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02090184 CITY OF CUPERTINO '`' ' - sl' � `V BUILDING DIVISION PERMIT CONTRACT,OO R INFORM'ATION:,^� WFIGjagp32RI'vICKSBURG DR SCHAUMANN AIR CONDITIONING,PERMrrrp2090184 OWDA"All'i HEATING & PLUMBING INC APPLICAJ"-YJ2off'2002 HONE: (408F428-0640 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Ooo LICENSED CONTRACTOR'S DECLARATION r,,f, Description F 1 he chy affirm that I am IivenseJ a cr provisions of Chapmr 9l commencing y}µy/.,Sy.TRrIpl100 w with. lin IXXdof Divisinn3ntN «and Pmfcssipns Oak.and my license is R/R FURNACE & IJ��VJ ll..11 DJ �opu infull 1, n 1e /)/f � Lice n t.X/ ,g�a�3 „-o D�c ,7y,�JTZ/y�ECL <F-1-� d ;� ARCI11y lECIS DECLARATION K 9 a I un eotand y plans shall he used as public records n Oww uS3o Licensed Pn,fcxsional OWNER-BUILDER DECLARATION H¢'�<I I hereby of irm that I am exempt from the Contractors License Law for the $10000 1 0 0 0 0 00 0O hollowing rcaam.(Section 7031.5,Business and Professions Code:Any city or county 9 a'x Be which requires a permit Iti construct,alter,improve.demehih,m repair any structure prior to its issuance,also requires the applicant for such Permit o file a signed statement C&< that he is licensed pursuant m the provisions„f he Cuntemrs Lima..Taw ccbamer n 3&P 000 d0s'ACLO Valuation (commencing wiNSectinn](XXp of Division Jofthe Businecsand professions Codc)or y that he is cacmpt themfrom and the basis for the alleged exemption.Any violation of section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty offy� Occupancy Type ant more than fivenpndmd dollars($50(p. 303 — ROUGH MECHAN CAL I,as owner of the property,or my employees with wages as her sole compensation, will do the work,and the struaore is not intended or offered for sale(See. Business — and Professiacror's ons Cute:The ConlrLicense Law does nut apply to an owner of _ HODS property who bunds or improves Nemon.and whodoessuchwork himsevorthrough his 505 FINAL384 Y� own employees.provided that such improvements arc not Intended or offered for sale.If. 507 — FINAL PLUMBING however,the building or improvement is sold within one year of completion.the owner- builder will ham the burden of proving Oat he did not huild or improve for purpose of 508 — FINAL MECHANICAL sant.). i]1,as owner of he property,am exclusively contracting with licensed convenors to construct the project(Sec.7W.Business and Professions Codc:)lire Contractor's Li- cense law Jens not apply to an owner of property who builds or improves named,and who conlrams for such projece,with a contractor(s)licensed pursuant o Ne Contractor's License Law. I am exempt under See. B&P C for this reason _ Owner Dale r_rFlt�lt .At— WORKERS WORKER'S COMPENSATION DECLARATION tttt{{1t�� p q/ Ihereby affirm under Penalty of perjury one of the following declarations: O(M1T Q 2 LOO`- ❑I have and will maintain aCertificate of Comenttnself insum for Worker's Compcm la1 L cation,az provided for by Section 370()of the labor Code.for Nc performance of the ®�� work for which this Permit is issued. '� 1 have and will maintain Worker's Compensation Insurance,u required by Section BUILDING 370X1 of the labor Code,for Ne Performance of the work for which this permit is issued. My Workkcrs Compensation l donance carrier and Policy number am. Cicrg(//'/ �a�2 Policy --cm OM WOR ERS' COMPENSATION I RANCE (This section need not be cnmple¢J if the pc dit is fnrmde hundred JOI1ars(SlUd or le"I I certify Nat in the pcothource of the work for which this permit is issued.I shall not employ any person in any manner so m to Mcome subject o the Workers Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:11.alter making this Cenilicate of Hacmption,you should heaomc subject to the Worker's Compensation provisions of the Labor Code,you must O Z forthwith comply with such prnvismns or Oi.x permit shall he deemed mvtiked. z O CONSTRUCTION LENDING AGENCY P '4 l herchy allirm Nat there is a construction lending agency lot he performance of 04 > the work for which this permit is issued(Sec.30X97.Civ.C.) n.1 Q LcnJcr's Name / aZ Lc Jcr'x AJJmss J O 1 canify Our I have read this applicmion and sate that the above mhnm,atina L,wP comet.I agree to comply with all city and county ordinances and sate laws relating to 0 U building construction,and hereby authorize representatives of this city it)enter upon the } U.1 shove-mentioned property far inspection purposes. Fd (We)agree to save,indemnify and keep harmless he City of Cupertino against Nliabilities.judgments,costs and expenses which mayin any way accme against said City U Z in consequence of the granting of this Permit. 711 ) r. APPLICANT UNDERSTANDS AND WILL COMPLY Will]ALL NON-POINT Issued by: Date V C/ SOURC ULATIONS. .t actor Re-roofs Si nature of AppiicaHAZARDO �iatc/ IfA'l.AR000S MATERIALS DISCLOSURE Type of Roof Will the applicant nr futum building occupant stow or handle hvaNnus material as Jef neJby the Cupertino Municipal Code.Chapter 9.11,and the Ilcalth and safety Gale.Section 2553x.)? All roofs shall be inspected prior to any roofing material being installed. C Yes ' Will the applicant or future building occupant use equipment urdevices which If a roof is installed without first obtaining an inspection, I agree to remove call hesardous air conammanu as defined by the Bay Area Air Quality Management all new materials for inspection. District' ❑Yes Dg Nn7 I have mail the hamodous\materials mquimmcnts under Chapter fi 95 of the Califoo- ma Ilealm&Safely Code Saatinds 255)5.15533 and 25534.T unJersucal Nat if be wilding does not currently haw a tenant.Nat it is my mspmxibility to utility the racupant of the rcqui xwtdehnottotc mmissaarda'it aCnineamof cPuniq Signature of Applicant Date or ammrirad agent All roof coverings to be Class "B"or better