01100045 OF
CI nut DING DIIVISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22205 VIA CAMINO CT SCHAUMANN AIR CONDITIONI G, 01100045
OWNER'S NAME: APPLICATION SUB DATE
GEORGE KITAGAWA HEATING & PLUMBING INC 10/09/2001
' _ (408) 428-0640
PHONE: SANITARY NO. CONTROL NO.
G c Z ARCHITECIVENGINEER: BUILDING PERMIT INFO
ad BLDG ELECTPLUMB MFCH
h Z LJ I'—U E.JZ' LICENSED L_.I
'S DECLARATION
S 1 hereby offrm the I am licensed under previsions of Chapter 9(commencing Job Description
�ytt°u with Section]000)of Division 3 ofthe Business and Professions Coda.and my license REPLACE FURNACE &
ee.iciaa �ieaa,aCi :eseGL, Lisa 770. REPIPE & WATER HEATER.
°"° Com�mnl (90IK BTU FURNACE &
3 u y
ARCHITECT'S DECLAR
1 undersand my plans shall be used as publi rte
3 p O Licamed Profbssice.1
OWNER BUILDER DECLA ON
o y 1 hereby affirm that 1 am exempt from the Contracmr's License Law for the
F Z Q following reason.(Section 7031.5,Business and Profusions Code Any city or country
F C which rest apermit to construct,sIter,improve,demolish or repair any stractum
3m prior to its' also requires the Wheam for such pemuuo file a signed amtamatn.
Lost he islicensed pennant o the provisions of the Contmcmrs License Law(Chapter 9 S Ft. Floor Area -- .tion
(commencing th Section]000)of Division 3 of she Business and Professions Code) 't j nr I } ...9'f•.1 f'� r. L /t f L .,i%f'' $13 5 4'
or that he is exempt therefrom and the basis for the alleged exemption Any violation I
of Section 7031.5 by any applicant for a permit subjects the app)icam so a civil penalty
of a.,moreman five hundred dollars($5oo). 3 2 6VM";rtb9r0 Occupancy Type
01,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and be s ortme is not intended or offered for sale(Sec.7044, 106 — SEWER & IdaTli)tI 1Mnspections
dozens.and pretensions Code.The Contractor's License Law does not apply to an
owner of impeny Who builds m improvas thereon,east who does such work himself 202 - UNDERFLOOR PLUMBING
or through his own employees.provided Nat such improvements proveents are not intended or
offered for sole.If.howc cr,the building or improvement is sold within one year of 301 - ROUGH PLUMBING
iimpletion,the owner-builder will have the human of proving that he did not build or
mprove for purpose of sale. 302 - TUB & OR SHOWER;
❑1,asowner othe proparty,con exclusively contmdinwimransedamide:atom. 502 - FINAL PLUMBING ENERGY
construct the project(sec.Tf)a4.Business and Profess?as Code:)The Comments, 506 - GAS TEST
License Law docs not apply m an name,of pmpeny who builds or impmves Nareun,
and who contracts for such projects with a convenors)licensed pursuant to the 507- - FINAL PLUMBING -
Convectors License Low.
IID 1 am exempt under Sec. B&P C.for this reason t -
Owner Date FINAL.ED
WORKER'S COMPENSATION DECLARATION
1 hereby affirm.under pcnehy of perjury one of the following declarations: 1.
A ❑ 1 have
maaa will maintain a Certificate of Consrnt to scB.inmm for Worker's NOV 1 V 20 O't
Co ,sonadon, as provided for by Section 37W of the Latin, Cada, for the I
pafmmance cf the Work for which tins permit Is issued.
❑there and will maintain Worker's Compensation Insurance,as rcgaired by Section BUILDING
.. 37M of the Labor Code.for the performance of the weak for which this permit is
insured. or P � Tatumes carrier end Policy number me:
t kcs Co. . tion •,_ _ ,. _
Policy No
CERTIFICATIONOFEXEMPTIONFR ORKE
COMPENSATION INSURANCE `
(This section need not be complded if the permit is for one hundred della.
(SI00)nr lass.)
I canify that in the parkmarmace of the work for which his permit is issued,1
shall not employ any person in any manncgso as to become subject to the Workers
Compensation laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
bosubject to the Workersprevisions Compensation pvisions of the Labor Cade,you must
Z Oecme forthwith comply with such provisions or this permit shall he deemed revoked.
