawed proann)for inspection purposes. les of tis city to enter upon
the abpvbmcmipneJ property for inspection purydses.
d, - tWe]vgrie msave.indemnify and keep harmless the City of Cupcnino ugninn
liabilities,judgments,costs and expenses which may in any way accme against said
City in consequence of to granting of tis pewit.'
APPLICANT UNDERSTANDS AND WILL COMPLY WITHALL'014 hT
SOURCE REGULATIONS.;',' Issued by; Date
Slgnpmre of Appucam/C.mmcmr. Date Re-LOOTS
"
HAZARDOUS MATERIALS DISCLOSURE
r AIPe of Roof _ .,�,_.
' W II te"vppl t o f rare Wilding occupant smrc handle haaandrus mmaial T
asdef Wby teCpen noM IapnICW< Ch Chapter 9.12.and Health and ft y 1 s - -- " -- - "-^
cures nnus32ljy a is.oi� 7FZ =f .` �' t=
aY (.roofs shall,be inspected prior to any roofing material being installed.
Wll dtapplicanto am Wilding OccupantyAequipment. reMana emnt If a roof is installed without first obtaining an inspection, I agree.to remove
sten hazed air comam tsar dcfnW by to Bayle eaQuaLrye,6ci einem
Diatna all new materials for inspection. Applicant understands and will tom I with
❑Y aN _ eregP
all non-point source regulations., " P y
I
ihafv,ethr.e,ed he chur2rmendtly Aavcaerimanant,qtuait i-t is mY arncdaponCsihbiplittYmnbtify tthheC Hcahh&Sof tilCWeSecpons35505,25533.ndSd3i.Iumemandta
the!h.lWomems which mint bmei poor m issuance of a Certificate oefi.p3mo8emutantDccnpanty.
Si nature of Applicant g_ PP._ _ _._-.. . . Date
owner or aUto„aw agsnt Date All roof coverings to be Class "B"or better
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,..:, �_. . .. ...L _ ..... OFFICE ....._ . . ._. .. _.. ......... ... - - -