00070147 (2) CITY OF CUPER•I'INO
nun.DINC DIVISION PERMIT CONTRACTOR INFORMATION:
❑1111.DING gUDlllitig: PERIM F NO.
OWNER'SNT§971 MERRITT DR HOT WATER INC APPLICAI(0007ti47
ONE: CHANG 2531 GRACELAND AVE' ser rrnaY�/24fo,
G-]. ARCHITECAF.NGINERR: ,} BUILDING PERMIT INFO
00 (650) 298-8494 FILING Eusa' PLUMB MECH
2va 1--I -1 LJ 1�7
Fy va
LICENSEDCONTRACTOR'S DECLARADON
a IherebyallirmthatIamlicensedunderpr,visiunvufChapter9(commencing lob Description
lel with Section 7000),,1 Divlximn Sof In,lhsim,,xand l'mfcx,ion,Cade,nndnry liven¢
<,4y1 is to full force and cheer.
re w 2 License Class Lic.ro
O d u Dulc Cnntmeu,r
ARCHff ECT'SDECIARAHON WATER HEATER
�`„g 1 andeiamnn imy puma nn:nu ere a,ea as paha,recants .
Licensed I`rofes,innal ^/
OWNER-BUILDER DECLARATION ViL!
y 2 v, 1 hereby ul'lirm Ihm I um a.,nna from the Cmmacmr's Licence',uw fur the
r 2< Pitiless brawn.(Section 7031.5.Busier,`,and Pmfe Binns Cade:Any city m county
z=o which requires;t permit in construct,alter,improve,demolish.err repair ary structure
.a5mpriermitsissuance,Aso myuireathe upplicum I'nrnuuh permit mfileasigned,,,a rat
thmneislicensed personal mthe pm.;wmr%of[lie CnntmrtnaLicense Law(Chapler9 Sy. Ft. Floor Area O ation
h,unmeming with Nation 71XNp of Divi,iun 3 of the Business and Profession,Cade)
ua Out he is exempt ih,relnnn and the ami,for the ullcgcJ axcntptium Any vitiminn
of Section 9031.5 by any applicant for a vanat subjects the applicant at a civil penally
of brant than live hundred dnnan a500). APN Number CcupaVl�o
o kin niter of the pmpcny.or my empmyces with wage,as their to cumpensadan,
will d(the w(rk,and the stmemrc i,not intended or(thereof for.ate(sec.9044.
Ba,i(Ls and Pr,lea,mn.Cne,�The C.;mtmcma:Ulan"Law does mer apply ,,at 31630070. I li�iyuired Inspections
,owner
,or apmromvuun gn an,o wY nW'h,o naJm•...(pr rohvatethat townnaenpdmnveenm ea«n are ennm woiintendedk mndedt r
pl Ila sale, : awse"uthe at err .enter, sold m(ane yeasofcompldiom,thee ) will havehe burden of provingflim heAid ern MilJrr
_
i-n
502 — FINAL PLUMBING ENERGY
fur pup...ra1fsale.
❑I.as awner(nhe protan y.am exclusively contracting wath licensed mmmnam,to 506 — GAS TEST
.,lmel he pmiat(Sec.7(44,Bnnima s ttnd Prmb„ o'Ir
i(ns Cadec C(inmemr's 507 — FINAL PLUMBING
LOimtua Law due,but apply ,,an(wncr al fluttery It,,band.or improv,,manna.
and who c(nnews for such projects with a cnaticuum,)Bcen.ad pursuant to the
Cnnvnno(,License Lay.
❑1 am exnnpl under Sec. 11 K It C for thls rmnon
Owner Dam
WORKER'S COMPENSATION DRCLARAfION
I "t'hy altiro under pamliy nl'Ot Jury one of the lidlnwing declarutiru.:
I have and will maintain a Certificate of Concert to whFinsum far W'orker's
ui an,utlar, ;a, pmvidrd No, In, Nation 391X1 of the L.bor Code, far the
performance of the work for which this Panama is issued.
O 1 have and will ninim.in Wm kct's Coatpvntradnn Insurance,as rsryired by Seelian
3711(1 of the LuN,r Gale,f n the peruminate of the work ha which this permit h
sued,My Warker's Compensation Insurance amrier and Policy number um:
Carrier. Policy No.:
CERDIlCATION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(l his,vainer need not Fee mmpine l if the permit is far erne handrail dollan
Shut”,less.)
I cenity Ihat in the perliumnnce of the work for which this permit i,issued.I
mull nm uaopla,any wrsna in limy era; a,en u,rot lice a suM1jsra m the Worker,'
Compensation Laws of Culilitnna.Data
Applic;n I
NCJZ
MatTOAPPLICANI':ILafter making thin CcniticureA I?nannani n,you should
became subject to the Wurkda CotnpenumM1n Coale.tian p ,signs of me LCoale.you must
Q O forthwith comply with such provisions er this permit shall be deemed mvnkeJ.
F = - CONSTRUCTION LENDING AGENCY
a ' I hereby affimt that mere n a constriction lending agency for the perlbnnunce
el'the work fur which this permit is issued(Sea NNA,Civ,C.)
0. Q Lenders Name
-D z LcnddsAddr—
U 0 I ccnilythat l have read thisapplicutum and state that he abate information'is
Lis E.a a(ccs.I ag:cc m comply wills all city mad cnainy announcesn and state law,mating
O U mbaimingemn,weliari:of hereby auladre repm,emative, it affix city rot enter upon
U ilia anave-mentioned property for inspection purposes.
. d (we)agree no all.imdelnaify Lnd We,hamaena lie City,,t Ca,mam ag:dall
V1 liabilities,judgments,cine,and granting
ofcatcaNO',this
which may in any way wemc apuiml said
U Z. City I,'ANT UNDERSTANDS
R T germing D flit,pc CO
^ APPLICANTULATIOTANU$AND WILL COMPLY WITH ALLNON-POINT Issued by Dille
SOURCE REGULATIONS.
Signaure of ApplicunlCunmmmr Ude Re-roofs
IIA%ARDOU5 MA'FCR'ALI DISCLOSURH
Will the applicant or future laddingcweupnLwomErr hmtdlena,admismaterial Type of Roof
i,dcthaed by the Cmmninn M.nlclpal Coda,Chapter 9,12,and the Health anti Safety
Cede.Sacs an 25532(.)'1 No
0 yes All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or footer,buildinguetapanl use equipment ordevices which If a roof is installed without first obtaining an inspection, I agree to remove.
eit haemdou,air commainants a,defined by the Bay Area Air Quality Management
111titf all new materials for inspection. Applicant understands and will comply with
ore, "Net all non-point source regulations.
411,
1 have read the huuudons ntatcdalx at,irmncn,ender Chupmr 0.95 of the
California Health&Sufesy Gde.Sections 25505.25533 and 25531 1 undersand that
it the building Aiws nat currently have a tenant,that it i,my respnmibility to nosily the ,
nocturnal aldw rcqulremertn which must be met prior no i"nanee al a Ccnlfe'mu of
,occupancy' Signature of Applicant Date
Ow net or aain(rimolagent Date All roof coverings to be Class •'6" or better