02020128 (2) CI eui DING oP,9SIO NO CONTRACTOR INFORMATION:
r , PERMIT ... . ... _ ..
•,; BUILDING ADDRESS: - '"� �' � , --" PERMIT NO., �
10864 NORTHVIEW_SQ JUST WATER, HEATERS,,INC, . ,, 02020128
OWNER'S NAME __ .. ...._ t:L.,✓ __. ...,.:._ ___._.__ __ _ _ ___ APPLICATION SUBDATE_.. .. _... ..
MOGHTADER HESSAM" 1764 . NATIONAL AVE - 02/28/2002
liONE: SANITARY NO. CONTROL NO.
(510) 293-9901
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
F BLDG ELECT PLUMB MECH
<ZFyy L� L" U L_J L.7
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LICENSED CONTRACTOR'S DECLARATION
14 I hereby by eRrthat I em licensed under provisions of Chap¢r 9(commencing Joh Description
»t with Seen..7000)of Division 3 ofthe Business ar.d Professions Code.and my license REPLACE 40 GALLON GAS WATER HEATER
y is in full fornicator!effect.
`e�< License Cie. Lie.M
S u a. tr
Da¢ Conact.;
ARCHITECT'S DECLARATION
0 'T understand my plans shall be used as public returns,
3 i p O Licensed Professional -
OWNER-BUILDER DECLARATION
s'fr n 1 hemby o(firm shot 1 am exempt from the Contractor's License Law for the
C? fallowing reason.(Section 7031.5.Business and Professions Code:Any city or county ,
F$, O
which reclaims a perm s m e ,tract;oho improve,demolish Or repair any strucmrc- .` .
td3 e�._pn s ssmmirdpal f( a thessioursmfst such pertmulumnse my pClaemem I- - - - -
598
(crusa ant S�pSctmnrathe pronuomn 3ofthflst nuuIine ;a nae law lmsCn9 Valuation
(sommrcmg ur Stntn7a00)dthebaisoof the Bu6tnegarsd RofAnyvi Cod) �,i��tx yl_s31'G J,tT VJ.4r.fV'U I}asi^1i ig.,�- ..
ac that heli exempt zany a applicant
and she basis far she subjects
thetl.tempt n Any violation
of Section;903f.5 by any aPPlirnm(or n perm s subJ.cts the applicant to e civil Penalty - _ . ._ _.. .. .. . _:_ ...
'! idf not more men five hundred dollars lS500) N. I' CCUPal7Cy Type
502- P'SNPAL PLUMBIN I'.,ENERG
y •Buantrcsse md(,-m n-CWerThemply dewagesusthcir sole tampon eui
°1ncrsof pmpcny Who Wads Drat someone is n s intended n 'nffercd for sale(Sec.]014 .
� P Perry. Y
'will do the wPnolli nd the Wa:,T
,oves s ,a selswt,such ,khi an _ -.., -507 ---- FINAL--P$606 GAS FR8B4 F'¢Peehons ....'_ _.__.
improves at such,and who does such t int himself
or
q• e' or eWd gor his awn employees.providn that such improvements art not;mended or
v ':gBc¢N;foi sale.If,however.the building or improvement is sold within one Year of
completion,she owner-Wilder will have the burden of proving that he did not Wild or
improve for puryom of sale.). l
°1,as owner ofthcpmpcny,am
exdusivNy comrazti Dove -
construct the project90;4,Business and Prefix ions Code:) Co ct "
License Law due,not pply s aowner of properly 9 W Ids o im v are '1 s
and who commcta for such Pr lects.w th a consme J _ sed P t ro
)IRE
J .. .. . l ..-.._ .... .. ..
Chntmctnra License Lew f
°1 am exempt under Sec '' ' ";8'@ P C is re
t Owner' " Data
WORKER'S COMPENSATION^ 1 hereby e�rm under penalty of Perjury oro of the fallowing declensions:
i have end will maintain a�&rtificase of Consent to self-imme for Worker's
rompemesion: as'provided for by'Section 3700 of she Labor Code. for the
.tdrformance of she work for which this permit is issued.
