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01070101 (2) CITY GUDIVISiO PERMIT Nc CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 21432 ELM CT WATER HEATERS ONLY 01070101 R AWY" DOHERTY APPLI TON 2 DATE 500 AIRPORT BLV 0723/2001 PHONE: (415) 349-3747 SANITARY NO. CONTROL NO. O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO U BLDG ELECT PLUMB MECH < LJ L.7 IJ I_I 5 i m LICENSED CONTRACT'OR'S DECLARATION JOb Description Z z_a 1 hereby affirm mat I am licensed under provisions of Chapter (commencing REPLACE WATER HEATER. F:t- wim Section 7000)of Division 3 afore Business and Profesions Curb, ad my license cem ; is in full force and effect. �o�`u Lieen.e Cla.a Lm.a (50 G GAS WATER HEATER) . ad 3 a t- Date Contractor "• ARCHITECT'S DECLARATION a'J,Maj 1 understand my Plans shall be used as public records �r yO O Lensed Professmnal OWNER-BUILDER DECLARATION ad at 1 hereby strum that I am exempt from the Contra Co License Law for the my < fallowinguirsna permit ]onstr Businessand Professions Code Any city or county O which requires n permit requires e airs the alter,improve.demolish,or repair any structure i 3 prior ts' a al q i sth<applicantfo hpermit oflsignedawtemem, thallin rs l c of d Inament To he pro :,was iNthe C uvcmrs License La (Chapter 9 S Ft Floor ACea . (c enc it with SG to,70M)of Division i fm BusinessdadP fessonsCd) S.il y F .0 Il'f S ,/r .1 ('I "y,. ValUatlOn ar that he is exempt therefrom and the basis for the alleged a ption.Any viola mn -of Section 7031.5 by airy applicant fora permit subjects the applicant to a civil penalty of not prone man five hundred dollars(s500). APN Number 'IF '*!'' I Occupancy Type °1.as owner oRheProperty,or my employees with wages as their salecompensation. 502 — FINAL PLUMBIN ENERGY will do The work,and the svucmre isnot intended or offered for sale(Sec:704L- 5 0 6 - GAS TES Business and Professions Code:The Commcror's License Law does not apply man TRequired Inspections: - Owner ofproperty Whbuilds p fl n,and who does such workhmself _ 507 — FINAL PLUMBING or Through,h- wnemployees provided that h improvements rc tintended or F -;ofromils If,h a the ti Ido ....___ . . . _ __. _._ ... .-_.-.. _ _ .._._ .. _. .._.... _ g pros li ,,within ane year of - — — oprove fa The owner ,builJer w II have the burden of prov ng mat he did not build or improve for purpose of sale.). f]Laenwner 0f,(be Papi-am-Bexclusively contracting with licensed Cont n t construct the project(Sec.Trial,Business and f. ons il The C nt t License Law does not apply to owner of property who bisIds or imp t LE ii .antl h tinct f such p jec¢w th commissions)I n ed.p odor '. t -;. :;'l �• t the Cont t I L<e La °1 a.Tied,p,under Ser, &PGfar,thiareaaan ;.0 7 2001 Own to WORKERS COMPENSATION DECLARATION BU'LD1JYG i.., 1 hereby affim under p naltY of P ,sa f 1M1.follow n8 dicamat ons: ❑ I Love end will ma uta n is Cemfcate of Consent in self-metre for Worker's Compensation,:as provided for by Section 3]0(1 of the Labor Cope, for the - - performance of the work far which thil peirmit is issued. . Cl 1 have and'will maintrialWorker's Crmpe t Insurance, required by Section 3700 of the Labor Cod•for the relfirommake of The ork for which this permit'is iss d My Worker's Compensation Insmampecarrier and Po l cy dumber arc., Camr Policy N tt i CERTIFICATION OF EXEMPTION FROM.WORKERS u '-,COMPENSATION.INSURANCE 1 -1.11t - .. ...._ ._ _._. ...... _ (Th' enlo 'need nm be c°'mpl<ted Rhe permit is fur one hundred dollars '-1' t,lr t „•I t� :,)[ � ran er as ro n to prat in the pe f of the k f ht h th - "- shall temploy any,P< in become mboop to the Workers' Compo at Low,of Cut f e Dole' NOTICE TOAPPLICIC ANT If after nuking m's Certtficntexempt of E -pn.on.You should zbermad laribilat the vAlk"'s Crimpimsalk,im previsimiIth Labor Code,you..it - - - 0 O forthis ith comply stiff ch provisions or this permit shall be deemed revoked. I, 'CONSTRUCT a ION'LENDING AGENCY - . . a.' I KIhiaffirm tarnconstructionI 7,C sge Y f. to perfonri ce . W .y 'L o Na which m admill, "'ed(S c 309) CIv.C) d. ' Led r.Name' _..-, ...-... Z Led Add;ads, rc'y hat I hmad this application d state th tth b information is E.r rte t 1 to comply with 11 rily and county achaturess ad t t lacing -rJ -tobldng construction.and hereby amhom representatives of this city to enter upon 'Thlaw,a-mapammodfiroppery - spedp (we)agree tos e ddn ify and k Fm lieCty fC p noaga mt t5O liabilities. pcov adexpo swhich yin any y a againstsaid Ctnco veruBF the granting of this permit I ' APPLICANT UNDERSTANDS AND WILL COM FL4'MRH ALL NON-POINT" SOURCE RE00LATIONS Issued by: Date Sign w<I Appl,,maa_ t ctr -; . .." Dam Re-roofs HAZARDOUS MATERIALS DISCLOSURE W1 theapplicant or fatilrebuilding«c pa t store orhandleh doesmaterial Type of Roof. s derned by th Cupm1 M n<p 1 C d Ch pie 9 12 d th He Ith o d 5 f ty„ Code S tf n 25532pd ; ';; e °Ye °N° All roofs shalLbe inspected prior.to any,roofing material being installed___ Will the dr,plicam ar t t rt building«c.,am use extudlimer, device,which�. If a roof is installed without first obtaining an inspection';`I 3gree'to,remove tbacdl a ocnt mm darned by the ayAieaA Quality g District all new materials for inspection.,Applicant understands and will comply with :1 : st CN. ''1 all non-point source regulanons.:,., 1 h read the h Nus atenal rey varmair under Chapter 695 sof the Cehfomia Hedltb&Sof ty CMe,Sections 25505 25533 and 25534 1 understand tha0 if.ittbiddingdces notcneilly have ate nicht it is T, at m n6ufy the pa tall c -f th' gnirem t h¢ti must M m t primp,iss a of,a Cenifcme°f ccup , Oy. j.. - - Signature . . ... _. . . . -._ .._....._- -. ._..- Dae Date All roof coverings to be Class B"or ow o aamortzw,ag nt - better . r!r'. ,1 _ •/- -; - - .OFFICE tis:; e . ., - •,