00120138 (2) CITY OF CUPERUNv
BUILDING PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: rF PERMIT"'Q10
120138
10815 PENINSULAR AV WAtkeg (A G l,
OWNER'S NAME: 'I APPLICA'IR SUB UIr�Ii./2000
REYNOLDS S�5 cS/�Ill �lEc/c.
I'1111N1;: _ /n1/l �/I SANITARY NO. CONTROL NO.
BUILDING PERMIT INPO
OO ARCHITECTIENGINEER: BI.DG ELECT PLUMB MF.0
w—
R�C IJ CI I_I I;.'.I
0 5 N 1LICENSED CONTRACTOR'S DECLAR61'1ON
fn e 1 herehy:drrm mal I am licensed tinder pm,winns of chapter 9 he on encme lob Description
m I- w wllhlce,it 7000)of Divl"ion3 of l he Busss
neund l'od,...... Codc',udtny 1,1,11a,ecnt
<ypJ is inIofIforce and efleel. INSTALL F/S GS FIREPLACE AND GAS LINK.
rc -e Lieena class Lic.4 -
oa� Dale cor„metra MA BTL! 145Gie
3w, ARc[iar.CI"S DE[;LAHATION
t�O, 1 undcrs'land my plan"hull he nsed a'puhlic unn1, .
�i�
a i p Liccnwd Professional
OWNBR-BUILDER DECLARATION
6= 1 hereby affrol Ihm 1 no<engn from the C,ntrnemr's Lteenw I.aw far the
hdlowingna:soa.scoinn 91131.5.thoinea and Pmfc",ion,Cor,An,,gor ounly
O which require,a pcouit In cunstmet,alter,improve,demolish,or repair any,rrat re
a== prier m in iswan<e.allo require,the applicant Inr wch penniuo file a aiBacd lit ltrand
mat he islicenses!punuammthe pmvi,mnsofthe cmnrawmr<License Law(Cnapt,,0 Sy. Ft. Floor Area Valuation
Iconm,cncing with Sectlou 70(u)or Division 1 of the Bu"incnv and PruIcsin t,Calc)
or that he is cnarn insist and the bei,Inr the alhped exnnuion.Any vinlaiiun
of Section 9831.5 b)any applicant for a Proud subjects the applicant to civil Penalty
of oat more than Bee haadred dollarsS5an. APN Number Occupancy Type
❑L n,owner of thepnywny,or tiny ran,lo,cc,will,wugus m Ilwlr sole cmnPanxmlon.
will do,he work,and the structure is nn,intavlcd or o11'ered for sale(sac.91114 1 Irl
If add 1'mfe,slon,Coec:3nc Contmclors Liecnne L,w due,and apply,o an "=—'t " °'• eyuired Inspections
owner of propcnY Who build,or in,proses,hamon,and who J,c,such work himself
... loough his own arloyce..pnwidcd that such itrmvenicras am not intended or
offered Bn sale.If,however. it,hurldingorhn,novetocar is sold w'mmt one ,at or 1.06 — SEWER' B WATER
nnplaion,the awncnbuilder will have the harder of proving that he,lid no,build or
nproveforproposeufs.l,L 202 — IJNDERFI.00R PLUMBIP1G
OLnu'ownerorma pr„rorty.aot exemavelreottlr::etmg w'tnt hcan,c,l eomr,a” to 301. — ROUGH PLUMBING .
m,tmct the project« 1&c.9044,nusine,and Pnorcvslon,Co,10 The Contra,or'a
License Law d ,not apply to an owner of propbun
cny who ds or nnpro,es mason. ,?02 — TIJ B a OR SI-I OU E R
and who contract,for.such pmjmis with a conara orad licensed Pursuant m the
Contractor'.%License Law. 5'02 — FINAL PLUMBING ENERGY
❑l aor assn,d ottdhr S.Y. .B&r C ao mi,re:sao
505 — GAS '1-EST
WORKER'S COMPLNSAI[ON DECLARATION 507 — FINAL PLUMBING
1,
I hurahy ufhn'nn under pcn:Jly ill perjnry otic of the following Jeclnnaion,:
1 have and will maintain a Cenilicme at Cn,enl In wif insum noir Worker's
Compm
cannn, as provided for by Section 1711() of the Labor Cod, for the
pet romtar",,of the work for whin,this)moil i,isxned. /
❑1 have and will maintain Worker:Colnfenxation Insurance.as re,tdted by section
3710 of the L lw r Coils.is,,the pernnna ke of me work for which,his .it I,
,,red.My Workers Compcmation Insurance currier and Policy nundw,are: /
Policy No.:
CERTIFICATION 0121 XHM14[0N FROM WORKERS' O
COMPBNSAI'ION INSURANCE'
1'I'his wrion need nut to co.. ,111W it h,rcrnou Iv for ane In ]red dollar,
IS I()IB or la,,.)
I WIA
a�; ,
k Pov partm In ryLic Jy,jnifinm of E<emp,ian.you shoulJ
Maonte subject mthe Workers Cmnpensa
ion provisions of the L thar Code.you boost
Q O fonhwith 11 try it such Pro, on,Or I,,ren l shall he deemed revoked.
rz+ CONSTRUCTION LENDING AGENCY
> I herchy affirm that there is a conswnion lending agency for the pcorann due
of the work for which this permil i,issued(Sec.31197,Civ.C)
6. (� Lcudc,s N:une
7 Z Leader,AJdre,s
U I croddy tread Pd state that dinformation',
t L O
W E.r car y t t pl ll III 'ty J tip J c t J u I P fog
O to fl y card
, Jh authorize
h5P ,'ern Ilh'city t t Int
W ..
} (ythe albove,arentioned tis pc t)1 M1, 1 Ra e
(W.)agree t d ny ad Ions,h les he Cry ofC pen .,.ins,
V1 I Lib I t 1 Jbmr.ms, tits anJ c,lanso h vh nw) n°ny Y'urvc agmnst saN
V t7. City to onn,egnernnn the grn,ting of this)emu's 9 O
”" AQYVLICAMI'UUL)110NSNnsA' WILL COMPLY WITHALL NUN POINT Issued byt; (J /—�/N/�V Date L G.
Re-roofs
Will tire applicappliapplicantZor puddingItecu,n Ustore
or IREh
,havaidatis l
Type of Roof
asdby the no MunicipaCode..Charter 9.12.Liad he Health start material
Code.Ser,inn 25532(a)?
ED Yes All roofs shall be inspected prior to any roofing material being installed.
Will the apri,I...alone hulldiag're.Pa.,use cyuipment ordeviea,whidt If a roof is installed without first obtaining an inspection, I agree to remove
unit haraNnus air contaminants as defined by the Buy Area Air Quality Managenient
. Di.„net'! fK/ all new materials for inspection. Applicant understands and will comply with
❑Ya, all non-point source regulations.
1 have,rad the haaurduo,mmeriilx m4uiremcnt,under C'haac,6,95 of the
Califnmia Health&Satiny Crile.Snaicnn 25505,25533 and 25534.1 anderoin d that
ifthebulldutgdoonol curt tlyln,vcu,an;an,thmiii,ntyreapornibilitymnatllylhe
ncupum at,her outer, "which nal, rut poor m la„lance til a Cc lilianvc of
( °°p°"° /,I:/y/J�� Signature of Applicant Date
—l/� _� ,o All roof coverings to be Class.•B„ or better
a:n en 1 ate �
OFFICE