04080034 ,I CITY OF CUPERTINO
CONTRACTOR,INFORMATIONc
BUILDING DIVISION PERMIT .
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BUILDING ADDRESS PERMIT NO
SCHAUMANN AIR CONDITIONING, 04080034
£INGTal CT — - -- --
s OW NER'S NAM1IE. PERMIT ISSUE DATE
IIANTRT I-IATTPV - - HEATING nT.caa31NE4 ..ate
ONE
SANITA0.Y 2Y�OL NO
-_-- -- (4r)A) d29-0640 -- — ---
ARCHTTECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECTI pPLUMB MECH
moo LICENSED CONDtACmR'S DECLARATION //✓� ({ �� O
m❑ I hereby affirm that 1 m hcens0 and provisions of Chapter 9(Commencing lob Descripth"ib 1 CXCXCX &61ayUO�a
—ZW with Scctron] nafDivison JOIthABY' NO hofcssmm Cade.ad my hcens is
I.C. infallf. It � REPLACE FURNACE & ADD A/C
=�o Dart Luan �-� GdntnA r SEP 21 2004
ARCHITECTS DEC IOds N
�i XandersunJ m s xhgll he dud a Ic recor
(1s� " �UIL®Ip
3LLG Crania Pmfcmonat {p 0�
a'o 3 Oat I AM CUILDER DECLARATION
the Con NIN
<x 1 hereby affirm oral 1 1. cacmpt from the C.i(om C's License rsyc Law for IW
un which mgrouon arrol l ]1I3L3,Buamessandw.daiona Cod Any<an os county
m which its issa a ammo as An arthe p tic,borrow.for such h penliah,sir repair any structure r] 3 3
Fiy
poor a)tucensed A,almicg0irs the applicant for Conrctor'lo0festo LAW statement t
< that(commencing rSeCdnt m do omvsmns of the the Business Ltanslaw(Chapter
odc)or Sq.Ft. Floor Area ValUatYO❑
w. (commencing with Sereirom And basisofr duIM exe and on.(Any viCade)of
y that he u exempt Ihmcfrom and the base for the subjects th alleged exemption.to Any violation of
nut mom than any red 1PPlKmE for
llars( Permit sub¢cu the applicanuoanvd penalty of 39W'Vni9*er00 Occupancy Type
nut more Nan five hundred dollars(SSfJn). r •
T,as owner of the property,or my employees with wages As their sole compensation, ;
will do the work.and the structure is nountendd or offered for sale(Sec.]Dad,Business
and Pmfessims code:Tae Comment,',License Law darn not apply to m owner of Required Inspections
pripenywho butldl or ineemms thcrcun,adwho doessuch work himself.,through his
tun employees,Provided Itm such improwmenu are..untended.,offered for sale.If,
however.the building or Improvement is sold wMO one year of mmplmon,the owner-
builder will ban the burden of proving that he did not Wild or Improve for purpose of
sal.).
El I,as Owner of One pr.peny,dm exclaovely contracting with licensed contractors to
consumer the Project(Sec.]alai,Business and Professions Code.)The Contractor's Li-
me Law does not apply m an owner of property who Wilds or improves thcmon,mtl I
who cones for such pm3ecs with a convactor(s)licensed pursuant W the CantOcer'S .
Lions law. I
C]1 am cacmpt under Sec .B&P C far BOA...A
Owner Date
WORKER'S COMPENSATION DECLARATION I
1 hereby a1Rrn under penalty of pe0ury one of the following declarations: I
I haw and will mamum A Ceroficze of Comer,to self-mesa.for Wmkee.Compen- I
Lion,m provided for by Section 3700 of the labor Code,for the Performance of the
weak for which this perm.is Issued.
❑1 have and will maintain Worker's Compensation Insurance,se required by Section
37W of the labor Code,fm the Id.ortmo.of de work for which d.permin se mmd
My Workers Comsemamon Insurance Caron and Policy number are:
Came. ZZ'� _Y�r.7 t
CERTIFICATE-OF EXEMPT OM WORKERS'
COMPENSATION INSURANCE
(Ths section need not W Completed if the perms is formic hundred dollars(SIW)
sir Isss)
1 eero(Y that In the performance of the work for which this permit is isamm.I shall not
employ any person in any mamterm as At hecomc subject to the Workeri Compensation l'
Laws of Cahromta Da-
Applicant
NOTICE TO APPLICANT:If,after making this Centficale of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you most
.JO forthwith comply with such hm,,umm or thR perms shall W deamcd awaked.
