03030066 FCITTY OF CUPERTINO �w� '^^'�� s +1"� `' � , '' �`' ` :`
BUILDING DIVISION PERMIT 7.V rU 'T12A. AOR TNC;tR�A.TTO �"
OINGADDRESS: SCHAUMANN AIR CONDITIONIN PeaMITNo.
0066
BR'SNAME: HEATING & PLUMBING INC �°lIT� A
ETHEL
(408) 428-0640 SANITARY NO. COMROL NO.
ARCH=KINOINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMBMECH
0 0
D p LICENSED CONTRACTOR'S DECLARATION
rd 1 Mmby affirm that I am Immsed under previsions of Chapter 9(commencing Job Description
with Section 70q)of Division 3 of tha BumnVmi professions,Code,and my license it
m
e u fome Act. ✓ REPLACE IFURNRCER�/C
Liccnw •� LIe.M 't
te Cam p
S CH177?CTS D UT ON
lid mah used.s ublic records Ar Licensed Pm(cnlnn ffirmOWNER-BUILDER OPALA0.ATION
1 hereby athat I am exempt from the Contractors License Lew for the
O o follnwing mason.(Section 7031.5,Business end Profession Cade:Any city or county
1§9 which requires a permit to conswet,elle.Improve,demolish,or repair any stmctum
poor in is,Issuance.also requires the applicant fm such Permit to file t signed statement
< that he la licensed treatment tothe psovlalonaorthe CmtactarslJmnxlaw(ChaPr9 Sq.F[,Floor Area
(commencing with Section 70D0)of DivtAim 3 of the Business and professions Code)in
that he is exempt therefrom and the basis for the alleged eamptim.My vlolation of
Section 7031.5 by any applicant for permit subjects the ePPllesnt w.civil penalty or 3 Arris IY0191W 0 0 Occupancy Type
Act mom dun Ove hundred dollars(MIKE.
❑I,As owner of the property,or my employee with saga As thetr sale mmpeoatim,
will do the work,and the moment is trot la.^e-a or offend for l,sic(Sm.70".Business — -I=HLIC�BtICCElBns
and Professional,Code:The Contractors License law dor ret apply in an owner of r
property who built a lmpmves thereon,and whodu
aauch work Mmseamtleaugh his 304 — ROUGH ELECTRICAL
CAL
ownemployees,provided thnsmh Improvements Ann re1Intended"armed for axis.If. 505 — FINAL ELECTRICAL
however,the building or Improvement Is sold within o"Scar of completion,the owner-
bulkier will have the bundan or proving tin he did ret Wild or improve for purpose of 508 - FINAL MECHANICAL
O L n awn"or tis,property..m exclusively contracting with licensed caran cton ut
..Met the project(See.7044.Buslaw and Rafe Wo"Cade)The Commences LI-
cerse Law doe not apply to an winner of progeny who builds or imprews demon,and,
who contracts for such projects with a contractor(s)Rcemwd pursuant to the commences
Licenw Law.
❑I am exempt under Sec. ,B&PC for this moon
Droner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby&Man under penally of pedury am of the following declantiom:
haw and will mainuln a Certificate of Consent to elf-Inause for Worker'sCamper-
137CO11D
n,u provided for by SmOon 3700 of lee Labor Code,for tis,perfarmnammce of the
t for which this permit is issued.
ban and will maintain Workers Compensation insurance,u required by SeNon
of the labor Cade,far t e performance of the work for which this pump is issued.
Wofke��'tcomppertatin huan=artier and Pollry number sm:
PoI -2aa.
CERTIFICATE OF UEM FROM WORKERS'
COMPENSATION INSURANCE
(Thu sailm need not M completed Have permh U foranehundreddollan(SI KE
cokes)
_- i certify Nn In the performance of the work for which this permit Is issued.I shall not
employ any person In any mover so As in become subject in tit Worke n'Compenndon
Laws of C.lifomia,Dem -
Applicant
NOTICE To APPLICANT:If.after making this Certificate of Exemption,you should
become subject to the Worker's Comianutlan provisions of the labor Cade,you must
.J O forthwith comply with such provisions or this permit shall W doomed mvoketl.
CONSTRUCTION LENDING AGENCY
[-r I hereby affirm that them is construction lending agency for the performance of
rG dm work for which this permit It Issued(Sec.3097,Civ.C.)
W Q Lendcr'a Nemo
.7 z Lender's Mdren
U Q I candy that 1 haw mad this pplication and state that the show Information Is
V. cancel.I agrm to comply with all city and county oNinances and state law mining to
0 abowngclioned Pro and hereby authorimrepresenutives of this city to env upon the
W aM1ove-mentioned property for Inspection loop hg
(Wc)agreeto neve,indemnifyand keep may
In
City o(Cupertino gsinat
IUbllidequemcc fftcosuand expenses whkh nary In any soy amus.pimtmid City
V A PLIICCANT UNDER ranninjol'
pe WILL COMPLY WITH ALL N N-POINT Issued by: Date
SOURCE RE LAT70 S. /
GF .f�� ✓ d Re-roofs
un err AppliaHAZARDOr of Roof
HAZARDOUS MATEMALSDISCLOSURE Type
WIII the Cupsator(Muni buildingaavpanln9,torandL Health ad
u
defined by de CupeNno Municipal Cade.Chapter 9,t2,and tic Nolo antl Safety
sae,Scctian 2553:(.)7 DAs,/ All roofs shall be inspected prior to any roofing material being installed.
❑Ya
Will site applicant or future building occupant law equlpmem or device,which If a roof is installed without first obtaining an inspection,I agree to remove
It havardous air contaminants As dcflnW by the Bay Area Air Quality Management all new materials for inspection.
tsmicl7
[3 Yet Ijlilg/
I have mW the hazardous meurla],requirements underChapur6.95oNeCelifor-
niaHceOh&SafetyCodo,Secdou2551)5,25533atu125534,lundcnmdthaifde building
tire[not comedy hew a ten m It Is my responsibility 0 fy tis,nccuPant of lac
requirmrns hichmua dor Inuance.FsOcrifiesuo cu cy' Signature of Applicant Date
mer"artharimd. amt acre All roof coverings to be Class"B"or better