02050012 CITYDIGDSONO
BUILDING IVIIINPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7440 BARNHART PL SCHAUMANN AIR CONDITIONI G, 02050012
OWNER'S NAME: APPLICATIONS R DATE
KRIEGER WILLIAM L AND CATHERI HEATING & PLUMBING INC 05/0272002
PHONE: (408) 428-0640 SANITARY NO. CONTROL NO.
s Z ARCHITEC)EN IINEER. BUILDING PERMIT INTO
w C BLDG ELECT PLUMB MECH
O I_..I
LICENSED CONTRACTOR'S DECLARATION
1 hereby offom that I or.licensed under f Chapter 9¢nnunencin Job Description
""°°`° g REMOVE PIPING & REPLAIE WITH COPPER TYPE
wnh Smeon�hi of Division Sonne Business and Pmfaslon,Cod ,and my I cause
in full forte f
E z ce< License CL •�U Lia.e O
O., Dam Comm r
3 E u y A CHIT= CI
DEC
C
r_1 1 undersand my plans shall be used as public records
i
3 i c Licensed Poifessi°nal
OWNER-BUILDER DECLARATION
,"_—'', 1 hereby affirm hat 1 am eaempr from the Conmcmr's License Law for he
t_i a following reason.(Section 90315.Business and Professions Cod,.Any city or emody $4000
ai�edo which requires a p<rmit m<on.umat,alter,improve,demolish,or repair vny swcture
a3°_° Poor mits issuance, Iw requiresm ppl'can,for such pemuno file a signed statement
that hes licensed pursuant the Provisions of he Coronation's License Law(Chapter 9 t'45d,*�r.,® f. •.M,. Valuation(commencingwithScu 700rD sion3oftheBusinessandProfessonsCode) (361F
lir that he's exempt hererroor and the basis for the allegea exempt on.Anyviolation
- of Secuon 7031.5 by any applicant fora permit subjmm he applicant,o a civil penalry-
ofn0,morehanftvehundreddollars(s500). 202APN RFLOOR PLUMBING Occupancy Type
01,as owner of the propeny.ormyemployees with wages astheir sole compensation, 301 — ROUGH PLUMBIN
will do the work.and the structure is not intended.1 d amad for .In(see.704.4,
Business and professions Code:The Cormorant's License Law does not appy 5 0 2 — FINAL P to an I9i4aJa'IGkispSNE 7 3Y'
.net Of progeny Who builds m oriproves theism,and who does such work himself 507 - FINAL PLUMBING
or through his own employeesprovided that such improvements are not intended or
-,offered for sale:If,however,,ate building or improvement is sold within one year of - - --
completion,she owner-builder will have the burden of proving that he did no,build or Y2f -
improve for purpose of sale.), r'�
❑I.as owncrofth,property, "elusively contractingwihl sed ntmcmrs,° .-
conswe,the prmecn(Sec.7044 B es and profession,Cod.)The Contractor s
License Law does no, I , ny no buildsp es thereon,
and who contracts forM1 is with c , ,ns)licensed pursuant ro.,he _-
p. r fp pc J
P1 ^
❑1 em exempt under Sec. B&P C for this reason `7 j O O
Door O. .yo�� f�n
Owner Da [ 7�Z`_7
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations
❑ 1 have and will maintain a Cenificare Of Consent ,o self-insure for worker's •Y
Compensation, as provided for by Section 37W of ,he tabor Coca for ,he
perfowanee of he work for which his permit is issued. Z
❑1 have and will mutation Worker's Compensation Insurance,as required by Section
3700 of the labor Code,for,he performance of theand
for which his rout
issued M/yQ/p /p�y�ae s 1 Poly number lir
YN.
Curti Nis
NO5UR_Ao . .. .. _. .. --.
kc's ,ionI c, e t
CERTIMCATIONOF
MWORKBRS t..`. 1 �. •�i .lr". OAS,-•:Ifo ly. 'si �a l..�,
_.. ...•.. .. CE _ r
(nits section need not be complemd if he parmn is for one hundred dollars 1 C
(SIO 0 m less.) '
1 canify than in the performance ofn the pork to;which this
oci,is issued,I
all no,employ any person m an an as,o become subject w,he woAers' � � •�
Compcnsa,ion Lawn of Cahfomia.'Datc,manner
Applicant I _
permit shall be damps!avok<d.
Y ..._-... _ .r•
NOTICE TO APPUCAN'T:1L Compensation
n p CmrEcerc of Exemption,you u must -
ptrcomsub'cPY the N'orkc�sovmns orths mush
forthwith comply th such '
tr 1 hereby ahw that here is a ION LENDING
lending aowisions rehe labor Code,You
F...�. CONS em is a construction
LENDING AGENCY a
y agency for thep oman<e
W of efor whichp`
,his rmn is issued(Bee.1097,Civ.CJ
LenLender's s Name '
7 Z Licari gdarcss '
U.0 I<enify that 1 have read hia•appliliumn and sate that she above information is .
Lr. Ea corzect.1 agree to comply with all lily and county mdo nnces and sate lawsrelating
�.V no building convocation,and hereby antherize representatives alibis city 10 enter upon
he above-mentioned property for inspection purposes.
.� p.t (We)agree to save.indemnify and keep harrnlessihe City of Cupertino against
(/l liabilities,judgmenu,costs and expenses which may in any way accrue against said
C,7 Z City in consequence of he granting of this Person.
APPLI 5T UNDERSTA SAND WILL COMPLY wTm A.L ON-POINT
sqD 4�noca� in? Issued by: Date
sof APPb<anUCcultmnur Data Re-roofs /
HAZARDOUS MATERIALS DISCLOSURE •�
Will the eOCupern or(mune opal o e,Chapter
store or handle hatHealth an Safety .Type of Roof -
C de.Sed iby on 25 Cupertino Municipal code,Chapmr 9.12.and,he Health end Safety
Code,Section 253721e) t .. � �};,vs,
All roofs shall be inspected prior to any roofing,material being installed. _
tin me air to `for r"lure b"ldng cupan,use egn�mm,tar de"ces which If a roof is installed without first-obtaining an inspection,'I agree to`remove
emit harardous air ronmminams as debated by he Bay Area Air Quality Management
Doren all new materials for inspection. Applicant understands and will comply with
- Dues ;, ❑No -, .. ,.; all non-point source regulations. - -
.'1 have«ad,he h uardaus materials oc,chemcnu under Chapter b 95 of the "
California Nealh&Safely Code;Seaions 25505:25533 and 25534.1 dcmandtint
if the buildingdoesno,curzeryy veatenant,that it is my respomtbhtyn omify,he _
ypaer of the rcquirem vo mw,be m�r m issuane of an ficaa of
OCcu n / T
f?(e / _� 2� Signature of Applicant Date
_ o
or aammdrm"ben, '- Date All roof coverings to be Class "B" or better
.- . . .. . . - - OFFICE