°1 have and will maintain Worker's Compensation Insurance,os required by Section
.700 of the Ube,Code,for the performance of Ne work far which this permit is ,
y` CERTI�OF EXr nc cmrend Pal cy numherarc:i - ^ _rt1i, ..•_':�,
.P_ .. ..,,.. .. ...
tssued
M W rkets Cam onset on Ins
w
-
EMPTIONFROM,WORK�— -•, { lr.4l:.;f a e jay 1,ili!�, i,1 s
'.,.'.,_..-:. _'p�_i.tOMPENSAT10NdNSURANCE'";'"` ... ..•, ___I____.,.._.____.__.._—_........_ _ •_ -. •• _ _ ____ __ _____ _ ____
"'0`Ibis sectidri nod nos be cnmpl.sed if Ne pennis is(or ane hundrtd dollar "°" ' '
($100)or Icss.) -
a hradfy than m the n in any ma n the dark( which ube ct H6 t e issued,1
• °^ �shall not employ any Person in any manner m as m become subject to the Workers' �_._ _._ _ . .. ..__ ,. ,.._.. .^.... _..._ ...t.. —._ ...._ .. ._ .. ..
Compensation Laws of Celifomia.Data
Applicant :__, 11_
c
NOTICE TO APPLICANT If.after making the Cemftcate of Exemption,you shbuldt ` -
'' Z become subject to the Workers Compensation provisions of the Cantor Code,you muss
Q forthwith comply with such provisions or this permit shall be deemed revoked,
^ VJ ;,0 -CONSTRUCTION LENDING'AGENCY
.•'. I hemby affirm that there iia construction lending agency for she performance ..
• of she work for which this permit is issued(Sec.3097,Cid CJ
a.(1 �LendeYS Nome__-
.� Z Lindh Add.. v.
V 0 1 ttnify mat 1 have read this applie.w.and smar shat the above inforrommn is
W+F so—' I,agree so mmDly with all city and county•ordinances and nese laws relatingT,) m1s.0d gcansuumion eadh reby'idth nm presedmtives fsms chyt smerupnn is
W the eW a mentioned Property for inspection Purposes.
'pyh (We)ogre.so e e indemnify and keep harmless she C sy of Cupen'no against
liabilities,Judgments. t and expense which may n any y ace against a againsaid
C�' City sequence of the granting of thispermit
'APPLICANT UNDERSTANDS AND WILL COMPLY WITHALCNON-POINT' IssuedbY: _Date
SOURCE REGULATIONS..'„'.”
Signature,of Applican✓Commetur.- -- Oane' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE „
. .. _ Wdl she applicant or fume W Ildmg atopens state ar herMle hiiisdaus mesedel .. Type of Roof,...”
Code. -
Sic
uiUt CLpttt an Mu�tnpN Code Chapter 9 12,end Ne Health and Safety M — s r,
CSaon 25532(x)' 1 s.
❑Y a r pNn .`-''' '.' All�roofs,shall be inspected prior to any roofing,material being installed,
W.
......Will the applicant or forums blueing ectvpem use equipment or device.which If a roof is installed without first obtaining atl inspectlori,'I agree to remove
emit haenrdoua air conseminanss as dcOnedby the Bey Area Air Quility Mone gem ant ..
Dintau? all new materials for ins ection. Applicant understands and will comply with
°Y"; e" ,i ._. all non-point source regulatlons_
1 have read the hszerdouarn't"als requirtments',under Chapter 6.95 of the
'Califorriio Health&Safety Cade,Sessions 25505x25533 sad 25334.1 understand that
-, •ifsht Wildingdmamac.rcmly havea manor,that itismy responsibility so natifythe
ocWjwm of she requirements which muss be met poor so issuance of.%Certificate of
°"a `r't t _• Signature of Applicant _ Date
+': owner oreamadssEagent Date All roof coverings to be Class"B"or better
,..,
,.�.....� (.:..._:.. ,;'.,r '•...'J OFFICE ..... . -- - - .. __...._.