00080004CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING )DIVISION PERMIT
BUILDING ADDRESS:
1117RNII r NO.
0315 STONYDALE DR
SCHAUMANN PLUMBING AND
HEATINGOOO60004
OWNER'S NAMI7:
APPI.ICA'I ION SUB UATI;
1455 LAURELWOOD RD
08/01/2000
PHONE
(408),986-9044
SANITARY NO. CON 'IROI, NO,
ARCHITECfd1NGINEER;
BUILDING PI?RMI T INFO
RLDG ELECT PLUMB MECH
I I NS]71)CONTRAC OR'S UIiCI.ARNII()N
hob Description
hereby ufBrn Ih°, I un3licensed ander Pmvininte of Clmpor 9
., it, 'eing
withS,11 ko .mal tlJ vininn3ohhcB w1 tcn(iun(Cfu .and myliccnvx
Ine ����j:� l
Liter a UO�
A/C/CONDENSATE 220 VOLTS
cla"°°d _i�J
INSTALLL 5 TON
Dale Contractor_
� �!� I RCIII'fECT'S DECLA
I unJmaanJ my plain shall be used as public recnNs
Licen.aJ Professional
OW NI: R. BUILDER DECLARAI
,c
1 here.. intone chin I inn exempt from thee Cnntrnctnr'x Ciccone Lux' for IM1e
.
ons Cola: Any ei,y or snnnty
[smrlol, 713I3. Bualnew nod Ive,
lollnwire
der
tAre, a r, is delll,ll'u1t. or rnp°ir our
Prior, reya toes pJm d, lu
n ..nslfne ;tp,l orsu, tleolcic
"' I. y e mf' If bbeh- lslimed.,llnen
5L]. Ft. Floor Area
Valuation
tPrior he( be.,
(loth I . JI : a n II 1 ciffit, C t 61' . Lt. '(CI
(commencing with t<uen ofhe bis 3.I Lire Hui ams and usled
An , n. Calc)
ion.Pro
om an
s e t is Any violation
.r that he is exempt )any amm and circ basis for the alleged applicant
l
fora permit atM1jma the applicant m a civil penally
of out by any to
A PN Number
Occupancy Type
dr d doll
ar not nmre man Bae hundred aauan (s500).
e, than
more,
Cl. a, owner of the pm,ry,o,my employee wan wagcx as their sale tom,pensminn,3263:7013
L710
Required InSPCCt1l711S
will the dirk, and the ahuc Flo C not Landed or nft'ered for talc (See l to
Law asst m
un
one" not apply m
Cn.o,'phu Cont 11teo, , teal w
)twines, and ,rty Who tbvrcan, and who does ll
r of pope,. won [,,lila, nr work nded
puled due r or
fferedngbhia.wmhowever,(.nmvdedmat.Caenveniovascnldwithin intended or
^G04 — UNDERFLOOR FRAME ,
co rple for hale. If, however, (lie [,ailJing or Im e. ,I vent it ebut within one build ul
emnwleaon,m<.wn,mnmlder xdu have,mr nmden.r proaing mm be em inn build ar
301 — ROUGH PLUMBING
imwmve for parpasc of ole).
303 — ROUGH MECHANICAL
O 1. as owner of th,property, am exclusively contracting x'ith liechwal contractors In
,
consumer the project (Ssc. 7014, Business and Pmfevsion% Code) The Contractors
304 — ROUGH ELECTRICAL
License Law does not apply to an owner of propene whit Wild%or improv[, thereon.
unit who contract, for such project, with a"contractor(•) licensed pursuant m, the
505 — FINAL ELECTRICAL
Contracmrs Li,enm Law.