V� CONSTRUCTION LENDING AGENCY'
a ' 1 hereby affirm that there is o rowdi
nsclm.landing agency fm thrm
e perfoance
kl of thc work for which this permit is issued(Sec.3097,Civ,C.)
G A Isnder's Name
ZLender's Addrers •-
C.) 0 1 certify her 1 have reed Nis application and s.,a mat the z"a information is
W I'^ correct.1 agree to comply with all city and county ordinances and state laws relating
Q f..) m building construction,and hereby authorize repiesentativu of this city to enarupon
ythe above-mentioned property for inspection purposes.
' (We)ti a cove,indemnify and keep handless the City of Cupertino a gain.
eA liabilities,judgments,costs and expenses which my in any way accede against said
U'Z City in consequence of the granting of this permit,
^
APPLICANT UNDERSTANDS�DWILL COMPLY WITH ALL NOPo Issued by: Date
i E NATI NS.
ign e f �rq DOUS MATERIALS DISCLOSURE ie Re-roofs
Will me.,Iicunt or farm,building eceupantslow or handle hazwdem,matarird Type of Roofas defined bYlu,Cupertino Municipal Code,Chap ar 9.12,and the Health and Safety
Code,section 25532(.)' 'a 'tl
ova. ❑Iva,' ._ 'ir; All roofsshall beinspected prior to any.roofing material being installed.
Will the applica riefumre Wilding uce.pamuseasimpmant.,devices which If a roof is installed without first obtaining an inspection; I agree to remove
emir hazardous air comaminams as defined by to Bay Area Air Quality Managamam
Diovan all new.materials for inspection. Applicant understands and will comply with
R -+� 0Y. ❑No all non-point source regulations. ,
"1 have mad the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505.25533 and 25534.I undersand that
if the building dues not current y have u.nam,that it is my responsibility to mork the
occupant of the requirements w ua,be fact prior to issuance of Casif�,t/o of
cm , /D g 41 Signature of Applicant Date
_
Me .mixed agent Data All roof coverings to be Class`B" or betier
OFFICE
.r t
OF
CI nut DING DIIVISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22205 VIA CAMINO CT SCHAUMANN AIR CONDITIONI G, 01100045
OWNER'S NAME: APPLICATION SUB DATE
GEORGE KITAGAWA HEATING & PLUMBING INC 10/09/2001
' _ (408) 428-0640
PHONE: SANITARY NO. CONTROL NO.
G c Z ARCHITECIVENGINEER: BUILDING PERMIT INFO
ad BLDG ELECTPLUMB MFCH
h Z LJ I'—U E.JZ' LICENSED L_.I
'S DECLARATION
S 1 hereby offrm the I am licensed under previsions of Chapter 9(commencing Job Description
�ytt°u with Section]000)of Division 3 ofthe Business and Professions Coda.and my license REPLACE FURNACE &
ee.iciaa �ieaa,aCi :eseGL, Lisa 770. REPIPE & WATER HEATER.
°"° Com�mnl (90IK BTU FURNACE &
3 u y
ARCHITECT'S DECLAR
1 undersand my plans shall be used as publi rte
3 p O Licamed Profbssice.1
OWNER BUILDER DECLA ON
o y 1 hereby affirm that 1 am exempt from the Contracmr's License Law for the
F Z Q following reason.(Section 7031.5,Business and Profusions Code Any city or country
F C which rest apermit to construct,sIter,improve,demolish or repair any stractum
3m prior to its' also requires the Wheam for such pemuuo file a signed amtamatn.