Z Vj CONSTRUCTION LENDING AGENCY
Ihertby affirm that there is a construction lending agency l'Mr the Performance of
G'7 the work for which ors perno a mued(Sce.3097,Civ.C.)
0.=Z Lcndcr's A dm-
O Q 1 cendy that I haw mad this application and man,that thc aWw infarmauon is
F-' correct 1 agree to comply with all coy and county ordinances and sure laws belong to
�U budding construction,and hereby aathorom reptocnutiws of this City m Amer drum Use
above mentioned property for inspection purpous /
(We)agree An san,Fd inconscquare emuecomma clfPernuwhich at ossth`City af Cupcnmo agatnsr
LJ Z inconsquenceaf the n expenes y� y my accrue against mid City
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS _Q
G A/ �� __ Re-roofs
L--,B,gnaWrt of ApplaanVConrta<mr I Carl
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future budding occupant store or handle havard.us matenal
a dined by IW Cuperona Municipal Code.Chapter 9.13,and the Health and Safety
adc.S n R,0es.25533(a)o tea. All roofs shall be inspected prior to any roofing material being installed.
r
Will the applicant or future building occa If a roof is installed without first obtaining n inspection,I agree to remove
sip d Pont us egmpmeu or devices which g P g
1 harardm art conuminans u refined by the Bay Arta Air Quality Management all new materials for inspection.
rosins
❑Yes 09<-
I have mmf the WmMLius maanals mquimens under Chapter 495 of the Cahfor-
nra Heald&Safety Codc,Sceums 35505.35533 and 255Jd luindromaddlialifus,Wilding
does nm curamfy haw A ROAM,Bat a is my mapersub,by m n.trf, pant M thc
requirmumas which muabeme, tam c.ofafbmrnew0 as SignamreofApplicant Dale
17J. rte All roof coverings to be Class "B" or better
Ownp/or amhonrsd agent Date
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: ^ ,.� PERMIT #
2/516 l�D I n1��n� �-, 04/0 Foo 3 u-
OWNER'S NAME: `�yJ a-I A t[ F 7_ I PHONE #q-7
GENERAL CONTRACTOR:�SC t.-,A LA um it n110 I FAX #
I am not using any subcontractors= -7 w_ 1Fr."-)o o S_c- -0 el
Signature Date
Please check applicable subcontractors and complete the following information:
® SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing I I,
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
J I Gj I Heating
( Insulation \
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper I I I
Paving
Plastering I I I
Plumbing
Roofing
Septic Tank
Sheet Metal I I I
Sheet Rock I I Il
Tile
%�� Contractor Signature Date
CITY OF CUPERTINO
FURNACE /AC
CIO PERMIT APPLICATION FORM
( APN# 3,S16 2/2- 0 3 � I Date'
Building Address: (�
AOUn 04-
Owner's N� v Phone#: 9-7 3 —c)503 I
Co acto : `` License#:
(` u tnmlv�h IIC { �I�• �n �. -7-70e-33L1-
Co tact Phone#: '
A li ant/Contractor:
Ao-
B Pemut Info:
Bldg Elect' - Plumb Mech
Jo n: kkAck -Cs- .
Residential: Commercial:
1-8—qXr7n'oor Area: $/Sq.Ft.:
Architect/Engineer: Valua _ 7I
Type of Construction: Occupan d p:
Qty. ..
Atli apte J /Femme ID Fee Description Fee Group
I l e v BENERGY Energy -BUILIDNG
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL J
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
(� BREMRECEPT Recptl, Switch&Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILIDNG
I / EPERMITFEE Elec Permit Issuance ELECTRICAL
n� MPERMITFEE Mech Permit Issuance MECHANICAL I
U_ 1 PPERMTTFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG f
I 1 BUSLIC Business License BUILIDNG J
J0 I
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