01110084 (2) CI BUILDING OF DIISNO
IONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22344 CARTA BLANCA ST HOT WATER INC 01110084
OWNER'S NAME: APPLICATION SUB DATE
KUNIYOSHI SHEILA B 2531 GRACELAND AVE 11/19/2001
PHONE: SANITARY NO. CONTROL NO.
(650) 298-8494
Q77 C ARCHITECfIENGINEER: BUILDING PERMIT
is, BLDG ELECT U MECH
y e i O C-1
- N z LICENSED CONTRACTOR'S DECLARATION lob Description
ilz_G hereby afnrm tM1at I am licenced under provisions of Chapter 9lcommencing P
mt-a, semimel .1orDiaaian3ormeeaamesraneFrnfe.aion,coaaanamyreen�e REPLACE WATER HEATER.
c x E, i n full fosse andgt,r3l ��
z w icense Coss C !� C.",e. 3
/Don
// //4/"I amr
ty A�RCHhTECT'S DECLA ATION
I understand my plans mall be used as puhlik acoNs
it
1_S p C L]ccnue Professional
i OWNER-BUILDER DECLARATION
I+ I hereby ofnml on 11. exempt from the Contractoriam,Cos License law for the
< following rcazo..(Semon)031.5.Rosiness and ve reaiona Cme:Any city or county $500
Y s ve x bleb requites a permit to conk me, alae improve,demolish, fie.air any seaman
3m .ptiot t seq the ppl tr npermtmrtess gam Cha a. (Chapter
]hale 1 opt amt )(0yof ni i tN C ntma -Endo U.(ns Cod) _
from he
with f 1000,1 The J fthe aleatoricam Professions violation
i Code) ; ;li'1 }-,3' I� qT. �?kt\r s. �C,'V - Valuation
or the he a exempt tang ap m and the bass for the alleged cxcmant to Any ver natty
-of section 7031.5 by any applicant for n Permit the applicant m a civil penally' �p
'ofnolmorctn.risehundreddollarsls5ln). 5OPN' + �1L PLUMBI ENERGYccupancyType
❑1,as owner of the property,or my employees with .,as as their sole companion... 906 GAS "RPT
will do the work,and the structureis not intendedoroffered for sale(Sec:71UI
'Business and Professions Code:The Contactor License Law does nor apply to an 507 - FINAL P�EFN4B C4Pections L'-
owner of propcny Who builds or improves thereon,and x'ho does such work himself
or through his own employees.provided that such improvements arc nm intended or
�oRdrm fur sale:If,however,the building or improvement is sold Within ote year of -
completion,the owner-builder will base the burden of proving that he did not Wild or
improve for purpose of sale.).
❑1,az o Cher of Ne propenY•am exclusive],mesy d Pro contracting is Calm The Comcmrs m
_ License
the ueproject ice.appl 1.4.a BusOwner O and Profusions Code:)The Coatmctam.
Licenu Law doca no,apply m an owner of property who bullas or improves thereon.
W whos foo inch pmjecu.wiN a rontacmrts6littnsed pursuant ta.Nc
Cont t,e License La
❑1 opt underS ,'" tl',B&Pre hours main. IL'��pge n � ®!
OwnerDae
WORKERS COMPENSATION DECLARATION
1 h7by offerscaber PealOf perjury ra
note of the following declamations: JUN 1 2 2002
y ] 1 have and will nainain a Certificate of Consent to self-mare for worker's
\ ocinematic., az provider for by Scnion 3100 of the Isbor, Code, fa the
performance of Nc work for which this parmit is issued. BUILD(fVG
❑I have end will maintain Worker's Com'ymnmi.n humarsnce,as requirc0 by Section
] of the labor Code;for the pcourn once of the work fa which this permit is
aliee My kens CIm, rania end PoI an r arc
Camer" Bryn R 4, ,;.
CERTIFI AT N OF INSURANCE WORKERS (^s�A1�. :J r ', "I ;d•i ,7 i.( !�
COMPENSATION INSURANCE'-
m ha,.)aion need not W completed if the permit is for one hundred dollars ----------
I,.
SIM)
Y then in the peR anac of the work for sen eh N pe tis'. akar' -
sheallCom t employ any person any manner s d become wbject idlhe Wnrkeri -• t '.f Ie. ,5 '
Compensation i' laws of California Dam
-Applicant '. . .__ .. .....
If.
�NOTICE TOAPPLICANT:the Workers Ctermakmgn p Cenincamsof the
Laboi,Code.you
ZZ become subject lb the such paCoions or ion provisions of the Labor Code.you must
O ,, --N comply with such provisions or Nis permit shall M decmm rcvokm,
fr t I 'CONSTRUCTION LENDING AGENCY'
_.
'r, I h by Biro that N m'i minsoottioni lending agencyllor the pelf rmantt is 1 1 ,•
of Ne kfor Hien N''perrdt s e(S<c 3099 Civ C.) - •"'
Z, Z 'Lane m
N e'
. ' Indere Add Y re
:,. ,.. .... ___.... ....._._. _.._-_..
�.0 icenir that l have ad this application and nae that the above information is .
;F" correct:I agree m comply with allcity and county ordinances and sate laws mlarng
O U to Wilding construction,aid hereby seductive representatives of this city to enter upon
}.ty I the y. above-mentioned property for mspectioa purposes.,C.' . (We)'etamemalve;indemnify andkeep hwmlcs'ihe Cityof Cuperiinuegainst
_W) liabilities,judgments,costs and expenses which may in any way accrue agdns said
CJ'.Z City onsequeb<c of the gaming of Nis permit.- _ n
AP I TUNDERSTAN 'D WILL COMPLY WITH ALLNON-POIN ' 1 / !/
S c p�TfONS o Issued by: Date' v
_ SiBaoare,of Applican Contractor : " -"' "• " ate
p5 Yes " HAZ' RDOUdS NMa.AT
ERIALSDUoRE+ r Re-iOOfS
wI Npplant f naetagoccupant timearlud) haired.uma
azdefined by she CupenMunicipal Code Ch pr912 d the Health and Type.of R
oof
Cole Se25532a1n il Safe,,
❑ t b t 1.v
" " ----- ---- --
- t
All roofs shall be inspected prior�to any roofing material being.mstalled.
l
Wil Ne pplicam o f t te building pant me equ p t r dev ns worn " —' -
If a roof is installe'd Without fust obtaining an inspection; I'agree.to`remove
finer bythe Bay Area Ai Qud tY ManaBcNcnt g p
cin'
Diane' all new materials for inspection.- Applicant understands and will comply With
n v?rdous cnntam t azde
I ores ❑nn all non-point source regulations,,
I have read the himmod to an amals qu nemems unbar Clal6 95 of the '
California Health&Safety Code;Sections 25505.25533 and 25534.,1 underhand that
'fg u Oyh tenet that s ymsp 'blty1 lift the _. . .. ... " . ... _ .. - -
en Ian does ntc
_upant of N qu � yty/�h must be met p m suanc /f a C nif¢aa of -
f� Signature of Applicant ._.. _ . _. . Date .. . _•
o Her ox apN t i t Date „ All roof coverings to be Class "B"or better „
• '
OFFICE" _.