02050163 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
Bl�LBIs�cIj9"MLLICK WY SCHAUMANN AIR CONDITIONI ";1TNO' 02050163
°Wfff;'L°1tPS DONALD L AND MARY ANN HEATING & PLUMBING INC A?31�7rf45/'nlR 2
PHONE: (408) 428-0640 SANITARY NO. CONTROL NO.
.O.0 ZO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
kC m C BLDG ELECT PLUMB MECH
fan f-1 O Cj L7
N z LICENSED CONTRACTOR'S DECLARATION }S(nJe$Q it TT�y((10
Sz 1 hercbyalFnntbt,lam licamedunder provisions of Chapter 9(commencing ADD 3 TON A/C �1T h `I I)UCT
,_C with Section 70001 of Division 3 of the Rusiness and Pro&ssi...CWam my license
5C ism Rall force �q y IJyS�/
O y U License Clas. I �k L- Lic M �/�
Uma GoWCLA
[ norne
3 t'-ti A CHITEC. "O
0 g I underunderstandmy plain shall he o,a DECLA sctl as public rccoNs
r
i i p OLicensed Professional
UP i OWNER-BUILDER DECLARATION
ser-:n 1 hereby affirm that 1 am exempt from the Contmemr's License Law for the
3 c following mason.(Section 7131.5.Business and Professions Code:Any city or county $5400
y wh h requires a permit to comtract,all, mpmve,clarmlish,or repair any structure
tri $ poto to it,haiurn'e.tiso nex,tims,lba.,plurnot for such Perot to Measigned statementc.
n' ` ...... _. .....
that he sJ ce sapin-sinint to tfig Provisions of the Confronters License Law(Chalaer9 st 3 (p'jpgr• Valuation
(commencing with Section 7")ofDivision S of the Badness and Professions Cade) v �� itI\jr.i, 3 :4..", r'O qt/({,�4}tl,,::r js' •
or that he Is exempt therefrom and the basis(Or the alleged cfemptton.Any violation
-�of Section 7031.5 by any appBeant fora Permit subjects the applicant to a civil penalty ��i ,ryp
of not mine than five hundred dollars($500). PN Occupancye
°1,as owner of the propmy,Or my employees with wages as their sole compensation, 303 - ROUGH MECHANICAL
';.III
ECHANI AL' will da'rhe'work;'and the structure is 1101 intended"or'nlfamd for sale(Sec 7(W,' --
IBusiness mid Professions Code:The Cnmrtemr's License Low does oat apply to an ti
owner of property Who huilds Or improves thereon,and who does such work himself 501 - FINAL E ERGY
or hroagh his own emplpyi,the Wilding
r orimphimprovemeold archon intended or '502'---- FINAL- PLUMBING--ENERGY-".... .._-- '--"....---
offered for sale.If,net-Wilder
Wilding Burden ocment is the within one year of
improveion,the of
will have the burden of growing that he did not build or 503 - FINAL MECHANICAL"ItNERGY "
improve for purpose of sale.).
-"°I;�s nwne:nnti� ...... . 505 -- -FINAL_ELECTRICAL - ---
Property.am exclusively contracting with licensed contractors to SO7 - FINAL PLUMBING 1- "t- '
eonsand who c e project(Sec.700a Business and Professions Code)The Contractors
License Low docs net apply to an owner of property who builds n improves thereon
d-who.rommcrs for such projecrs.wilh a eontmcmas).licensed pursuant to the .... _.__508_.7...FINAL-,MECHANICAL,_
C 's License
Cl' lam mSer.'
