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01030038 -CITY OF CUPERTINO suil.owcmvlstov PERMIT CONTRACTOR INFORMATTON `�, BUILDING ADDRESS(' '' _ � - .., PERMIT NO., 20345 CLIFDEN WAYSCHAUMANN. PLLIMBIN 'AND OWNER'S NAME: Y' A r _ - - _) APPLICATION SUB DATE RON HEYMANLRUP.ELWODD I?. 03 10A�PL71L7[1 PHONE: • ' - _ ! SANITARY NO. CONTROLNO. (408) 986-9044 w Z 'ARCHITECTIF.NGINEER: - - - BE PCRMIll INFO Fe 0❑0 ( - 1� .BLDG 'CECT PL.UM�B• CCH H Z z N LICENSED CONTRACTOR 5 DECLARATION m [ Job D05C1'Iptlon s OZ—p Ihereby 7(f)(hnnikllart l' B d p fChpt m e - r�r3�et wth Sudan 9aNp ofD lot tb'd ndP I . t .Cod•and myl e fallf, . w t.tcn I e a REMOVE ' 8. REPLgCE FURNACE; 45;:000 BTU, a°d Dat.'d c orae .ADD 2 'GUM ALC Iahl I , Rcunral snhcl FtSy„g I a t I YPI hllb Ip of - d: _ •. y60� License,]P f :' I. . rr OWNER-BUILDER DFR DhCI ARAl10N ti' 1 1 sY d that-]10 nco thecoronation',L 1 for the •�j _ „ roll y (S f "c,u 5 13 m ro f Code'.e Y 'tY ante � Dowhich requires permit a t It p demolish, p Y't tuc u�i m Pr t t '. q ' pr gl tf hafile a 6 tat m " o, roti f do tt top In Contractors L Law(Chapter 9 'S' Ft FloorArea :` - Valuation m, 6 thS t ...d., :l d) q' or mat he 7 exempt a f oro end th' m.r d for he ullobed empho L Any omit n 4 of Social, .aeo1156yv hundred dollars apenn't. bj cle meappl -mmacivil penelty' ' of net .are dtnn t.,e n l d I titin.Issap. APN•Number Occupancy Typto <' - ❑Lar owner erne property,dr my employees with wages as men stile compensation. will d he work,told he t t I'mardi offered to IS,,9044 Business aid Professions Code The C t t :License Law Joe,art aTI,or an - r 2693700fg:� tied Inspections ` mr of pfoperty Whol ids m imp...s thereon uad wh I m such work bmself - mmuglu ni,own employed..provided that such improvements arc not intended or ' -offered for sale.If.M1owover,the buildins ur-itnpnw amid is sold within one year of a,mpI,Iid. meownd.-hmIderwmlame tire burden nfprevmsmn,hedid not build 204 — UNDERFLOOR. FRAME impose for purpose f salej, ❑1 we ftnP pny 'ly ntfyw th license(]conditions to 301 — ROUGH PLUMBING the p i ct Ise 7044 Hostile I Profit:: .CW ) rhec i a t 303 — ROUGH. MECHAN I CAL. Licensed aw does not apply to an owner of property,who builds or'improves thereon. and who eentmets for nmh'p leas with a onrzarnorfs)licensed pursuant m the _. 'a,, - 304' — ROUGH, ELECTRICAL I CAI_ - f 'Contractor's License Law. ❑I am emmpt under Sic. °_; - .H k P C,fon,this reason .. .505 - FINAL-ELECTRICAL owner' Date ' - 507YF,INAL PLUMBING'. " '• WORKERS COMPENSATION DECI.ARATION - 508 - FINAL MECHANICAL''. In rorty,drnn a–flatly fpi v nn ,followingp 1 f 51+4:'—,,.FINAL PUBLIC' WORKS ❑ I have and will anceporm a ceirldidde or consent ,, self mad, to,worker's e . -- Cempensaion„m provided for by Stettin 37od of the Labor Cede, for the - performame of the work for which this permit is issued. a ❑I hate and will maintain Worker's Compensation resonance,m rrquiad by See 2 a 3700 of the Labor Code for the orn f the m,for Hdi this scanit's soentire and Poly card, a' s CERTIFICA OT EXEMPTION FROM WORKERS OMfit PLNSATIONJNSURANCL If section need not be wmpleted If the permit is far ane hundred dollars IS 100)or less) I If, - - 1 unify that in Ore perfomonau di tl irk for whi h this pendi,is Lcsuril,1 'hall bt dna,ltly any personal in a.,mon ter sn us to becom•.uldea to the Workers ' (76amear,mind L v, f C l'f .Date s I - _ 'Applicant NOHCHTOAPPI.ICANT If udcrnrtk gth-C tr..e of L6dmptot.you should ' 5 btcone suhjecua theta k Compeu t 'Incisions of the Labor CON yml ta ° + Emhavth comply wlh .Or potshots,or the per r't shut hedecmed revoked. ' - z ,a CONS ISUCTION OLLNDINC ACFM1CV -j '1 heady, ri m that them Iconsumerism J'ng agent)forthe pedti ranee - - - a L' afro ,,,it rich lh p ni ssw.d(Sec 3097,Civ.C) ta l7W,tQ hcl Name t7 z Le Address U p - _5 K, I certify mad lyant dattlttl binformationt • ko '� to t l g t pin with ll tY 1 county of and ti,am llfng: ' Q V tan Il gunstna an and henAy euro ' p'.auotbe of tbls_c'ty roman Iron _ ' ry the h onedp , Of inspectionp l .. C6 (We) 6 t d ifY dme,h dl .Ibe Cay fCpen'noagtn:t V] Ilnl It j dg t: r. pe es 1 ch Y n any Y tdn'n t -tiJ U .zi .City 1 "'Goer¢of d gr tit n f b peri t. 2 AP Cf TUINDERSNS J WILL, PLY WITH ALL ON-P INT Issued by: ` Date iga root Applmadcof ct ow, r Re/�,sha t t - - HAZARDOUS MATERIALS DISCLOSURE ' µ Will the appneatnon future building andnpam.tard m l5andle havntJtid.material, Iy ^. . a as defined by me Cupertino Municipal Code,Chapin 9.12,and the Health andShfmy. Code.Section 25532(6)° I.- q No -- ,El . Albe inspected prior to any'roofing material being installed.worn ppliu t r t nwldi s p tr"6 eq,pmentnratette. roti Iftall@d.without first obtaining an inspection, I.agree to remove*h' d cmt t: dddnW b)tM1 Bay Arte A'r Quarry Mnnag tit Di t ave. ' ,r El No, - All new aterials for inspection, Applicant understands and will comply with all non-point'source regulations. is I hmse mail the h nd cn :regorc t. u 1 C pt r 6.95 1[lie - - - , Call II Id &Safety C af tyC I Se 5511 25513 d11114 t 1 nJ r nJltrt �6 p r- ' + fifth btld'ng dor,pa tlyh to tlht i y r'pershltyto noff e - - - ' _ tofthemmot I,wh' teethe mpnurms m ieofu teat f J- tp' ) , . Q t ';0. Sigita[ure of Applicant Date, r. n ,t mer:.t stns - ate All roof coverings to be Class"B" orbetter :.OFFICE . , '