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01080133 (2) CITY BUI DING BUILDING PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMUTING. 10407 COLBY AV WATER HEATERS ONLY 01080133 OWNER'S NAME: APPLICATION SUB DATE PAULSEN EILEEN F 970 E . MAIN ST, SUITE 20 )08/28/2001 PHONE: (415) 566-2209 SANITARY NO. CONTROL NO. O m z ARCHITECT/ENGINEER: BUILDING PERMIT INFO O BLDG ELECT PLUMB MECH �< r=i LJ I_J GI LICENSED CONTRACTOR'S DECLARATION I heab (firm that i am licensed ander f Chat 9(commencing Job Description ra prvvismnsa per g =C� is in Jul] on701)(0.4 Division 3.f,be Business and Professions Cale,and my licence REPLACE 40G GAS WATER HEATER m g is in full I...and cffcm. f5 Date Clas Lia.B i 3 a v Date GDECLA LARCH it be u e DECLARATION O g I undemand my plans shall tie nxd as public records T Licensed Professional 6M, 1 hereby affirm th at I amB emDEfromE Comnu�or's License Law for the I_3 a following reason.(Seaton 7031.5.Business and Professions Code:Any city or county $700 2,x a which q Permit t consumer,al[ p demolish,- r repair any structure, ne wap_..pro e Io m 9cing wit puffs and ld the pro Divi of the C v 1 e V ante Law(ChapterY �$ p rQ t } (commencing a with Section400anof Division n J of the alleged and Professions Cmc) f f i"d : '3 1�Ly. QJ�t�V a"�qt f!4.# L -t' S- Valuation I or that io Is exempt lAny Applicant lfi and the apes for the subjects thif eiempdto Any violation - - t of Section 7031.5 by Any dred deft for a permit sublems Ne applicanno a civil penahy- :afno,mommanfiseoanareaammrslasoo). 502APNA�i � pLUMBIN ENBRGYOccupancy Type ❑1,as owner ofmc .,ml,Dray employees with wages as theirsole compensation„ rnr _ r. ; -will do the work,tied the structure is not intended or offered foPsole(See 701- A 2s. `Business and Prb(essions Cmc n The Commor's License Law does And opply m nn' 507 - FINAL PI�dT4s6.ectiohss , awthr ofh his ow Who builds w improves at Inc m and who doer such wah himself or through his own employees.provided that such impaveiwnrs art bar intended ye r or �,b(facd for sale.IL haweveq the buildinglem is sold within one � f or impmvem yew o completion,reavthe owner-builder will have the burden o(Pmving shed he did not bode or FINALE D improve for pomose of sale} ] �i %ithtimnmdconuwwrsta _'.-.._...,ILL ti _ ❑1 a a pe she P(Sm. am Business vela d professions S E P 1 D LO O I. l(" .. construct the project(Sm.]1.a Bmmeo,and n, ons Codr)The Commmw i L L dao net apply m an owner of property won bald or Improve,thereon ( f' _and. M1 commas for such projectswith a commissions)licenud porsoam to the 0ca1 amexe Limnsclsee . BUILDING ... ._ .,.. .. . _ _. - ❑lam eaemptuma Sec. " •' ',B_&PCfw skis reason d: �.�.,:, ,': " WORKER'S COMPENSATION DECLARATION - I hertby afOrm under IrenaltY of Icryry.ane of she follvvin6 dcdanon tis. ❑ 1 have And'will mainuin'a CeniGcam of 6.t 1.elf-inwm for Warier, Compensation, as provided for by-Section J]W of the Labor Code, for the perfonnmee ohb'e'work,for whish ILis permit is issued.. 