02070070 (2) OF
CJ BUILD NG DIIVISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
10798 WILLOWBROOK WY JUST WATER HEATERS INC 02070070
OWNER'S NAME: APPLICATION SUB DATE
=1 BRENDA DERAMUS 1764 NATIONAL AVE 07/12/2002
PHONE: SANITARY NO. CONTROL NO
(510) 293-9901
O O ARCHm3C rENGINEER: BUILDING PERMIT INFO
wp BLDG ELECT PLUMB MECH
Q W l_7
z 8 D, LICENSED CONTRACTOR'S DECLARATION Job Description
1herebya)of thatIam oftheB under and
Praneof Chapter9lcommm�cing
FyF, wimfllfameandefect. onJoflheBosincssandPmfcssioroCwcowmyliceme REPLACE WATER HEATER
=ceE,,
isineffect (40 GALLON GAS)
rc K 6 License Class Lic.N
a Dam contractor
w 3 0 to ARCHITECT'S DECLARATION
E.,v.O; 1 undcrsmnd my plain shall be used as public recams
Es-
w i p 2 Licensed Professional
w e� OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt tram the Comracmr'x License Law for the
a following reason(Section 7031.5.Business and Professions Coda:Any city or county
F x o which requires a permit to construct alter,improve,demolish,or repair any stmctum.
no 3 m`poor to us issuance,also requires the applicant for such permit to file a sigmd statement -
tatheislicensedparsybm!o the provinces of the Contractors License Law(Chapter 9 r,__Sq.Ft f400r-Area_ U.aI1o0
(commencing whit Sectio-n,]000)of Division 3 of the Business a pd Professions Cade) 4'';1:x';.9 .:'L +�Ast A.;s•WRIN I:, 101N
or that he is a.iinl Neniforni and the basis for the allpgid as mption.Any violation I
of Section 7031:5 by any appI icons for a rcrot fait eon the applicant a a civil penalty-
ofnotmomthanBvehundreddmlar.(5500). Itl -,t\".I ' Occupancy Type
❑1,as owner of the pmpery,or my employees with wages a their sole compensation, ,.J�
will do the work:and the structure not intended or offered for sale(Sec.7011.' 5 0 6 — GAS TES 1'� -
Baine..and Pmessmnx ewe:The Cnmranar't License Law doer,not apply to an egwred Inspections
owner of property Who builds or improves thereon,and who docs such work himself
or 0)roagh his own employee, pma6led that such improvemcros a,a not intended or 5 07..-r_.F INAL_.PLUMB ING_..'....__
..offered'limslle.IChmvmh,the building or io,mvcment is sold within one an,of .�
completion,the owner-builder will have the human of proving that he did not build or
improve for pumose of sola.)
__01
. .. . .. ., .,._,.... . . ... - _ - - . . . .._._ — __._.._..-, .. -... ..._._ _. ._. .... _ _. .._. _.....
isc
❑Lax owner of the P(Secny,am Business
and mmcasiil on with odliceaeJ armranou to - -construct the prolan(Sec 76W Burnes. J P f Code:)The Cammcfor, -�� LED
License Law does not apply loan owner f p pent' 'h builds ort parva thereon,tit
. . and.who mmraens far Inch Prmects wilM1 cOnuasmr(s)licensed pununm m the .. -
... ,
Contractors License Law. .. . .__.._ ._ ......_.. .._ .... ........
O l am exempt under Sac.',. f :It&P C to,thls rearm ��� l n ... ....
1 (r
Dwner Data 2002
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of Perjury one of the following declarations BUILDING®I NG.
I:] 1 favor and will maintain a CeniOtac of Common In seli-imme for Workers L7{J
Compensation, as provided for by Section 3700 of The Labor Cade, Iia the
- performance of the work for which this permit is issued..
❑I have and will maintain Worker's Conitatmti le Insurance,as required by Section
3700 ofrhe Lahor Cwe,for the performance of the .,it for which this permit is
named.My Workers Compensation Insurance carrier and Policy numher arc:
Carte A.''1 1
Is i'• Policy No. S Y i r')�f"l 1i: l�R� fib., \ i.�t
'r CERTIFICATION OF,UEMPTIONFROM WORKER S'' y.fJ: P. ..
COMPENSATION INSURANCE" '
(This section need not be cmnplefed if the permit is for one hundred dollars -
S i0H or lwss.l
1t empl That bride p in any
mann the work for which this pcmrit a issued,1
sham not employ w, person in any manner so as m become subject to the Workers'
Compensation laws of California:CDine
Applicant
ICAN
If.
aft
n.
NOTICE TOto hasVorlars Co making
cation scenics Certificate ode.you
bernme' comply
subject to Thr Workers Compensation provisions of me loiter Cwe,you must
O fonhxith rnmply with such provisions or this permit shall be Jttnmd rooked.
v,r_ -"''a CONSTRUCTIONLENDINGAGENCY - �
a, ' 1 hemtiy a irse that them iia contraction lending agency for me performance
of Be work for which this pcsmit is issued(See.3097,Civ.C.)
Inca's Name_ _ ,- - ... _ - .. ._ . ..._._ _ .. _ .... .. _. .-.. ..
7-z Lender's Addms
I cconly that 1 have mad this application and state that the above information is
tL'-E.r .correct.I agree m an
with all city and count) anowe, f hi stem laws relining
��CJ mflimile of this city toenter upon L�—
} 'me aW(We)ii tinned pmand for inspection and an pmpnsn.
es,judgme m scosts and
expo ped whiarepch
ham y in the way a copeniasstsaid against
h liabilities,judgments.,cotes and iall f d which maY in any way accme against said
U-� Co,In AN'T.UNDadf thegrantingof s'I LCO .
SOURCE REGUAIIONSNDSANU WILLCOaIPLY WITH ALL eONN-WLNT Issued by: �1 Date
SOURCEREGUL,V'IUNS. � Y'
Signature of ApplicardCommaor Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
.. - WIIl the applicant or future huading«eupant store or handle butardoa material ..Type.of.Roof.
as defined by the Caperton Municipal,Cwe.Chapter 9.12,and the Health and Safety _ ,? v Coda ❑,YSiberian
.-;,5532)) L:O Nn`. n'ir f� r, r t \.. i \ oi'.A, i g"1:�l.Tla:! �a� I\\s• '
AIL roofs shall be inspected pnor,to any roofing,material,being installed, •.
Will the appl cwnsr:imtl«building occupant usaequipmeatmr demtts whian If a roof is installed without first obtaining an-inspection, I agree to remove
mit hueamous air come.burns as deGneJ by the Bay AEaSi,Qi alis,Management
Gos ion all new materials for inspection. Applicant understands and will comply with
oras ❑Nn - all non-point source regulations. ;
1 have`read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25537 and 25534.1 understand mat
'ifthebuildingdoesnotcurrently haveatenant,that itis Illy rcsionsibil'uy I"notify the -
receptor of he requircmenf.s which mail be be,prior m I..smma of a Cerid,am of
Occupancy., - _ Signature_ of Applicant Date
Damao,namaeacd ager,. Dam All roof coverings to be Class`B"or better
I.. r.. . OFFICE . . . ....