03120093 CITY OF CUPER'I'INOa , •'
BUILDING DIVISION PERMIT MNTRACTOR�INFORMATION
BUIL DING ADDRESS: RYON COMMERCIAL INC PERMITNO0312053
OWNER'S NAME: PERMIT ISSUE DATE
NE: SANITARY NO, CONTROL NO.
(408) 590-2294
ARCHITECTIENGINEF.R: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION O O O O
Y FF I Mrcby affirm that 1 am licensed under previsions of Cnaplcr 9lcommcnc Job Descri
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SZ,y with Sauon70N fDivsOon3ofdw Busmessinllamr.ilm Code.aro myli is AL`s®
�onumrte an r«t. TI- -LAW OFFICE
j n z Limare C'. Lic.M
`n-° D°te FEB 2 4 2004
as`,j' \Y ARCHITECTS DEC AT
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as
U L dersland my plans shall W used m public records
0„1', Licensed Pmsia
fcsnal r ��'�®I��
OWNER-BUILDER DECLARATION
a 8 I hereby air".that I am exempt from the Contractor's License Law fist the
00 following reason.(Section 7031.5.Business and Pmfcmium Cadc:Any city or county
K m which nammis a Permit hs Ctocons t,a@r.impmw,demolish.or repair any al.w.
Lzi prior.its issuance.also inquires the applicant for such permit to rile a signed statement
EiG thin he is licensor pursuant to the provisions of the CuntreeturiLiccnse Law(Chapter 9 Sq. Ft. Floor Area Valuation
zI• (commencing with Section 7")of Division 3 of the Business and Professions Cok)or
y $ that M1e is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 w1AAi-T.Isra,A.QrQ O Occupancy Type
not morc than five hundred dellae(5500). sVDsJWti'rY P Y yP
❑h as owner of the pmpcny,or my employees wish wages m their sole compensation,
will do the work,and me structure is not intended or offered formic(See.70Nu,Business
and Pmfcssions Code:The Connector's Liccme taw does not apply to in owner of Required Inspections
pmpeny who builds of imposes thereon,and who does such work himself or do ough his
own employees,provided that such improvements arc not intended oroRcred for sato.If.
however,the building or improvement is sold within one year of completion.Ne owncr-
builder will have the burden of proving Nat he did nm Wild or improve for p m me of
saki).
1,as owner of the property,am exclusively contracting with licensed contractors to
comwat the project(See.7W.Basin.and Professions Code:)The Contractor's U.
CO.Law does ooupply I.an owner of propny who Wilds or improves Neman.and
who contracts for such projects with a eomramm(sDicensed pursuanuo thO Conoacmel
License taw.
❑1 am exempt under Sec. ,B&P C for Nis reason
Owner Date '
WORKER'S COMPENSATION DECLARATION
1 hereby aRrm under pearly of perjury one of the WIIA ing declarations:
I have and will maintain a Certifies.of Consent to self-insure for Worker's Compn-
sasion,as provided for by Sereno.3700 of d.Labor Code,for Ne pdonnnrcc of de
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance.as required by Section
3700 of the Lor Code,for the psforramce of the work far which this pie it is issued.
My Wprkef Compensaion maimmo artier and Policy number rt:
Co.
� A Policy No.: 7/3a-1a
CERTIF ATEOFEKEMPr1ONFRO KERS'
COMPENSATION IrNSURAN E
(This section need not W emnpleted if the permit is forom hundred dollars($191)
or 1cm)
I certify Nat in the erro mance or she work for which this permit is issued,1 shall not
employ any person in any manna m as to become subject o the Worker!Compnsation
laws of California.Da.
Applicant
NOTICE TO APPLICANT:IL after making bots Ccnifica.of Exemption,you should
became subject to Ne Worker's Compensation provisions of the tabor Code,you main
.J O forthwith..,Iy with such provisions or this permit sbmlo deemed revoked.
ZC7 CONSTRUCTION LENDING AGENCY
F I hereby afnrm Nat there is a construction lending agency for the performance of
IY Ne work fur which Nis permit is issad(Sec.3097,Co.C.)
boa 0 Lendcr's Name
lender's Address 7
Z
U O 1 certify Nat 1 have toad Nis application and sure Nn Na some mrom u.n is
L. P Cmrcn.1 agree to comply with all city and county ordinances and aac laws elating to
0U building Conswction,and hereby suborn representatives of Nis city to Omer upon We
above-memilnW property fm impnion ofpnses, I
Egy (We)time to emit,indemnify d tech harmless the City of Copnst id City
rq inmitics,judgmcn ,1111 and oxen which may in anyway accrue against mid City
U z, A APPLICANT
afthegraming if mit. C
'-" APPLICANT UI�ERSTAN �AN WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURCE REGULATION .
12-1 Re-roofs
more plianUContraemr Date
HAZARDOUS MATERIALS DISCLOS Type of Roof
Will Ne applicant ur future building Occupant store or handle merdous material
as defined by the Cupnino Municipal Cadc.Chapter 9.12.vM she Health and Safety
Calc.Schon 25532(ay! All roofs shall be inspected prior to an roofing material being❑rex ^PfN1 P P Y g g installed.
wu me. Iinntor rruttuure Wilding Occupant ace If a roof is installed without first obtaining an inspection,I agree to remove
Pp 6 p a Air Qu or Mara which g P
havadnus air conmminants u Jcfncd by the Bay Arca Air Quality Management all new materials for inspection.
uuia?
❑Yet;
I have read the havadnu a els inyuimments under Chapter 6.9S ofd¢Califory
oia Health&SafetyCade, oto 505.25533and2553a.lund.rsu uif Nit Wilding
docs not curtcmly home a non et it h my mtprlibililY.notify Nit t<upant of she
Milo cnuwhicM1 IW tpoortoisvlanaofaems �teo clpancy. Signature of/z-is Applicant Date
owner lr and:gen D,te All roof coverings to be Class"B"or better