1 have and xill'ma timin Worke's Campe. dun Inswerince,aslictuired by Scnion 37110 a the Labor Code,far the performence of[he want,far which this probit is issued MY Worker's Cmna Atam•1.6 mrwe carr ar and,Kolucy,number am. -'iIasi, amer ` -Poky No RT ( i♦ n. (. tis CERT 1FICATIONOF,EKEMPTIOWORKERSj','•; " •+ G 3- v ,. lr, COMPENSATION INSURANCE E 'I .1h.9 ,- Q4:' i'.aliCl tilt- ("''(This section need nal tie compicted if she permit is(w one hundred dollars '' ' j I ISI00)or fess.) I _ shall not em to any „ I mfy thinny in m in an n is of m s or to which u petit S lssum L l _ P Y nY perwn m any maim ser to become mbJect m the Wohers: ,,1 T``1 „�tA j'sJJil:f.. - Compeoa6tion of California Dam 1 • -Applicant'::”.. ..::.:.... .........., NOTICE TO APPLICANT If.after midnnglhts Certificate of Exem lon.you,houldi licca bJ l ,the Worker's C ",ere d- pm n ons of the huhor Code,you amt 0 0 forthwith complywnh such provisions or this permit shall be deented revoked. - t ....., - _._.-,...___, . _-, .- _ . . ",•�L`v" .'d`CONSTRUCTION LENDINGAGENCY;"".. .. -. _.... _. __ .. ._ _ .. ..._. _ _ ._ __ .,i i•P' .. - -_. ___ ._ I hertby oRtm that she names on lending agency for the ferformanm I I r, •I W, of she wk for wh'ch so perm��I Is.tied ISee'3097-Cie.C) Cr Lend Add _ _ . : __ ..__-_• _. ... .. .f, 0 .1,l -ifythnlhavcmadthisWlicationamswet fficabveinformation rsi correct.I agree to comply with all city and county ordinances and state laws relating _ 0 O' to buildingconstruction,and h by aufficeire,repmaen i5es f this city to enter upon '[T] the above-mentioned property f :Pis nP rp -(Ss agree io save,mdemmfy and keep harmless the of Cupcmno dguinn (ii!) liabilities.es.judgmcros,costs and expenses which may in any way ocrne Against said V z City in consul of she gaming of this permit."l- '�' ,APPLICANT UNDERSTANDSAND WILUCOMPLy WRH ALL'NON-POINT SOURCE REcut.AnDNs.;;, Issued by: Date Signowre' fApplican/C vachr,. "' f :Date';: ' Re-roofs v-•, HAZARDOUS MATERIALS DISCLOSURE - .:+ t Rl the it'lieam w furore fat 1. 'occupant vole arhvdle heaaM ted 1 .TYPe Of Roof ;as defined b,,hA Caption.Municipal Code.Chapt r 9,12,and the Health And Safety' -- Cm4 S❑c Yon 25512(e)"' ❑N a 1 It iY.'ti, y f , I"';_YI 1F+` a2i a x �,<:Li IF ..{ All roofs shall_be inspected prior_to any ioofing.material being installed...._ ' LW ll the applicant or future baIding w pamuseequpm nt or devices,.nch.. If a roof is installed without first obtaining an inspeetiori;'Pagree''to'remove em s h Mous a c nw t.as defined by diBay Are.A Quality Management Milicil _all new materials for inspection Applicant understands and will comply_with- -ill lf OYes / '' I :`,O No l t '., - s ,. .. all non-point Source regulations 1 have rend,Ne herard a materiels regmremcnu ocher Chapter•6.95 f Neo i,l•.I I- C.1ili mm Health&Sifny Cme:Sections 25505.255]3 and 25534.1 understand thus i ifshe buil,ing does nm emrcndy have amnans.Ihn it is my mrs,rsibiliry to not the - P 9 Ss an f a Certificate of r wco tied of, r ' o"ups ay requirements is n h mall e t r w i signature of Applicant Date ....e. Owncrw ausnoriud agrns,i' .„ All roof coverings to be Class "B"tiffDna.. : better" OFFICE. . ._ .. __... . . . . . . ._...._. __ .. _