02110035 (2) Iswl.ntrvc rnvlsu3n PERMIT CONTRACTOR INFORMATION:
Bol �3� B'-'4 ER PL JUST WATER HEATERS INC PERM]rNg2110035
OwiY 1EGAIL A AND WARREN P TRU T1764 NATIONAL AVE APPLICATIlCil41
TR2 OO2
IONIi: SIO 293-9901 SAN]FARY NO./ / CONI'ROLNO.
ARCIIITECOINGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECU
i3700 LICENSEDCONTRACfOR'S DECLARATION
ce r I hereby affirm that l am licensed under pmvixinms of chapter 9 anmmencing REPLACE WATER HE�'g' prion
iwith Sectinn]INXgol Division 3of the DuAresc and Profession.;Code,and my license is
n ecu Gane and eBccl. (5 0 GALLON GGAaS)
ZC}a= Liccnseclass LmN
Uutc Contractor NA lam®
F=�� ARCUITE.md.,MLARATION [S.at�
z< 1 understand my plans shall W used as public rccoNs
NOV 2 6 2002
3 u Licensed PrOlexsinnal
°j OWNER-BUILDER DECLARATION
1 hnro by million thin I um umni from the ComMo,ba's Liccam Law for the
p O following reason.(Seeman 7031.5.Business and Professions Code:Any city tar county 1
%$ which requires a Permit m consumer.alley,improve,demolish,or repair any simulate BUILDINr. $698
'°'r^ prior to its issuance.also requires thcapplicant forsuch Permit o file axignedstxtemen(
F=a that he is licensed pursuant,,he provisinroof the Contractors License Law(Chupter 9 Sq. Ft. Floor Area Valuation
g�$ (commencing with Section 7000)(if Division 3mf the B usaress and Professions Code)ter 31646026 . 00
i — Nal he is exempt merofrom and the basis for be alleged cacmption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
nrnmofethadlove hundred dollars D$Wr. 502 — FINALPLUMBI G ENERGY
❑ I.as owner of the property.or my employees with wages as their sole compensation,
will do the work.and Bre swewm is not intended or offered for sale(Sec.7614,Business
and Professions Code:The Conteaerots License Law docs not apply to an owner of 507 - FINAL xe@A1Aq1ffections
property who builds or improves thereon.and who dosssuch work him off or through his
own employees provided that such improvements are not intended or offered for sale.IL
however.the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not Wild or improve for purpose of
sale,),
❑1,as owner of the property,am exclusively contracting with licensed contractors In
construct the project(Sec.7044.Business and Professions Code)The Connacmr's Li-
m law does not apply to an owner of pfopeny who Wilds or improves Merton,and
who contracts for.such projects with a commercials)licensed pursuant to me Contractor's
License Law,
❑ I am exempt under Sec. ,B&P C for this reason
Owner Dale
WORKER'S COMPENSATION DECLARATION
I herMy aRrm under penalty of perjury one mf the following declarations:
I have and will maintain a Certificate of Consent to self-insure for workei s Compete
cation.m provided for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,.required by Stetson
37(x)of me Labor Curie,for d¢performance of the work for which this Permit is issued.
My Worker's Compensation Insurance curia and Policy number am:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section mad not he comploncil If thc permit is for tune hundred dollars(Sllkq
or less.)
1 calmly that in the Performance of the work for which this permit is issued.1 stall not
employ any person in any manner m as m become subject to the Workers Compensation
Laws Of California.Date
Applicant
NOTICE TO APPLICAT:II,after making Nis Cenificate of Exemption,you sh I
be.me subject to the Worker's Compensation provisions of IM laWr Code,you must
O Z forthwith comply with such provisions or this permit hall he deemed revoked,
zO CONSTRUCTION LENDING AGENCY
(-+ I hereby affirm that from is a construction lending agency for the Performance of
Ix > the work for which mix permit is issued see.3007.Civ,C.)
1a Under Name
= Z Lcadcis Address
U Q I certify that I have read this..PIII and sure that the aWve information is
W (•' etmect.l agree to comply with all city and county ordinances andxute laws relating to
Q U building construction,and hereby authors®mpresemmivaa Of into city to enter upon the
ly aWvc-mentioned properly for inspection purposes.
t0. (we.)agree to save,indemnify and keep harmless the City of Cupcninn against
rat Iiabilines,judgmenls,trusts and expenses which Mayon any way acne against mid City
V Z In consequence Of the granting tit this permit.
.-t APPLICANT UNDERSTANDS AND WILL COMPLY WI'1'll ALL NON POINT Issued by: Date
SOURCE REGULATIONS.
RC-,OOPS
Signature of ApplicaMuconoamr tram
HAZARDOUS MATERIALS DISCLOSURE, Type of Roof
Will the applicant or future Wilding Occupant store or handle hasardnus material
as defined by the Cupenim,Municipal Code.Chapter 9.11,and the Ilcallh and Safmy
crwc.thou 25532(a)'r All roofs shall be inspected prior to any roofing material being installed.
Yes 0N
Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emir haeandous air conmmimnts as defined by the Bay Arca Air Quality Management all new materials for inspection.
IDistrict,
❑Yes 0N
1 have read the hambdous materials requirements under Chapter 6,95 of the Califon
ria l health&Safety Cale and Sections25015.25533 25534.1 understand ma if de Wilding
M.rad.,unity have a lenanl,mut it is my resl ou"bnhy to nmtily the,cconnt of me
requirements whichmust bemet prortoissuance OfaCertificate nlacupancy. Signature of Applicant Date
Swmrm mrthmnedagem Date All roof coverings to be Class "B"or better