C l nm exampl order See. .B&, P C far his mass.,
507 — FINAL PLUMBING ,
Owner Dmc
-50,8 — FINAL MECHANICAL
WORKER'S COMPENSAI]ON DECLARATION
51.4 — FINAL PUBLIC WORKS
I hereby iffin r under ponolfy of Perm, one or Ibc following Jeclmntinm:
❑ 1 here and will maintain a Certilicam of Consent mself-insure for Worker's
Canape ns he pork is,, for by Section 370X1 of the LvM,r Cade, for hire
perti,m,1,nce of the work for which this pcnnit is issued.
ee
Labor Code, ILr rk Couipnce al't In wurk fol winch tiro,
01 hoe and,ah is
)90th Code, o, he 'n Contpm,c of Insurance, is tar .huh mi by Sectionis
U/ �[•�
w, per
of Inc r
n/c�ur/u{n•�en canoe. an/d11'.I eynntm[,ar vra
Issued, qty Wndne'rL/s G/tB
/iAc4p
/pe(nfsuptin�ngl
Cam&/yp VLJJL_L.W=1WiM'N,n: /L'
cid r1IBCA'InON OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thi, sermon mad! not be completed if the permit is for up, hundred dollen
_
IS 100) .11,11.)
I certify that in the pedon,mnac of the work for which this permit is i... ed, 1
'hull not employ any pannn In any nanner w, a1 m neeutne subject to the Wmker<
.
Cno,wanvation I uw' of CaNmnin. D:IIC
Awpheam
-
NOTICE TO APPLICANT: IL after making Ibis Cenilicuta of Bn,mption, you should
become subject to the Worker'( Cony,ntsation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONS "IRUCTION LENDING AGENCY
1 hereby affirmthat them is a cons metion lending agency for the perfannwee
of the work for which this permit is issued (Sw. 3197. Civ. CJ
-
Lmder's Name
Lender's Addie..
I rdify lam I nave read thin uppikulin i and store mal the nhovc Inronnudon Is
lee,. 1 agree to svm,ply with 1,11 city and county mdinuncto and state law( relating
a, building con%tmetion, and loco, amhadze representatives ofthi.s city to enter upon
the aM,ve-mentioned pmpeny liar ins,ection purpows.
(We) agree u, sure, inJe,m,ify and keep bri the City of Cupertino against
liabilitiesjudgmems, cases and expenses which may in any way aceme against said
of Ih<gaming wnma.
City in CANT
O�
US ANO WILL COMPLY WITH ALL NON-POINT
UNDERSTANDS D WILL
Issued by: —� Date
y'
SOURCE REGULATIONS.
SOURCE REGULATIONS.
Re-roofs
Signature of ApwnrnWC... lonalor Uma
IIA%ARDOUS MATERIALS DISCLOSURE
Will thel'nwrc hullding:,ccupant.zmm nr handle nazare.as lmuremd
Type of Roof
the Cacmaor
av mimed by the cawc Lim, Mmd,ipm Code. Chapter 4.12, and Bre Health and Safety
Cole, Sermon 255320)I
0YOs
All roofs Shall be inspected prior to any roofing material being installed.
!0
Will the applicant or hilum building occupant use eduipment or devices which
h
If a roof is installed without first obtaining an inspection, 1 agree to remove
emit hamrams. air contaminants as dclined by the Bay Area Air Quality Management
Diemicn___ /
all new materials for inspection. Applicant understands and will comply with
Cl Ye, y�
all non-point source regulations.
I lave recut Ibc Iaranlnul i Ownl l reyuirenII:ala m,dm Cbaper 6.95 of da
Cnlirom)1, Heoltlt N Snfcty Co Sett9) ,x255(1.5,? 55}3 and 25531. 1 und.rnumd t hal
docsnot lyho dos ins oily the
if lire building cy)a�rrIe laint,)hut lay respmsibllity
AenI be CeMrilit • or
ocet, of the na'an is w MCI pr m'gsam ec of a
"'��.�relo
Signature of Applicant Date
/r
rOx'ncr Did
All 'roof coverings to be Class `B•' or better
nr aamnriz Iagent
OFFICE