02050013 CITYBBUILDI c DIVISION
PERMITCONTRACTOR INFORMATION:
BUILDING ADDRESS PERMIT NO.
7440 BARNHART PL SCHAUMANN AIR CONDITIONI G, y�TT 02050013
DKIY�6E R WILLIAM L AND CATHER N HEATING & PLUMBING INC A05/ 0251/2002
PHONE: (408) 428-0640 SANITARY NO. CONTROL NO.
O O ARCHITEC(ENGINEER: BUILDING PERMIT INFO
w— BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
= 1 hereby aft tha,lam ncenaed under Job Description
1 pmvisiansofCnaprer9lcomrmncing ADD 5 TON AC UNIT
�mrw with Section]000)of Division 3ofthe Business and Pmfessians Code,and my license
i y y,� is in full force f 1 n
s z License Clas k' J Lic.p 77r/W
%Oa Dam Contractor
'!,i, iCHU ECr'S DECLA
us
O g I understand my plans shall be used as public records
i n apo Licensed Professional
OWNER-BUILDER DECLARATION
or 1 hereby affirm that 1 am exempt from the Commebm's License Law for he
ad< following reason.(Section 7031.5.Business and Profession..Code:Any city or county C
E
.EQ which q permitconstruct.' ❑ improve,demolish.or repair any swm
$8000ctu
ad $ prior tonshourance.alsomquires meapplcam forsuch pundit to file a stgnMsmtemem A�.
that be is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 ,, I `3 R�aGr,❑3v.,r,cR.nr•�.®3 .a Valuation
(cont - s 'hSect7000)of Div on 3ofthe Busnessand ProfGsons Codi , l-.a,1! '
or that hes empl Ncmfrom and the ba:,fin the alleged exenpurm.Any vmlith int
of Section 70315 by any applicant for a permit subjects the applicant to a civil penalty
Of mol muff man five hundred dollars(5500) 3 01APN NOL09H PLUMB I N Occupancy Type
nl,as owner or the pmper,y.or my employees with wages as their sole compensation, 303 — ROUGH MECHANI AL
will do the work.and the amcmre is ao,intended an offered for sale(see.7044, 3 04 — ROUGH E
Business and ProComm"
Professions Code:The Conr s License Law does not apply to an JRWWWWE;i Zctions
owner of property Who builds or improves mmeon,and who does such work himself 505 — FINAL ELECTRICAL
or offerectnoboughr his own employees. building
that such improvements are not intended or
completion,the:ownerwmider he will havethe imen of proving threat
welkin one yam of 507 - FINAL PLUMBING .._ _._.. . ..... .___. .. _.
completiaa,the awaer-baaeet will nava the wmea or proving Ina,rte did no,bane w
improve for purpose of sale.). 508 — FINAL MECHANICAL
-❑1.as owner of ins property,am exclusively contracting with licensed contractors to .. .__ .. ... ..._..._. _.. 7-
consumer
onstroct the pojeen(Sec.7044,Business and Professions Code)The Contractor's -'
License Law does not apply to an owner of property who builds or impruves thereon, .oma
_and who contract for such projectswith a contractors)licensed pmsaan,to the
CGwgnheor red s License law,
❑I am exempt under Sec.. ,B&P C fo,,his reason M�YNA.YYY
fleras-
Dolm
WORKER'S COMPENSATION U S I(2G(�010pO2 aN
y
...
DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
..I ❑ 1 have and will mainain is Certificate of Conan,10 self-insum for Workers BUILDING
Compensation, as provided for by section 37W of the Labor Code, for the
perf irmaned f,he work for which mi,poen n is issued.
❑1 have and will maintain worker's Compensation Insurance,as required by Section
3700 of the Labor Code.for the predominance or the work for which this permit is
issued My WorkJ}er�ea C�/offin�`�a/t/oJ'Insumnce carrier and Pobcy numbs
Camcts, lld_Pnfcy Nn.. _. ... . _ _ .:- — .. .
.. _ . . ...
CERTIFICATION OFEXLMPIION FRO ORKE
COMPENSATION INSURANCE'' "a I '
4This section need not be completed if the perms,is for one hundred dollars
(Sla)or loss.) '
1ri fy Ihat m o of Inc work for which this I is smad,I
shall not employ any pertain in any manner an as to become subject to the Workers
Compensation Laws of Califomie.'Da¢ -
Applicant
NOTICETOct .,he Worker,after making thisw ism. fi Exemption,you should
Z becomesubjdnotht Worker's Campton or
row shall theemed Labor Coda you mus,
� 0 fonhwnh comply with men provisions or this permit shall be deemed revokes.
_.. _. .. .. . .... ... _ .. I- . .
CONSTRUCTION is a construction
LENDING AGENCY
1 hereby suffirm that then is x construction lending agency for the performance -
W 6f the work for which this pcmnit is issued(Seed 3W7.Civ.C.) '
L Q 1<nder s Name .. .. - -
�,z Lender's AJdrtss '-
C.7 I comity that I have mad this application and state that the above informmion is
t obecl.1 agree to comply with all city and county ordinances and state laws calming
C.) to building construction.and hereby ordnance representatives of this city to enter upon '
�,. ka] the above-mentioned property for inspection purposes.
r
A. (We Sgrecrosave.indemnify and keep hanNess,ne Ciiyaf Cupedwit,rame
(Z) liabilities,judgments,costs and expenses which may,in any way deems.gains,said
V,z City in consequence of the gburdin of mi,permit. /
S Pr RICE REGULATIONSLCA UNDERND. . (D WILL COMPLY WITH AL Issued by: n Date
Sig I r o UCun to Date
IAZARD S ATERIALS DISCLOSURE - Re-roofs
vrdme appheant or rot re ailamf a<cuvom dmre or nmme naeardova material Type of Roof — b
adder db th Cu m p1 YP .. .. z .. . .�
y pe -p 1 c e cn pt 9.12 .d m H Int a saray -- -
Code Section 25532(a01 11 No
-AIL roofs shall.be inspected poor[o-.any roofing.matenal being installed._
Wrdons air coma,or future building by the
yAuse e.At,Qu litdevices
Management
If a roof is installed without first obtaining an ins ection, I-agree,to-remove
emit heurdoue am contaminants a de0ned by me Bay Area qct Quality Management g p
I Domir, all new materials for inspection. Applicant understands and will comply with
❑Yes {. 0 No .. _
all non-point source regulations. '
-'•1 have road the hazardous materials requirements under Chapter 6.95 of the
Califamia Health&Safety Code,Sections 8505,25533 and 15534.1 understand that
if me building does nes comee55n//d�wvy have a tenant.that i,is my responsibility m notify me
O I of,rte rtquircme nick mud n be taprior
m routine c f a Cenificme of
/AD/L Signature of Applicant Date _
or soma a agent- Data All roof coverings to be Class •'B"or better
�, a . . .. - .. . . .. . . - OFFICE