03040040il96
nj
RE
Fu reC
U
CITY OF CUPERTINO
C
I � 111�._�,Z
BUILDING DIVISION PERMIT
112p, om (10 AT
" 110,
�4009N)p
BUILDING ADDRESS;
PERMITNO.
10461 BAYWOOD DR
SCHAUMIiNN AIR CONDITIONINC,
03040040
WNERS NAME:
OWNER'S
PERMIT ISSUE DATE
STAUFENBIEL LEROY AND CELIA
DHEATING & PLUMBING INC
04/07/2003
413:
SANITARY NO. CONTROL NO.
(408)428-0640
ARCH17ECTIENCINEER:
BUILDING PERMrr INFO
BILDO ELECT PLUMB MITCH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I bamby surrion do, I am licensed under pmovisiom of Chapter 9 (commencing
with Section 700r) of Division 3 of the Buslassam, and Profession, Code, and my luease b
In full fsed;'I
"' on;
Lk..0INSTALL
FURNACE
Dam fe-'7— `5s--7 comosmtmc=y�y
ARCHrrECT`S DECLARATION
FINALE0
I understand my plans hill he and an public records
ou
Licensed Professional
OWNER -BUILDER DECLARATION
'2003
1 hereby AMM that I am exempt from the Contractors License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct. slux, barren, demolish, or repair any struclum
prior to its issuance. Also nexpArel me applicant for such Permit Or rile a Signed statement
Contractor's Uccoss, Low 9
Sq. Ft. Floor AreaValuation
that he Is licensed pursuant to the provisions or the (Chapter
Section 7") Division 3 of the Business; and professions Code) or
$3000
(commencing with of
dust he is exempt therefrom and she basis for the alleged exemption. My violafl , an of
Occupancy Type
In hlb'T.
Section 7031.5 by any applicant far a Permit subjecu the applicant 10 1 civil Penalty Of
net a= then nen handed delta. ($50D).
3 0 0
j, u mvner of the property, err my
IO2P_kQ1tbWCtiOns
will do than worl4mad the tructure 4 no, I❑ ntended croffered image (Sec. 7044. Bunsiehwk mmus
and Padessiom Cade: Its, Contractors Liam Law does but apply m an owner of
301 - ROUGH
preMnywho buildsortropmanattemorm, andwhodocatsuch worlshimselforthrough his
303 - ROUGH MECHANICAL
moternpl.yens, provided thmmuch Innimovemccals, man Out intended reoffered IffStle. If.
however, the W11,11.1 or barman ve as en 11. sold within am year Of mumpimmm the marmar.
304 - ROUGH ELECTRICAL
Wilde, win have the Wolon of proving that he did not build na improve for portion of
505 - FINAL ELECTRICAL
"[a.).
0 1, a concur of the property. am exclusively contracting with licensed cantracher, to
507 - FINAL PLUMBING
consumer the project (See. 7044, Business and Profications Code:) 11s: Contractors U.
508 - FINAL MECHANICAL
ceress, Law does not apply to an owner of property who Wilds or improves, thereon, and.
who contracts for such projects with a licensed paramount to the Con moors
Liclues, Law.
0 1 man attempt under Set B & P C for this reason
OmerData
—
WORKERSCOMPENST11ON —DECLARATION
I hereby Liffiren under penalty of perjury am of the following declavasions:
man and will crudwash, a Certificate of Consent to self-finsuare for WOftes Compen-
on, as provided for by Section 37M of the Labor Code, for the performance of the
work for which this permit Is banned.
I ban and will maintain Worker's Compensation Insurance, U required by Section
3107YOlD of the Labor Code, for the performance of the work far which thl, permit Is Issued.
My Wcalmei compensation Insurance carrier and Policy
M
Mer: Policy No
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rids auction need not becompicuall time Permit is fortarmhurremaddallar, (SIM)
or Its.)
