02070114 (2) CIBu DING DIVISION PERMIT CONT INFORMATION:
BUILDING ADDRESS: .
7586 SHADOWHILL LA WATER HEATERS ONLY PERMI7N 82070114
Al oM69EYEN 970 E. MAIN ST, SUITE 200 AIILICAT30t''1191/ 2002
PHONE: U
(415) 566-2209 SANITARY NO. CONTROL NO.
00 ZO ARCHITECVENGINEER: BUILDING PERMIT INFO
�j BLDG ELECT PLUMB MECH
< ' LJ CJ L. U
�.R z, LICENSED CONTRACTOR'S DECLARATION ��,Qt� PT1 IIOn
Ihereby Nrm that I..licensed under prm isions of Chapter 9(commencing REPLACE WATER t-1L'"g p
,_C with Section 7000)of Division 3of,h.Husineu.nd Professions Code,and my license
M
ae nd2>tOc.u LiccnseCia. Lic. '
7
4157—
c. remu Connector
ARCHITECTSDELATIO 1 undemmy plans4s .'P2! Pnh I
�l
"bar, 1>f
26 o Licensed Profession.)
2 0 u I hereby o0iw that m exempt from the Cement Ciale Ar se Ire or the
following requires a.(Scotto]mit to r -,ate..resend vi.de io li Code:Ani'A;b9 my $700
Nat lGansM prsaaml a(,'Din roe�othed8 ooeuand Profge siosise f "iv%'•• i
(Com hecis exemptNert rem fodbasiv S.fthall gw tmfldanfMdy cart
n 3 of Semon 703166 en n Ifcam Torn nni3 sub'ms Nea applicant u mem _ __ _ __ __._._.�__
D
Cl $ -p xmite uaax,d o u hexpplucent fo saM1p
v ' -st 'pioal;ynaofUercsigtryct LiccmeLaw(CnaparrI _',-36�2Aq; )Prk* ys -' �'4 . Valuation -
s : a ) . .. _ . ..r\ ' ,, .•.:. \.➢_'
e-ed com ton.Any violiumi �p, }y[j�,�
'of.1 more Ndf f s hundred dollen(5500) 1 PP "a civil Pendry 5 0 APN?Rffial"CgL P
,,agency Type
❑Las oumerof the property,o my employ,.with wgrsusshcir sole compensation, 506 - GAS TEST
'will'do tiro'work-and'the structure-is not intended-or offered for vale(Sec:"1044;' _ p,
(Hcons.vad Professions Code:The Conwcmr's License Law does not apply to an pectionS" `
owner of progeny Who builds or improv.thereon,end who does such work himself
or throw h his own empinyces.provided that such improvements an not mantled or
-coheredor tele.whoweverethe Wildinge Iinden of proving
rove wld within one Year of a\;1.flf� C - t'.� '. -
'improve for the own"Wilder will have the buNcn of proving that he did not build or
improv for purpose of sole.).
con,uowner of the inexpertly,am exclusively[ommcongns Code)Theomnmonw
c Licamsconsumer the Prodoes
no(Sec.7044,Businmann o and Pmf.uo b Code)The Contractor's n - „i I It f,
Liccnu law docs not apply man owner of progeny who builds a improv.thereon,1.th '' "-'
_ ..utdvbo.canva mea.such-In"jttu_wiN a eontmna(s)licenvd pumuant m.Uer _ -
- Contncm/s Licensq law. .;.f;•.�.; _
p� _ ❑Lem uemPt under Sec: _ 'B$PCfa this ueson f' P t't'•.,;;'iNi01
Owner Data
WORKER'S COMPENSATION DECLARATION
' I hereby e@iw und.penithy of perjury one of the following decWtions:
❑ 1 have cad will mainuin a Certificate of Convent to self-insum for Waka's
Compcmation;as providedfor by Section 3700 of the labor Cade, for the
pelfomubce of the work for which this permit Is i...ail.
