02070036 (2) CIBUtOF
G DFExONrlo CONTRACTOR INFORMATION:
' PERMIT
BUILDING ADDRESS: PERMIT NO.
20327 CLAY ST JUST WATER HEATERS INC 02070036
OWNER'S NAME: APPLICATION SUR DATE
WILLIAM LO 1764 NATIONAL AVE 07/05/2002
• PHONE: (510) 293-9901 SANITARY NO. CONTROL NO.
O O ARCHffEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
mawt r::]
y i LICENSED CONTRACTOR'S DECLARATION Job Description
O Z_C 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing P
F,'s t-w wid,Seen.70001 of Division l of the Business and Professions Cole.and my license REPLACE WATER HEATER
c, = is in full force and effect.
_ a Littre Cass Lie.a (5 0 GALLON GAS)
s`<O O Dam Comracmr
to a,a}-n ARCHITECT'S DECLARATION
O g I understand my D]an,shall be used as public reveals q /q��{J 1y�+�
ip 0 Licensed Professional IIWI ALVE
n a OWNER-BUILDER DECLARATION
us 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 29��
i'z a following mason.(Section 7071.5.Business and Potassium,Code:Any city or county DC(S L
Y r o which rectums a permit to conwrua,alter,improve,demolish,or repair any structure, LU
umJ3- ..Drive to i¢issrnce.also rtquiresthc applicam fwsuch permiuofdeasigrmdsm¢mem. .-, _
tWt he blianaed pursuanugghe previsions of the Contractoh License Law(CM1apmr9
Sq Ft. Floor-Area
(eBmmeacis ciimrh•Sectionisiti'a do
basis
o theaBuejneineod Profession CWe) t'.�t -?'';`-1k.Ti oil !:v r•:-r,;;`rna iii 5'\• '�®' �ahOn
w Inas he is 3LS by
t IWiefrom anJ me basis for bj cts the
applicant
Any violation
-of ilat Section ie any applicant for a pcnnit subjects the appbcam to a civil penalty
:pfnprmoretnanBvenpnarwanuars(stoo). A No her Occupancy Type
0l f the D 1-1 y employers wnh wages as their sole ema,carstinim, IS Q 2 _
-w II do'IM1 oak d he loachm,'is an,intended'or offered far late(Sea:]oli;- ---- - - - - -
'
Bialimi4s rid Profession,CW The Communist's laccnse Law does net apply 1.an 506 - GAS TESTRequired Inspections 't' •
owner itf,opnity WhWild,or'mpm,v,thnm
thinner, ad 507 — FINAL PLUMBING
or though his own employees.provided that such
,n improvements arc not intended or
-
offered for i'he.ILhowcvicer w building -
or iinpm4emcm is sbltl withinbnc year'of s --- --------
improve for'he owned sale') will have the burden ofproving that he did not Wild or ^
improve for purynse of sale 7. ,
ofthep pent' 1 : ly t t g ,Cade)The Common x
+ ns t theproject(Spa ]to a,owner . and Prty whov Cade)The improves
tmnor s '
_ -
License Law d«s not apply man owner of a,cont y who W lids se.p pursuant
thereon, - i �.
.,and who commWs.fLaw., projects with a.commctor(sl licensed.pursuam ro.Ne ,
Conoano/s License Law.., _-_-_.___. ..._ - . ..._ --_-.__ ._.-. _..__ ._._.__-_..___-_..___...._.-.._. .__............... .-_.
❑lamexemmimilar Sec 'I ,B&PC forthixreasom
Owner' r Dotc"
WORKER'S COMPENSATION DECLARATION
• I hereby alErm under penay o
ltf Perjury one of Ne following declvatinnz: -
O I have'and'will mainN
tain a CeEcate of Consent m ar
df- me for Worker's
Compensation, as provided for by Section 3700-of the Labor Code, for IM1e
'perfwmence of the work for which Nis permit is issued.,
❑1 have and-will mainanin Worker's Compensation Insumntt,as required by Section
37W of the Labor Code,for the performance of the work for which this permit is
sued.My Workers Compensation In4umnce carrier and Policy number arc:
------- I. . .. _.�.... _. _...,.,._-.._....
t , CERTIFICATION OF EXEMPTION FROhf WORKERS' h�.T� 1 1 I•g)yry ?,' -t?„-{,16.1,.q
COMI ENSAI'ION INSURANCE I' t.= I • ,
' t i (Tti sircomn need norW completed if the permit is for one hundred dollars -
(SI(p)wlacl
I c turify Ih at in t be performs c e af the rk f h' h Ih' Permit s .sued 1
shall of employ any person In any man as to become subject to the Workers
Cumpcnsmion Laws of Califomia.Date '
Applicant
Q
NOTICE IOA' PAN r ,after han,it,fail Cnf mebof E=pliihn,youshould
Z become
% Io the Workers
oe r Compensation pan the LaborCafe you must6oh tbo ply with suchpa,s,,i hisp1hall e demdmoked.Z
—"- -
F,,, ��•, `''j __-
.CONSTRUCTION LENDING AGENCY - .._. ..
I h by R th 1 rc - oma on Iced ng age cy for the perfumunce
y .., of the work for xh cb this permit (Sec.7097.Cut C.j -
LeWers Na a--_ . . _ -a"
Leader's Add...
I verify th t l It as c mad`��+ F• '.applicationJ rte that[he oe1gtreplyth all tyadotdin andt fo toi.
U laws refining but construction and hereby amhweexof this city to enter upn
;a.
'`—
W the a W i,m t red p pert,par impeci n D apo
L.46 (W Ie ew.lme.indensiufy and keep l atlas the Cly 'fr'up ono a'minm
V7 liabilities judgments.costs a l expenses which max in any wityraccom against said
yCity in consequence blow isrting.,"his pcimit., ,
APPLICANT UNDERST,\NDS AND R'ICC'COMPLY w'ITHALL NON-POINT
SOURCE REGULATIONS. . , Issued by: Date
Sgnanum of Appheanvcommrmr . D;ne �
HA]1RDOUS MATERIALS DISCLOSURE Re-TOOPS
Will•the mpplicant or four,Wading ocaupam scare or handlelimanlous mammal _.Type of ROOF
...Cod I S by
the
pen Mun p I CW Chapt 9 1 d the H IN d 5 f t .---'- -"^."• -�`•,• - .... ....._,-._- .-
lOY tt bNot allf iJ l (i t ` ( sIt
tI IIJY -11 ( . t.
Allmaterialshall be inspected paver o any roofmatenal being Installed.
Will h pil: t In ca building' p t equy t d es which -
min,ar,l -r contaminant dcrocch Bay meisgm' coal age , If a roof is installed without first obtaining an inspection, I'agree to remove.
Dist ' all new materials for inspection. Applicant understands,and well core 1 with
1. - all non-point source regulations: . ' - - . -._ -
Th read die ha ai doses materials requirements and Chapter 6.95 of the - - +
,
6alifterin Health&Safety Code Sections 25505,25531 and 25534 1 understand that
ti the building docs not contently have a term:that it is my respovibility m notify the
occupant of the requirements which must be met prior to issuance of a Certificate of -
Occupancy. - '
Signature of Applicant_ Date
oxnea awnoraea agent
Data All roof coverings to be Class "B or better'"
OFFICE- -