Lost he islicensed pennant o the provisions of the Contmcmrs License Law(Chapter 9 S Ft. Floor Area -- .tion
(commencing th Section]000)of Division 3 of she Business and Professions Code) 't j nr I } ...9'f•.1 f'� r. L /t f L .,i%f'' $13 5 4'
or that he is exempt therefrom and the basis for the alleged exemption Any violation I
of Section 7031.5 by any applicant for a permit subjects the app)icam so a civil penalty
of a.,moreman five hundred dollars($5oo). 3 2 6VM";rtb9r0 Occupancy Type
01,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and be s ortme is not intended or offered for sale(Sec.7044, 106 — SEWER & IdaTli)tI 1Mnspections
dozens.and pretensions Code.The Contractor's License Law does not apply to an
owner of impeny Who builds m improvas thereon,east who does such work himself 202 - UNDERFLOOR PLUMBING
or through his own employees.provided Nat such improvements proveents are not intended or
offered for sole.If.howc cr,the building or improvement is sold within one year of 301 - ROUGH PLUMBING
iimpletion,the owner-builder will have the human of proving that he did not build or
mprove for purpose of sale. 302 - TUB & OR SHOWER;
❑1,asowner othe proparty,con exclusively contmdinwimransedamide:atom. 502 - FINAL PLUMBING ENERGY
construct the project(sec.Tf)a4.Business and Profess?as Code:)The Comments, 506 - GAS TEST
License Law docs not apply m an name,of pmpeny who builds or impmves Nareun,
and who contracts for such projects with a convenors)licensed pursuant to the 507- - FINAL PLUMBING -
Convectors License Low.
IID 1 am exempt under Sec. B&P C.for this reason t -
Owner Date FINAL.ED
WORKER'S COMPENSATION DECLARATION
1 hereby affirm.under pcnehy of perjury one of the following declarations: 1.
A ❑ 1 have
maaa will maintain a Certificate of Consrnt to scB.inmm for Worker's NOV 1 V 20 O't
Co ,sonadon, as provided for by Section 37W of the Latin, Cada, for the I
pafmmance cf the Work for which tins permit Is issued.
❑there and will maintain Worker's Compensation Insurance,as rcgaired by Section BUILDING
.. 37M of the Labor Code.for the performance of the weak for which this permit is
insured. or P � Tatumes carrier end Policy number me:
t kcs Co. . tion •,_ _ ,. _
Policy No
CERTIFICATIONOFEXEMPTIONFR ORKE
COMPENSATION INSURANCE `
(This section need not be complded if the permit is for one hundred della.
(SI00)nr lass.)
I canify that in the parkmarmace of the work for which his permit is issued,1
shall not employ any person in any manncgso as to become subject to the Workers
Compensation laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
bosubject to the Workersprevisions Compensation pvisions of the Labor Cade,you must
Z Oecme forthwith comply with such provisions or this permit shall he deemed revoked.
V� CONSTRUCTION LENDING AGENCY'
a ' 1 hereby affirm that there is o rowdi
nsclm.landing agency fm thrm
e perfoance
kl of thc work for which this permit is issued(Sec.3097,Civ,C.)
G A Isnder's Name
ZLender's Addrers •-
C.) 0 1 certify her 1 have reed Nis application and s.,a mat the z"a information is
W I'^ correct.1 agree to comply with all city and county ordinances and state laws relating
Q f..) m building construction,and hereby authorize repiesentativu of this city to enarupon
ythe above-mentioned property for inspection purposes.
' (We)ti a cove,indemnify and keep handless the City of Cupertino a gain.
eA liabilities,judgments,costs and expenses which my in any way accede against said
U'Z City in consequence of the granting of this permit,
^
APPLICANT UNDERSTANDS�DWILL COMPLY WITH ALL NOPo Issued by: Date
i E NATI NS.
ign e f �rq DOUS MATERIALS DISCLOSURE ie Re-roofs
Will me.,Iicunt or farm,building eceupantslow or handle hazwdem,matarird Type of Roofas defined bYlu,Cupertino Municipal Code,Chap ar 9.12,and the Health and Safety
Code,section 25532(.)' 'a 'tl
ova. ❑Iva,' ._ 'ir; All roofsshall beinspected prior to any.roofing material being installed.
Will the applica riefumre Wilding uce.pamuseasimpmant.,devices which If a roof is installed without first obtaining an inspection; I agree to remove
emir hazardous air comaminams as defined by to Bay Area Air Quality Managamam
Diovan all new.materials for inspection. Applicant understands and will comply with
R -+� 0Y. ❑No all non-point source regulations. ,
"1 have mad the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505.25533 and 25534.I undersand that
if the building dues not current y have u.nam,that it is my responsibility to mork the
occupant of the requirements w ua,be fact prior to issuance of Casif�,t/o of
cm , /D g 41 Signature of Applicant Date
_
Me .mixed agent Data All roof coverings to be Class`B" or betier
OFFICE
.r t