Al beveled will mdnuin Worker's Compensation lasumnce,.captured bi Section
work f r huh this gamin n
00 of the labs Code r the rf'munce of the of ry mbar tie.
,h a .. .._ _.. .. - --. .. ......
Cssuec,M[Wakes' CCATION'On EsPumm�ce caner nnd,.WORKERSs 'OI ( 1 s'il I 1 11 ♦ ( gid 1.. � . tli .
4 ,
�XEMPTION M
- -_'COMPENSATION INSURANCE
,.: . arta'.: �1'i\ `'.'..:1:''� a •t• tCCi:^:GIC\' fbliC
0y)mbis section tered ata be'eemPlered if the permit is(a ore hudmd dollen s
15100)or leu.)
IN
`h- Ittnlf that in the Reim .J ..• ...-r.. ' _. .,...._._._......_.... ... ..... . .. .. _ .,,
y _ once of th 'work for whi h this permit iv ismed I alt
ci II not employ any Persian m any man erre as m became mb3ttl to Ne,Wokcn'
C6mPensption laws of Ctlifomie.Date"
iNcome auOAPPLICAeracei If.afterrankingNis Cenln.as,of or Labor Crude. it mold
becomeh comp)norhe Workers Compemathis provision
.of the Leber Code,you most
O O forth uh comply with such rov s onwnh s
FFF2777 p y p Penntt ah II be deerned rcvok d
AGENCY ..,
GG.,.. which
Leader's
effnn Chet N,rt rs e con Latton lend n eCnry fa der peAowena ( V
Q Londe Ise oaf Not I have mad Nue. -_..
CONSTRUCTION LENDING
ofthe wok for h ch Nn int s scud(Sec 3097 Cts
Z
-,� t y pplication and state that the above mfonnaton is `
<� Women.I agora to comely wiN eU sity'Ynd cotnlY ordinances ad.suer laws relating
tob ildny ronsuiuti"n end hereby a. contains amletiv.of Utes city to enter upon
'(T] Na above me t and Property f r inspect".purposes
f�,yt.96 (We)igrte to ave lndemni(y end keep It as the C.y bf CupeAa""e`uns[
f r-rI1 I ibUN.f dgmenu.Cosa e d expenua ax ch may n any ay seems against said
V City 1,conlors,ce ofUre krenung of N s Parton.'
A ICA'NT UNDERS'f(N'D - RL TOM Y PITH TALL N6141&1111''
soeE'REa n Arens., ie 7//q/0
Issued by: Date
Sgnamce of Appbcanixonwaor :"",f,; ':Y"^ ,' .pets '.)'.'.
I,,�� HAZARDOUS ATEMALSDISCLOSURE 1'�" '%'.:{`,- Re-roofs
)WI the epplicam o f tum Wilding ecu cant atone or hurdle havrdous model Type of Roof --- - -
.defined by the Cupenmo Municipal Code Chapter 9 12,and the Health ed Safety !, _ { ,., . .. t! •• I :. ..
Codi'Octh 25532(a)7A3 ! -' _. ._
___All roofsshall-be inspected prior to.any.roofing material being.installed. _._..._
Will Na applicant or fuer Wilding secularism use equipment or d.lces which If a roof is installed without first obtainingan ins ection;-I agree toiremove
amt el? !our dr comamidann k defined by the Hiy'Ana Air Quality Management
. P - g
Dirwa]' all new materials for inspection. Applicant understands and.will comply with
l °Ye ht � j all non-point source regulations. .,,,
-� 1(Q rtad'the lizoa0ovriledala regoicemmu�dnder Chapter.6.93 of the
"
ecu am o N' tic vrnta which must ba mo or m 1 23334:1-oorersud that
P 'm9 Pn s responsibility to notify
Cel fomus HeaIN&Safety Core Scctiem 23303 23533 an
if the building does ata currently have e moan(that t t my
5 s...nee of a GMIBLete M
aetp.n _ Signature of Applicant Date
J All roof coverings to be Class B"or better
Owne oeutho dageN ",t li- r� Da ."
OFFICE _ ._._.. . _ , -----