Loading...
03030065 CITY OF CUPERTINO BUILDING DIVISION PERMIT okc�to',� `rroRMao " BUIIAING ADDRESS: PERMIT NO. SCHAUMANN AIR CONDITIONIN OWNERS NAME: HEATING & PLUMBING INC PERMITL4 A CREW AunREY W TRUSTEE B. (408) 428-0640 SANITARY N9. OL NO. ARCHITEC AINGINBER: BUILDING PERMIT INFO BLDG ELECTPLUMB MECH I� t� toga LICENSED CONTRACTORS DECLARATION JbDescri tion 1 hereby of ism Nat 1 an licensed under provUlov of Chapter 9 memimuJob p with Section 70001 of Dlvtsian3ofilm B and Pmfedam Dodo.and mylkemm la FINALED r� .� O lif en co,; p REPLACE FURNACE f n.0 IlMaagE aMmAirnmNs MAR 1 .7 203 I as Licensed Professional OWNER-BUILDER DECLARATION BUILDING 1 hereby afNm Nn I em exempt from the Contractors La ors Lkense w for IM p o following won.(Sudan TW Id,Business and Profession,Cade:Any city or county $ which acquires a permit to crmdrexl alter,impmw,demol W,m repair any succu re -z19 prim in its iasmnce,also acquires the applicant fmsuch permit to file a signed statement —o Ihahelaneensedpereuemmwepmtalmtaorthe cantrenanuseaelaw(chapur9 Sq.Ft.Floor Area $ on (commcneing with Scetion7000)of Division 3 offt Businessand Profruions Codc)m 1 $ that he Is exempt easefrrm and the basis fm the alleged exorcisms.Any violation of Section 7031.5 by nay applicant for a permit subjects the applicant m a civil penally of 3 A,DT.f U...V'..F.er O O Occupancy Type not mart than 0w hundred dollars(9500). Y'(Y' ❑1,u awaer crew property,many employes with warn n thehsom eompermalon. will do the work,and the muctum Is not intendedoroffemd Russia(Sm.7041.Business 30,3 — ROUGH 4,2&rOn; and protrusions Code:The Contractees License Law dm to apply an owner of prertywhohullda mimpmwauemer"ne1who dneaauchwork himmiforthmugh his - 304 — ROUGH E E(-"TR peIC"AL awn employaea,provided that Such impmwmenu an,not Intended orarfemd fm.sle.If. SOS — , FINAL ELECTRICAL however.Ne building m ee Improm res Is sold within one you of completion,the owner• build.)er will haw the burden of proving that he did not build or Improve for purpose of 508 - ' FINAL MECHANICAL sate . ❑1,as owner of the property am ucludvely contracting with licensed contractors to ' comtmet the project(Sec.7044,Business and Profusions Code:)The Contractor's Lt. tem.Law data not apply to an coma of property who builds or Impmws thereon,and who convects for such prefects with conuacmr(s)licensed pursuant to the Con omicai s License law. ❑I em exempt under See. .B 9 P C for this reason ' Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury am of the following declaralom: haw and will maintain a Do0finm of Consent to self-Imure for,Workers Compen- - - - 190filof n,u provided for by Seaton 3700 of the labor Cade,for the performance of the k for which this permit a Issued. haw and will maintain Workers Compensation Insurance,u required by Section 1 aLabor Code.fm eM pufarmamc of the work for which this permit is Island. esCom nsadimlmumam carnia end Policy num rem: Policy Na.: 2 3 CER(FICA L•OF E%EMFr10N FROM KERS' COMPENSATION INSURANCE - (Dismctimneedtrot W completed treat permit Is f rrom hundred dollars(SIM) or kaa) 1 ceNfy that In the performance of the..,it fm which Nis perch h isawd.I shall no, - employ any person In any manner an u in become subject to the Workers'CMPemation Laws of California.Dam Applicant NOTICE TO APPLICANT:If.after making this centrals of Exemption.you should became subject to the Workers Compensation provisions of the lahm Cede,you mase ZO forthwith comply with such pmvisiom or this permit shall be deemed revoked. y r CONSTRUCTION LENDING AGENCY 1 tomb,af@m thet them Isa consumer.rending agency for tic perform em ser Y,> tiat wore for which this Permit is issued(Sec.3097.Cih,C.) Lendeea Nemc Q 14wfy that I haw mad this Applintion ears sum that the show Information Is gy correct I agree to comply with W city and county omfinalleas and NM laws mining a building construction,and hereby suthmice rdP.nusvm of this city to sweet upon tic t21 above-mentioned property for Inspection purpmca (We)agree to raw,inrscmnify and keep humme,the City of Cupertino agalmi r n Ilabllitia,judgments.CM and expenses which may in any coy acerae against mid City I Jz in cmruegmnee of the gnntinr of this permit. I �, APPLICANT UNDERSTA AN WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCBR Uf.AT10 W• _ Re-roofs SiN of AFPlicam/Convacmr ate HAZARDOUS MATERIALS DISCLOSURE v Type of Roof Will the applicant or future building ucupant nom or handle harANom material u donned by tic Cupertino Municipal Code.Chapter 9.13,and the Health and Safety aha,Section 35533(a)7 All roofs shall be inspected prior to any roofing material being installed. pyre t3+�' W01 the Applicant or future building occupant use equipment or derma,which If a roof is installed without first obtaining an inspection,I agree to remove It haardous air contaminants u dcOned by the Bay Area Air Quality Management all new materials for inspection. aerial? - ❑Yca Nis] u Ibawmalthehentdousmawdalarequimmenmundcr Chapwrd. cited lifor• ma Healthlk Safety Code,Scctiuna25505,25533 and 25534.1 understand the eat (Wing ' date n I currently hew a Moan is m mapomlMllty m notify 0c m u of the mq enuwkh11 mm arm AnceanCeNncaMafOcm Signature of Applicant Date i� gem Data roof coverings to be Class"B"or better Owner oremhor