01070029 (2) CITY BUILDING DrnSIONSINOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10191 PARISH PL JUST WATER HEATERS INC 01C0PP70029
G59Ma'�T RICHARD B 1764 NATIONAL AVE 07 10/2001
PHONE: (510) 293-9901 SANITARY NO. CONTROLNO,
w O O ARCHITECT/ENGINEER. BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
f-1 LJ LJ =-I
bast
t- LICENSED CONTRACTOR'S DECLARATION
z o y 1 heah firm that Tam mft1a,cd under f Cha t 9(commencing Job Descr TER
GN_o ya pr°"ixi°"`° per Y REPLACE GAS WATER HEATER.
p_r_w tion
with Sectione and efec,l. on3of the Business and Prefessions CWe.and my lieenu
ea Y Z J is in full Tose and effect.
Cas
6 License Class Lic.as
O n G Date Carl..,
w vARCHITECT'S DECLARATION
- ; 1 understand my plums shall be u.wd as public records
o
Ac Licensed Professional
cOWNER-BUILDER DECLARATION
w=m 1 hereby mfrs that 1 am exempt from Ne Contractor's License law for the j
following reason.Sealers 7031.5.Business and Professions Code:Any city or county $840
f o which requires a permit to conawel.altea Improve,demolish,or apair any sticture
w et
-prior to its issuance.also requires the applicant fch permit to file a signed.mamem. - - - -. -- - -
thalhGis licensedy rs rut it,larollool ofah C ImcmV License La (Chapter 9 ,. (. �'f 31$14 O�11gor fta , ., j Valuation
(cn an y 1hS t 7(ol)) tD no l f1heB 'rte: dP [.sons Code) ,' I�' v.lrj iQ,lr i
or that he is exempt therefrom and the basis for rhe alleged exemption,Any violation „
of Sation 9031.5 by any applicant for a permit subjects the applicant to a civil penalty
of not man,dom five headed dollars(5500). 502ARNAIIENOM PLUMBINq ENERGY Occupancy Type
01,as owner of the prolperty,or my employees with wages as their sole compensation. 506 GAS TEST t _
will do the work:and the structure is not intended or offered for sale'(Sec.7044' 507 - FINAL PL � IlFnspections'r': .1
Businea and Pmfessions Code:The Commonor's License,Law Law does not apply an
owner of property Who bui Ids or improves thereon,and who does such work himself
or through his own employees. building
that supM1 improvements are not intend.or +
offered far sale.If,however,the building or Improvement n sold within one yea of
oproveifar the owner-Mulder will have the burden of proving ria he did not buil)or '
improve far puryose al salo). +
Cl 1,as owner of the proper,,a xclu,nely ea m acting wmmrs m
with licensed cocm
consume the project See.7044.Business and Profession,Cndo:)The Cnmmcmr'saI A
i A ��®'
License law docs not apply to an owner of pmpeny who builds or improves thereon, r F
and who eommetsfor such Vrojeas with."contractors) licensed pursuant to the.
Contractor's License law.
0 l on esempt order Sac. &P C far this reason `D•E C :0 '4 2001
Owner Data
WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penalty of perjury one of the following declarations: BUILDING
❑ I have and will maintain a Certificate of Cnnscnt m•self-insure for Worker's
l. Compensation, as provided for by Section 3700 of the labor Code. for the
performance of the work for which this pcfmit is issued. .
❑1 have and will maintain Workm'i Compenution Insurance,as required by Section
37W of the Labor Cole,for the Performance of the work for which this permit is
issued My Worker'i C p i I noulms&career and Pal icy number are
' Career. Pobcy No:
CERTI rICATION Or E%EMPI'ION FROM WORKERS'; -
COMPENSATION INSURANCE
(This section need not he naoplerled if the permit k for one hundred dollars
(SIW)orless.) ,
1 oily!hm in the perfar nn,tie of the work(or tali h tb p mit is issued,l _ I '-' ,)fin: it. -
shall no,employ any person in any manner so as m become subject to the WmUrs
Compensation Laws of California.Dae
NOTICE
making
.sibs .. . ...-.. ._.. . ... .. . .
NOTICE TO APPLICANT.the Worker,
aftCmrnwkl"g tri... im a toe Labor Coyou de,
muld
ust r
Obecomes comp m the such to Ckin.,or tion piovivions of the ented Cale,you mull
forthwith comply with such provisions or this Dermic shall be Jcemed rcvokeJ. '
CONSTRUCTION LENDING AGENCY s
I hereby affirm that lime is a olnsu Brims lending ogcncy for the ferfomance
L 0 of the work for which this permit is issued(Sec.31097,Civ.C.l' I
Lender's Nunn
tender's Address _ --- •I- . .
V Q I certify drat I have read this application and state that the above information is
W [.. coreit 1 agree to comply vall all city and county ordinances and state doing
0.V building construction,and hereby authorize representativesof this 1 to enterupon
Er
be h' dproperty for inspection purposes,Vc51s indears
keep rrrIleC of Collection allot and
liabilities dg 1 t. d expense h h may ay avec _... Q_
against said
City to comrgren.c of the gnarl rigor this perm t. a 4
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
Y•
Sigramt of AppliearmCont...or - Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Willme'I Alioal,il,forn,bu W'ng everpma score as handle Ir .N ..al - l Type of Roof Is _
nsJf dbylhe Cuperin Munmpel Code.Chapter 9.12.andlt Health andSafety _ '1 ( ,
.
Coda SectmP W3'_!al .s.r f•e, '+ .!.s,•i .'� S. sl � t{..
Cl Yca"' ',.ono. . ___All.roofs shall.be..i nspected.prior.to any_roofing.material being installed._.. .._......
Will the applicant future building p t tseequipment ordcvscs which If a roof is installed'without first obtaining an inspection,l'agree'td remove
'entb d cot i t. ler ed aM1 BY Area Quality Manng eat
D t t all new materials for mspection,•Applicant understands and.will comply with
or ❑No all non point source regulations:,,
I have read the huardous materials requiamenu under Chapter 6.95 of the
Cmiromia Health k Safer,CWe,Sections 25505,25533 roti 25514. understand rias
rthe buidingdoes not curemly have a term,,that his my rcsrymsibil'ny m notify the -
occupant of the require bears wboth'must be met prior to issuance of a Cenifimre of
Occupancy.,
. Signature of Applicant _ Date
-
Owner oramhorizedagent. - Dat All roof coverings to be Class "B"or better ,
OFFICE_ .