02090141 (2) CI 6
BUILDING DPERTONNO PERMIT CONTRACTOR INFORMATION:
716D1N8ADg EACH BLOSSOM DR JUST WATER HEATERS INC PERMIT
gwyER'SN6yE:. HO ET AL 1764 NATIONAL AVE APPLIc019N�y2B01
002
PHONE:l:ri 11V (510) 293-9901 SANITARY NO, CONTROL NO.
Q60 ZO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
m BLDG ELECT PLUMB MECH
y¢6
S!!2= LICENSED CONTRACTOR'S DECLARATION
Z Ihereby0).fIhtlam,iccnudunderprovisionsofChapmr9(commencing Job Description
oz-o - REPLACE WATER HEATER
F:Fw with S«tion]gp)ofDivisionlof the Business and Professions Code,and myliccnu
d is m run carte and effect. (4 0 GALLON GAS)
a,«a License class Lie.a
3 D Date Comr«mr
fn ARCHITECT'S DECLARATION
t1=O 1 understand my plans shall be used as public records
Ep O Licensed Professional
OW NE.exempt
DECLARATION
X K m 1 hereby,them on 1 1. exempt from me Contractor's o e:Any c Law for she
E1FQ followingrcosa(Semon)onstr Business and Pe.dcaons Crile:Any city or county
se which rryussu n permit ac rons;the alter,impmve,demolish,fi repair any suuauu
w- 00
w pit earl req m applicant for such pctors License
8eJstat m - - . .
o,3- mA62 5t1 'hwJphrsngmcpmm.wmof the dre Business
L c Law(Chapters)h)
y,•, �Sq:�Ft Floor Area a e a y�T Valuation
fen me 9 wall S«,i* ]BOhJ f e vssisoof the Busmessa Ji ranana code) I, Ik':aq �.'•fat��•
era mat is i5 daemps Zany appli rand me basis for the subjects
th d aemant to Any violation r 3 6 611119 . 0
-af S«lion,than
v any hundred
+r,a permiuuhj«*s the applicant m a civil pcnahy
-
wrnmmaremanfivanaaermengars(ssn)l. APN Number .er::.oT>.:� Occupancy Type
❑Lasowner onneporKry,ormyemployees wimwagelher,mlecompensation, 502 — FINAL PLUMBIN ENERGY
-will-do the works and-the'swclure'is a,,,intended a,offered for sale sxc:]Bit, 506 - GAS TEST
Required Business rand Professions Code:The Cant.«tar's License Law does not apply m on Required Inspections;,!' Itt 11 1,•�''
macer of pmpany Who builds or improves diatom.and who does such work himself 507 - FINAL PLUMBING
or through his own employee,provided.ma such improvcmems art am intended or
-:offered'for sale!lChuweveo*fie liuildin tis Hold within one --of " -------- ,1.'.`.�_sA1f / 1 _.
gmurden of pro Year � ,..;ria-.,.__ ............
'completion,pu owner-builder will have me burden of proving that he did wt buil)or s '
improve for puryou of zale.l
t]I tr nl ja,p pe*y exclusivelycontestingi with I«n)Thenmmcmrs m -�a - -- ❑. t .:
construct i th project fS ]to a B sine. d e Professions Cole)The venwcmr s
License law does not apply m an v«rcr l pmpe tr who huiice se improves thermos
. Contra ..L p f.....`r 1 licensed p rsuant.m the ...__ . -------------
Coal
._..
.and ho<onuac¢for such o«u w th contractors,
uL
0 exempt neer Sec' ` U&PCror this reason
� WORKER SCOhIPENSATION DECLARATION
Ilicash,liffinartmadePe by of Pe 1 ry one ofl0c follawmg d«lamunne:
❑ 1 have rad will'nmir lain o Cauifca,of Consem'tu ulf-insure for Worker's
...i]�. `Compensation..m provided fora by Saint. 37W of the labor Code, for the
'perfam,arrccofthdwork,forwhichthispermitisissued.
❑1 have
ani maintain W rk s Ccml�pxiarmlmuaanva goired by Section
JOM of the'Lrbir Crile for the performance f the work for which this permit'is
issu d.My Whirl Clorriptoresslimi Insurance tarn a d P y mhr am:
„ t ..w -sass. ... .- _ .Last .. ..u._ sass .....--. .ter-� - ............_.._sass..