<mptondcr Sec' . ',B&PC for this reason
Oa%ner '� 'Date,
WORKER'S COMPENSATION DECLARATION
FINALE-13
1I hereby affirm under pc unity of perjury one of the following declarations:
���/ ❑ I have and will mainmin a Certificate of Consent 1.self-imure for Worker's q
J
Compensation, as provided for bySection3700 of the Labor Cade, for the MAY d U 2002
0
performance of the work for which this permit is issued. . ,
3700 of Ih IoW Code f the k'f r hick this Section
is BUILDING
y pe n 1 um ce m and Policyix requ red by
ssu d M W er C pAnumPermit s
and.Ill
1;CLRIIIICATION OP/hEXhMP'110N FROM / ,/fin
Cemcle molmsIn NsoiY Hrr ars Pluyl,".L" unt /Q 7mr:.,
R
ii WORKLNS � -; sl1. .. . .A x:4f I•
" COMPENSATIONINSURANCE' .,_ '
section ----------
nIed not Wcompletedm
d If the pedt is for one hundred dollars
(SIIK17 or less.),,
.. _. - ...._.., .0 .-.-
n fW Ih e n the liar of lin k f which this pemur Is amid 1
shall at an
any Pew In any mit s e to become subject m thetWorkers 1 T`
nn
Compensation Lows of California!Do"
1.
NOTICE TO APPLICANT:the Work r Compensation
n Qnons,of,
of Ese ptdn,you should
Q 0 become subject to me Workers Compensmlon previsions bf the Labor Code,you most
formwalf comply witti such provisions or this permit shall be deemed mocked.
Zr .- -_.. . ....._. .- -. _ . _ - ..- __
f.CONSTRUCTION LENDING AGENCY t
F" 1 hcmby affirm That there is a conetrvemb lending agency for The performance
e•a
� ofth kf 'which thisp 'i issued(See.307,Civ C)
'Q -Lind rsN me ._t. . .o.-. ..,1 -: _. . . ...... .. ...... ... .. . . .. . ..... .
ails Aorta's,
0 I certify that I h read this application and state That the above information is
correct:I agree to comply with all city and county ordinances and stele laws relating
�i L) no Wilding consWeiicam and hereby authentic repreurniives of ihiscity to enmrupon
4W the above-memioned property fm inspection port-
Fa, eW)agmets.c Indemnifyand keep h may in anyCity
way accrue against
Ir rn
liabilities, sequence c res nd expenses may n any way accrue ageinsn said
t:) City consequence of the gram g of this permit.
APPCICANr UNUIiRSTpNDS AND WILL COMPLY WITH ALC'NON-POINT
SOURCE REGULATIONS' Issued by: Dale
Stgnalcu of ApplicanUContmnor -' "' am
HAZARDOUS MATERIALS DISCLOSUREr��+"t Re-roofs
adi . : Type of Roof
Will the applicant or future building a Chapter
stole or had the IHealth anSafematerial _ ....._ .. _ - -
- Codi.Sed by the Cupert no M c Pal CM Chaple 9.12.and the lieehh and Safety -- -- - -
as,e Section 25532(e) f
' k a s r
°Y N fou lbe,i .., to
All roofs shall be inspected pnor,to any-rpofing,material being installed. _ ._....
Will the ire applicant rfumrebefinedOc�pmtorec.Ai Quality Mining
If a roof installed without first obtaining an inspection, I`a agree to remove
cmii havnrdeus air comaminanis as defined h)the Bey Area Air Quality Managemen( g p �i
Dist^m7
° , all new materials for inspection. Applicant understands and will comply with
� y Y - ; all-non-point source-regulations.,:,-
y Lh varcaJ Ih<h ous materials q mnti
Imcand Chapin 6 95 0(rhe -
6iromi.Health&Safety Cral Sections 2550525533 and 255301 understand that
if the Building Joey havelhatitisin nsibiliry the
oceanic? fI cr,mmrptmtwhichmost be me P o m issuance ( Certificate
.__..-_.... .. .-_. .. ._ ...i .. .. .- _,
of '
11
cca
° tySignature of Applicant Dale
_+
6WAI roam m g d Data All roof coverings to be Class B" or better `
. . .. - .. . - ---OFFICE.