I carfify that In the Performance of the work for which this Permit is Issued. I shall not
employ anymesom in any manner so as W became subject to the Workan'Comparvaidon
LA. ofCalifiamm. Dum,
APPlimst
NOTICE TO APPLICANIR. If, after making this Cemnam or Exemption, you should
became object us de, Worker's Compensit provisions of Im LaWr Code, you am
forthwith comply with such juantiflons or Oda permit hall Ise assured smalcul.
CONSMUCTION LENDING AGENCY
I Womystfibran that there Is a construction lending agency for the performance of
the we* for which this permit Is issued (Sec. 3097, Civ. C.)
Namo
Leader. Addrom,
I artily that I have read this application and term that the above information Is
correct. I agree to empty with all city and county radiances and sum laws relating to
building construction, and hereby sumodre termsechative, of this city to cover upon the
above-mendoned property for Inspection purpmant.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments. touts and expenses which may in any any accrue against said City
A
in consequence of the granting Of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by; D49
SOURCEREOUTATIO
Re -roofs
Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
I z J'ApplimallContractor -bEc
ncurious mann al
ill the applicant Or future building Occupant arm orhandic, Iau
an by than Cupertino Municipal Code, Chapter 9.12. and the Health and Safety
dented by
do
Cod., Scale. 25532(a)?
Oyu qv_.�
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will ft applicant or future building accurplin! = cuildprecal or devilsea which
It hotairdow, air comianammus as defined by the Bey Am Air Quality Misalignment
all new materials for inspection.
win?
[3yes mlsre__�
I ban mad the incautious materials mulnemcants under Chapter 6.95 of men, Califm-
niaRulLh&SatetyCode,Smd=25505.25533W25534.lLm*mdftifLhe building
does an, currently have a enact. that It 6 my resparessild1hy to nadly the occoment of the
I requireTints wniehm ren rmissuance of a Cani c cy.
Signature of Applicant Date
—
42
All roof coverings to be Class "B" or better
CLvm/
I or mitandocul $..I Date
•
0
4
CITY O
CUPEkTINO
CITY OF CUPERTINO
FURNACE/AC
PERMIT APPLICATION FORM
36//60 L o
APN #Date:
-Energy
BUILIDNG
BREMFURN
Relocation of Furnace
MECHANICAL
-7-0
Building Addr S.
BREMACOVER
A/C Unit > 10,000 cfm
MECHANICAL
BREMAIRHAN
A/C Units <= 10, 000 cfm
O ner's Name:
BREMRECEPT
Rec tl, Switch & Outlets
Pone #:
enb'
BSEISMICRE
ractor:
ZZ
BUILIDNG
License #:
� U3ct.
�
EPERMTTFEE
Elec Permit Issuance
Ph ne #:
i G/\C •
Mech Permit Issuance
MECHANICAL
23 -
Applicant/Contractor:
PLUMBING
itis
Bldg Permit Fees
BUILIDNG
Building Permit Info:
Plan Check Fee
_
Bldg
Elect Plumb
Mech
Jo ti n:
Business License
BUILIDNG
esidential: h'
r
Commercial:
Ft.joerea:
$/Sq.Ft.:
Architect/Engineer:
Valuation:
ob
Type of Construction:
Occup y Grou
c/
Qty: if
ADDlicable Fee iD
Fre 1lrcrrintinn
Fre (:rnnn
BENERGY
-Energy
BUILIDNG
BREMFURN
Relocation of Furnace
MECHANICAL
BREMACOVER
A/C Unit > 10,000 cfm
MECHANICAL
BREMAIRHAN
A/C Units <= 10, 000 cfm
. MECHANICAL
BREMRECEPT
Rec tl, Switch & Outlets
ELECTRICAL
BSEISMICRE
Seismic Fee Res
BUILIDNG
EPERMTTFEE
Elec Permit Issuance
ELECTRICAL
MPERMI TFEE
Mech Permit Issuance
MECHANICAL
PPERMTTFEE
Plumbing Permit Issue
PLUMBING
BPERMFEE
Bldg Permit Fees
BUILIDNG
BPLANCHK
Plan Check Fee
BUILIDNG
BUSLIC
Business License
BUILIDNG