Cam<NI.iCERTFICATION OF EXEMPTION FROM WORKERS e f �s'•: l :p' jttk: il>isr t. `.tyy 1.?•' 1t,� 'tl; :,.`}•6l.
COMPENSATION INSURANCE
t(Th a ueuon need arm be completed if the permit is for one hundred dollars s�* \ I l 711,'7': s �s:'r Lsl 11 I':I"' •A
ISH100 m las.!lriF
-i. .._..
, Y -nfy lh t' tl<p�fnl* ,c of the drA fo 'h¢lul pe, tsta ed 1. TN,( .J 111.�1b aigi:l ♦` el .
shall not employ aa,pe wit m any manner m,as o bechynome mm the Work is
Co pc wsf n LaoC 1 f ,Dau .1
-App,cal ' :_ : 1 .4 ._
Nu TICETO APPLICANTIf.mur'nak gis Certificate t L.an,a......should'
bee - u
bjeco the N iA r' Compensationprovisions of the LaborCade.you must
0 O forox ah comply withsuch pm isions or this Permit shall ba y mn J rawaked.
rw. IT
� `sfa hertbY"1 CONSTRUCTION LENDIN(IAGENCY V \,, \ (
I affmn that it is a n t a oInd nB age f the performance
- -_t'
of the kf hch thik perma,is asued!Sec Jfri9 Ciie.C) w:.u_s..."
Lciadc,',Address
`1,e.I certify that I ply rine ails city
and
any state mm and stale
infmmmini is
%U mnN agree to comply with ibyay any coumy ordinances matinfoil sae laws era upon
_�..V i:.buildingabove mensuunion:and pertyfri nspe tion purposes.
vcs of this [center upon
he abavWc)lig uned,ove.ny for inspection purynui., _ .. , ,
Zl (W} g ria de ipe and which
mless me w accrue against
agand
��h Ctyliabilities.judgmentz costs ml fifth h h Yin any y gains*said
U.2.• City <AN'r end f*h g mngDW pe t- `
APPLIG',1NTU{dpER5'Frt\DS AND WILCCOhIPLY•N'ITH ALL N'ON=P01(vT Date
. ....�; souRCE REGULATIONS:{1111 ".'S'kT P',Iry. Issued by;
Signature gf Applicem/ConmcmrlC;i ;'.,.� . .. , fi mote .. Re-roofs
f ', HAZARDOUS MATERIALS DISCLOSURE
-; Will the applilmora or future building a cupam nun,iir handle n.uanlo sin;,'rad -....Type of Roof,.-.---.,- sass..._._._ .. sass. . ..t :- .�_..._.. ......,_
as defined b the cu r Municipal Code Chapter 9 13, d d Health and Safetyt,
CWc Section 355R(o) {. l. . 'f t' .\k•' fir- f i `,.a.tiry t fs Y, 1,
Y,. ( ) -
❑Yee r oil .._.All,roofs shall-be inspected prior to any roofing..material being.installed.,._,.,..... ...
��r wu d,epppr to f I h.mite« pat cq pmrn* rade n n If a roof is installed without first obtaining an mspectton' Lagree td remove
mat haza0 us air contaminants a.defined by the Bay Area Air Quality Ma agem 0
D aYall new materials for inspection, Applicant understands and will comply with
�Cye, * ❑Nn'• ,b ' - all non-point source regulations, 1 ,
'-I havea lead Safety
ety Code.
mmaiens req cements under Chapter understand
f.fhe,
Cluilif
Health&Safety Gide,Steens 25505,t it
one responsibility
I ity to n by that
if the building dgcs not currently have a mnam.that it u my rtsponsibilitY to notify�
'ace p m of she requ -met which Mut him,t pit--,w issuance enificae of
°" ° y _ Signature of Applicant Date
r �.t .. _ ... -..._.__. .. __ ..... .._. ..
*
z�.r All roof coverings to be Class "B" or better
8 II`
mh.med t Data
:O g
OFFICE
.. C.e .. * . . .. .. ,._ .. . .. . 'cit a. .. . n.