02040011 (2) OF
C,BUILD NG DIVISION O 'PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22036 RAE LA HOT WATER INC 02040011
OWNER'S NAME: APPLICATION SUB DATE
I KUNG 2531 GRACELAND AVE 04/02/2002
PHONE: SANITARY NO. CONTROL NO.
(650) 298-8494
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
e w{r BLDG ELECT PLUMB MECH
a 6 . . 1=1 (-J C.1 l_.-I
LICENSED CONTRACT'OR'S DECLARATION
•z z `` 1 bercn firm that 1 am li<cnsd under s fence s(cummemam lob Description
5z!20 oY a provi lona o p g
„Cw ..ilhseednn�000) Dhi.innJnrNeBu.meaaagd�ro2.xjr.cp.`Ie. pyyBcen.e REPLACE WATER HEATER.
('2 isi lulDfnrcc�Jq t 0 I to7L.P� b
c m < Licen C cess .....JJJ`L� Lir.M
fO e.O Date Gsmraanr
?u 0 A C ITECT's UECLARA3 O
I uneenwnJ nmy Plans.hall he used as public records
3 p O Licensed Pmm,ional
w n o. . . OWNER-BUILDER DECLARATION
I hereby affirm that 1 tun exempt from the Contractor's License Law for the
t'i< fellow ing reaam.(Section 703 1.5,Business and Professions Code:Any city or county $500
s4 o which«quires a permit to constmn,alter,improve.demolish,nr repair any swnure
c3c -poor tot issuance,alsorequiresthe applicant for such Permit to file axgnd surement .coot. _... .__..._..._... ..
tint he sl and punulnnotn p' ions of the Co nracmrs License law(CM1aper9 r a 5 t Valuation
fcomm<nc n6 ith sttt 9000) fD vis onJof the Bu{tncssad PmfessmonsCde) i'(iti,�,', f3,��0�`�°.f�a��.1t'�e1:bi' ,4 ,
or tharhe ms exempt thercfromunJ the bas¢for the ullelcJ coemgmn.Any violation '
-of gminn 7N1-.5 by any applicant fur a pemnit subjects the applicem m a civil pmahy-
'of not mt,rcthan five hundred dollars($5Iw). 502APN'' L PLUIst ENERGYOccupancyType
°1,as owner of the property,a,my employees with wales as their sole rompcnsmom,
will do the work,and the structure is not intended or offered for sale(Sec.7614: t -
'Bdsincss and Professions Code:The Comment,s License Law does not apply to an 507 - FINAL PIR0 qif r1WtDspections •: '
owner of property who Incites or imprmee thamn,and who does such work himself
or erred for
his own employees. building
that such improvements arc nut intended or
_ offcrcA'for sac.IC however,the builJinl uF impm.<mem is mid within one year of
completion.the owner-builder will have the burden of proving that he did not build or •m
improve for purPme of sale.). .
._—.- ._ _. _ ..
111.as owner mf the pmpcny,am exclusively nm Praaing with liccnsThcommmct to L ® ..
construct the does
i (Sec. to a,Business and property
who b Code:)The Contractor's F1N ..
..L h Law does not apply m an owner of.com who builds or improves thereon,
,aod.who conuaas far prejeeu.wiN.a commensals)licensed pursuant to.No..
01 a.exempt ase Scie O 2 20 2•'. .
% ? ❑lemeacmpt under Sec. � ':B&PC fonhis JUL
_ Oxner °Date
WORKER'S COMPENSATION DECLARATION
•' The«byarBrmuneerpcnaltyof)icrjuryonoof.lhcfollowingdalamtions BUILDING a
° 1 have and will maintain a Cenificmc of Consent to self-insu«for Worker's
a Compensation, as provided for by Section 37W of the Labor Code, for the
_ performance of the work for wnieM1 this permit is issued.:
°I have and'will mainmm Worker i Compensation Iruurance,as required by Section
3700 of the Lather Cede,for the
Performance of the wor�k'k( which this
Permit is
Cem'MY .. nvt\ InPoa .c 'lry al -
and
C21'xf
n . .h:I. CERTIFICATION OF WOinRtK•E:R.$m c,
COMPENSATION ATIONINSURANCEe •. ., ,:
.__.__..__.___.___...___._C_•___.__..__.-__-....-. .coon.+
.........___.._...__..._______..
f7his section need not bo completed it the permit is for one hundred dollars
' f I' emfy ilmm n
he perfbrrrenct,of the work for which this perm t is ismed 1 - � - ss�tltr; .,•.„� � •- _•• � - •
shall not employ any person in any notioncr so as to become subject to be Workeri
Compensation Laws cf Cali ounia;Dna,
..Applicant.' -
'NOTICETO APPLICANT:If,ufle,making This Cro ficam of Exemption,yea should -
become subject to Ne Wo it Compensation previsions of the Labor Code,you must
OQ forthwith comply with such provisions or Nis permit shall be deemed revoked.
.._ - . - .-
,If - r r'""iO' CONSTRUCTION LENDING'AGENCY
a ? 1 hereby affirm that them is s conswnion lending agency for Ne performance -
Lender's Name wM1ich Nis pctmim is vsucd lSec.3097,Civ.C.1 .a-..:r..
v
.7.Z Lee,der's Add«ss`
C.1 1 certify that 1 have read this application and state that the above information is
W:tr c.4oci.I ngrce .comply with all city and county ordinances and,state laws mining
ro building consmnnimn;and hereby aathorim}epresentatives of this city to enter upon
the abovo-memim mid potim"for inspcn into purposes.
(W'q igrec io save,indevudfy and keep harmless the City of Culmina against
W liabilities,judgments,costs and eapcuses which may to any way accrue against said
U.Z City inconsequence of rhe' 'ng of this permit..,
., APPCICANI'U ER. ND$ ND WILL COMPLYw'I Ala N -P)INT !
souRceRE q " D Issued by: Date
signpm2 ofnppIi omr r '....,..' .: .. - '.. nine Re-roofs
' HAZARDOOSMATERIALSDISCLOSURE' '
W, the pplica fo rut mbuild'dg¢Ulu tstart icavdle mourleas materrial Type of Roof
.w def ed by th C pen M Cod Ch pt 9.12. d theH hh d Safety -
asde $n 25532(a)
°YeS " " " " _ All roofs shall be inspected prior to.any,roofing,mater al being installed. _
w nm appl'c m r a«nand ng>< p ter ase equ p -t a which If a roof Is Installed without first obtaining an inspection, I agrel remove
coothaza does air conmmm tsmdefined by Ne Bay Area Am Quality M1fanegcmcm
District? � all new materials for inspection. Applicant understands and will comply with
°YeS /`p all non-point source regulations.
I have read the h mod itenals requirements under Chapter X6.95 of the
California Health&safety Code.Sections 25505.25533 and 25534.1 understand that
Joe,
ar
builein amt curzen0 havea«nant,Natit ism -'nilit ro notir the - - ". .. _. coot ...
dohs, gy yrcspny y ,
ozcupant of Nme require cots which must be mm prior to issuance
tt of a Cenifcma of
Occupana !
_ _ Signature of Applicant Date _
:a OwmTor avt on�ed,la' " �Date� All roof coverings to be Class"B" or better
OFFICE..