02110089 (2) CI'T'Y OF CUPER'1'INO 'v, sets . �*� = �
BUILDING DIVISION PERMIT. CONT RAGTORINFORMATION:�I
"Cs ,•<a. x yea„f ffi Gi�'i'
nut N E F DR REINSCH ROGER A AND SARA EPERMIFN02110089
40 dpi;INSCH ROGER A AND SARA D APPLICATIPgS�"TY2002
PHONE. SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
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z , LICENSED CONTRACTOR'S DECLARATION
w F I hereby altirm thin I to Iicomed under pnwismas of Chafer 9(commencing EL'b Description
0
< D with section 70UofDivuton3oftheBusiness and Pro(ecvionsCode,and mylicense is KITCHEN REMODp
trw
oy infull fo lass effect.
try o hate m.clava cmumsm I�N //m p R3
F-1—',j' ARCf11TEC1'S DECLARATION ��o ®�—"a T� r�
a, 1 understand my plans sMll M used as public records
a0
w3° LicensodProfessional JUN 1 3 2003
t=n=y� OWNER-BUILDER DECLARATION
w<� I hereby affirm that I am exempt from ftCord actor's License Law for the $19000
wrp0 following masua(Sttdon 703 IS,Bulinus and Professions code:Any city or county BUILDING
e K$ which requires a permit n ;mtade
It)construct,alter, use, molish,or repair any mesturc
rZr prior Ra its issuance.also requires the applicant!orsuch permit to file a signed statement
Rx< that he is licensed polocint to the Provisions of the Contractor a License Law(Chapter 9 3A656EQI"A19!® Valuation
a, (cummeoeing with Section 7000)of Division 3 of the Business and Professions Code)Or
y $ Nat he is exempt dcmfrom and the basis for de alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom than rve hundred donate(SS00). 10 2 PN NPIERS
Occupancy Type
❑
1.as owner of tM property,or my employees with wages as their sole compensation.
will do the wort.and the shecture is not intended or oRcrtd for vd.(See 7044.Business
and Professions code:The Conuaeum's Liccnm Use does not apply to an owner of 104 - REBAR Required Inspections
property who WiMsor improves demon,and who dcessuch work himsel(or through his
man employees.feevidedded,such imprmemenu are not intended.,.ff.ed belittle.If, 105 — ANCHOR BOLTS
owever.the building of improvumem is sold within one year o(enmpletmn.the owner- 106 - SEWER & WATER
builder will have the burden of proving that he did not Wild or improve for purpose of
sak.1 202 - UNDERFLOOR PLUMBING
Dl,as owns,of the Untrue.,am exclusively conoaning with licensed contractor to 203 — UNDERFLOOR MECHANICAL
conswn the project(Sec.7044.Business and Professions Code:)The Conuamor's Li-
ecose Law does not apply to an owner of property who holds my unpirroma themon,slid 204 — UNDERFLOOR FRAME
who contracts for such projects with a anntfactor(s)licensed pursuant to the Contractors' 205 - UNDERFLOOR INSULATION
cove Law.
Ta criunderli/e�, B&P C f but aresor 301 — ROUGH PLUMBING
nm ca k Eme l I y 302 — TUB & OR SHOWER
WORKER'S COMPENSATION DECLARATION 303 — ROUGH MECHANICAL
Ihereby afrrnunder Penalty ofpjuryomofthe(nnrwI eclararnna: 304 — ROUGH ELECTRICAL
D 1 have and will maintain a Certificate of Cnnsem fusel!-insom for Worker'scumpen-
sabon,as provided for by Section 37M of the labor Code,for the performance M the 3 05 - FRAME
w AI whichthispermitisissued. 306 - HOLDOWNS
D 1 bare and will maintain Worker's Compensation Insurance,as required by Section 3 0 7 — INSULATION
370(7 of the labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am: 308 — SHEETROCK
carie`: PolicyNo.: 309 — EXTERIOR LATH
CERTIFICCOMPENATE OF EXEMPTION FROM SATION INSURANCE ORKERS' 310 — INTERIOR LATH
(This:eetionnmd not M completed ifft per mit is furore handfed dollars PH00) 311 — SCRATCH COAT
url`aa.) 313 — ROOF NAIL
Ieenify mat in tM perr,up(aree of me workfor which this pefmh;:;c ned.l:bas tart 501 - FINAL ELECTRICAL ENERGY
employ any pers�ni /mnnersslo her. esob'ccIt the Workers'Compemettinn
Iawa urcalm ta
A 502 - FINAL PLUMBING ENERGY
ViY
p tic
NOTO PP 6.1l�afmr maknng t is colla...of Evcmphun,you shoulJ 503 — FINAL MECHANICAL ENERGY
secure subject to the worker's Compensation provisions of the labor Code.you must 504 - FINAL BUILDING ENERGY
z forthwith comply with such provisions or Ones permit shall M deemed revoked.
z OCONSTRUCTION LENDING AGENCY 505 — FINAL ELECTRICAL
[- = Ihomily affirmthat them isaconswctionleadingagcmeylorthe performarecof 506 — GAS TEST
x >
do,work for which this Permit i,issued(SO,.RAO.Civ.C.)
Lender's Name. 507 — FINAL PLUMBING
ILI Q
7 Z cndcr'sAddrtss 508 — FINAL MECHANICAL
U O 1 certify that I have read this application and sou:that the above information is 509 — FINAL GRADE
fL Pcorrect.I agree to comply with all city and county ordinances and state laws relating to
pU Wilding emsarrefirm.and bemhY allthOriM opmeselmdoeS Of his City to cmur upon the 5 FINAL PLANNING
y above.mentioned property for lnapcchonpurrynes. 14 FIN PUBLIC WORKS
y (We)agree m saw.indemnify and keep harmless the City of Cupunino against
iF'i N
liabilities,judgments,costs and expenses which may in any way license against said City
U z in consequence of the granting of this permit.
ICANT UNDERSTANDS AND WILL COMPLY WITH A N-POINT Issued by: Date
OU E RF.GULAT N
grater Applicam/crntmo,nf` Z Re-roofs
m
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicantor fume,budding occupant score or handle h l zmous material
as retired by the Cupeninn Municipal Code.Chapter 9.12,and tM Health and Safety
Sec
tc.OYe`25532(x)? WN. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant nr future building occuls m use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air common mines as defined by the Bay Area Air Quality Managcmcni
D'str;n? all new materials for inspection.
DYes IHNu
I have read the hacasko s matcrialsmmirements under Chapter 6.95 ofine Califon
nits IculOnkt Sdcty Cwk.Satinrs]55115,15533and25534.1 underslarM thati(tse Wilting
n currently nuc a m.Nat it is my rexpms;bi ity to nodfy IhC tecuponl nl th.
moms wMeh a 'Fum O'evemcce Ce.
feamn pan.y. Signature of Applicant Date
I3
Owner., uthnrimdas.nt p,p All roof coverings to be Class "B"or better