01010082 (2) OF
CIBUILDING D ISIONV ° PERMIT CONTRACTOR INFORMATION:
HUILDING,UUKESS; PP.RMI'1NO.
220592 SHADY OAF: LA JUST WATER HEATERS INC 01010082
OWNER'S NAME: APPLICATION SUI]DAT Ii
JOANNE WOO 1764 NATIONAL AVE01/19/2001
PHONE: SANITARY NO. CONTROL NO.
293-9901
0-.7. ARCI IITLCHI NGINL'I!R: BUILD NG PERMIT INFO
m❑ BLDG ELECT PLUMB MIRCH
16 i ed
2N
N
LICENSED butEU COcenRACnder rDECLARATION
Ihon 7000lims mallstreameIna,merprn.'isinn.surehaplee.morameneinx Job Description
with Senior and cle",cion lar the l3usincss and Pmrenaiuns Crate.and mYlinnsc
is in fall ClkesC1NdeOL REPLACE 40 GALLON GAS WATER HEATER
�(y J
L y 6 Dare CLux Lic,p
pp O a
Dare l DELLA
lar, mlI the t"S DECLARATION
1 unJemm�d my plane shall M nod ns retitle rnn,rJe
`
at
cei C O Licensed Proleeaia lot
e LL OWNER-BUILDIiR DECLARATION
m 1 hclvhY affirm that 1 inn exempt tram the Carmelo'Licence Law for the
F[;r lulls g (Scalia,7031.5.Hooness and Padfi (7oweAnycilyorcomay
.• M which 1 II 1 1 'll I I lh, p ny:laWn
d. pro 1 c.aJx 4 Il all'ma It ipa till II 'y d.aw,vn
e. 'not he 1111.1"d ama, rt t p I fla,Cramll ,La.(Chnper1) Sy. Ft. Floor Area Valuation
lu,mmcncmg wish Sccmn 703)ol'Diem 13of the Buvinco and Pmfcoiom Cale)
I,,the he is exempt therefrom and the hav,fur the alleged eacnupliom Any vinlaiio I
of 5ealon 7031.5 by any applicant for a comit subjects the applicant to a civil penalty
of ma once than five hundred dnnaras5an. APN Number Occupancy Type
❑I,us owner of the prol,co,or my anrpluyom will,wages as their sole AnaKoenGort '--'
will Jo the walk,and the gmcmre iv not intended or nllcled for sale(.Sec 71114,
Basi,lcs alta Ill Cada,'I lie Conlrachrr's I-ecn,e Law docs not apply ,,nn Required Inspections
r nFpopcny who larld tar iuq,mvev droa.,and who does such walk hinodl'
orth g p 5022 — FINAL PLUMBING ENERGY
offered them h his own however.t boRdin slat®ch int n cols wi inn intended tar
comple for.ale.lU however.Incl have t or un en of proving
that within one year of
completion.the nwnerJwilJcr will have the harden of proving lh:n he did not build or 506 — GAS TEST
improve for paHnwcor,alv.) 507 — FINAL PLUMBING
❑1,as owner of the property,our evclusivcly wnracting with licensed cnmmnnry to
stared me IF cel(Sri.7044,B-anes,and Profcsuox Calc:)The Coal lracanfr
License Law dnex nut apply Io no owner or property who builds...improves baron.
and who contnrctx for such Pn9eCb with it Connor,....(') Iieemed pur.oanl tar the ``]
Cnntrecmr's License law. -
❑I um exempt under Scc. .B M P C far this oca.urn
Date e J\
ce
WORKER'S COMPIiNSAI'ION Il[CLARAI'ION r)
I hcrchy at for umdnr penally of Inapoy one or the 6dlowing declared...I,
❑ I have and will atuimaln a Cenifaatc al'Consent to sellan.um lot Worker's
Compensation, as provided for by Section 3703 of the ladar Cade. 1'or the
performanm of the work for which this permit is rival
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
J7q)of the Luh r Cole.roc the lerfonit nce of the work lin which this pemtit is
sued My Worker's Compensation Imsnnnec carver and Policy nand er are:
Carrier; Pulley No.:
CERI'I FWAHON OF CXFMI'1'ION FROM WORKERS'
COMPE.NSX1HAN INSURANCE
(This social need not he confided if the permit is for one hundred dollars
151131 or le".)
I eerily thin in he peifnnnana of the work lith which this Ircrmit i,o,a d,I
shall not cup,lny any Iemon in r any o ,o as hcm"c,hexnhieat to ma Workers
pplicant n Lows nl'Cnliforniu.Dale
Applicant
N(ymnevalAI',,Ile wta IL a far taking his Cenitic:nf oflixemptiast you should
� Qhecomith co par thelsuchpr Camber,,tion pod,shall theItaha Cove,you mus
fonhxith comply with each pinviunn.or This permit shill be JmneJ resvkeJ.
E CONSTRUCT ION LENUI NO AGENCY .
a 51 hcrchy all!rms,tint mareW a comtmcl I Icnding agency fnr the perfornoul
rel the ,,,it Irl'which Ili,poFod a I1,unl Sees 3w7.Clv,C.)
0.. Q I<nJer'e Name
7 Z Leader',Address
U O 1 certify that I have real apdwaann wild smm ma dm slew inf nualion is
k. p wrest.1 agree to comply withal oily and county ordinances and sae laws relating
O U thembuildmg coetraaion.a ad hereby anthoriac representative m ofillks city enter upon
ahrvc.memioncd Pmleny lie Inspection pa,,,cs,
r y
(We)III rnemciadcn...ity and keepharnllcsclhe City of Cu,,ramoaeaino
(n Iicludilics.Ingo IUIII......1,Ilot1 cnleoacn'Meth Ina,IIF mIy way accme agalna xlliJ
U G
City in consirl of the Starting or tills retool.
r. SDURCANTUNERSTANDSAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
Signature at Apphcanucnntmnor Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will ne:q,prc:nn m Future budding aecmpanumre tar hllnme ha,aAl m:ncd:J Type of Roof
lar dcfnat by the Cupurinn Mi uipal Cod,,Chapter 9.12.1 1 the ue:dm and Salhty
Qnde,S aian 25532(u)P
❑Yet 0N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future bailding«capant u.ve equiprien]or Jaice%which If a roof is installed without first obtaining an inspection, I agree to remove
emit h rourbus air contaminants a defined by the Bay Area Air Quality Management
Ulster all new materials for inspection. Applicant understands and will comply with
Is D Yes 0N all non-point source regulations.
. 1 bl a read 11, bu,ardons maerialx requ r6ul x under Chaprcr 6.05 of the
Culil'mnia HvvlIh h Safely Code,Sections 25511.5,2559 and 25.534.1 understand that
it the adding dace all cur only haven lmmnt.chis i]k na,esprmsibila,it ratify he
cupanl of the requimrnents which nuns]be met prior R,issuance of a Ceriticme of
Occupancy.
Signature of Applicant Date
Owner or umthorieeJ agent Date All roof coverings to be Class "B'•or better
OFFICE