02060004 (2) TINO
CI BUILDI C DIIVIISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
: '22156 CLEARCREEK CT SCHAUMANN AIR CONDITIONING, 02060004
OWNER'S NAME: - APPLICATION SUB DATE
ROBERT CLIMO HEATING & PLUMBING INC 06/03/2002
PHONE: SANITARY NO. CONTROL NO.
:... ..
i:' a (408) 428-0640.
.pW O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
g BLDG ELECT PLUMB MF,CH
Z S v=mi i LICENSED CONTRACTOR'S DECLARATION Job Description
O -o I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing P
<-t-j
sLiicmScel'C000ba,,y [DivisionJoftheBusines
sandProf
essioane myR,e REMOVE &
REPLACE FURNACE, INSTALL 4.
TON
enss C
Lid.x77 A/C UNIT
3au Dme �g� ARCS DMLARATI
I understand y plansshall be used
as public recoMs
a y H 1�4f a OWNER-BUILDER DECLARATION -
1. i1 hereby affirm on 1 am eBusin from the mWortstor'a Liana Law for the
t? following requires
mason,(Section]03L5,Business and Professions Cad,:Any city ore stricture SFC
which q person w c mints h p demolish, p any swaum
cis .-poo tot also rtq sin PPI' tf hpemi tt fl gruel smmmm�t
Ibt6e mi nxdp rsoammm)) si ar of heBusi e L xLa fnsCod9 „t Sq.-FL.Floor-Area1 74 , luation
.{c n 6 lM1 Sen '!qM)) fDi ' on3ofm B ❑P Professions Cada n V �,at !;j
or that he Is exempt therefor n and the basis for the allegca em npaon Any violation
-of Section703 L5 by any applicant for a permit subjects the applicant o a civil penalty
of war mom than five hundred dollars(5500). 3 2 fn r Occupancy Type
i -01 of the prolarty,or my employees with wages as their sole comp,. t n,
- 11 TTbz111,IJ
-w ll:e thework.-and'm avaure Wom intended or offered for sale(Se ]011,' - --- pptp -- - -.------ -_.-_ _..
tB . i d P fes:' Cem The Convenor s License Law does not apply t an 303 - ROUGH ML'+C;) IASBeCtlon$ ' :t'",i F
owner of property Who build,or improves thereon,and who does such work himself
or through his own employees,provided That such improvements arc not intended or 3 0 4- — _ROUGH-..ELECTRI CAL.__ ------__.
'off Tee for s heflLhavi5verethebuilding thor urden of prove old within one yea of -- --' _" ---_ - -"- - --- -- -'-'-- --'
'anppl rrove f or r m fb—act-builderhave m Imd rp gm to did tbafle or 505 - FINAL ELECTRICAL
(L p . a , n
507- - FINAL PL_U._M.._B.
ING
p prp e ly Gg ml mismatches to
c t t projetf(S IB Pofe.on Code)T C t m's 508 FINAL MECHANICA
L
License Lawd«s oto an owner f prepeyhoId. p cs m
,and ho contrast,fo.1mchP.j s m c mrs)L<sJ at. Nie
Czrdm,lj,�
...-....-..._._ _. .. _ _ /
V
c '. OI nor,eardopt under See.Tse_ B&P C for this on
0 net - `Date
'
WORKER*S COMPENSATION DECLARATION
lhanday.fliormader penalty of p rl Y rte of the f II ng d I anions '
0 1 have and well matemain'LCiatificine of Ci—rant to self for Worker's
I Cdmpq,.6daITpmriidmfor by'Se t 3]00 of the labor-Code, for the -
"performa' 'of the work f&whichthis,pa.,.I,is,,cd.l... ,
O1 have and will m m n Worker's Co pensm nn'Insuea e,-as r,qu red by Section
f m tabor Cod fo m<pcRo e f rhe-wo k f huh the pc t's '
twcf My
Carfi< s -It'LPoI cy No./Ly(p/ w/ ._._ .. ._ ,Y g •__r... ._....._ ,e. ..
"LIiRI'11'IGATIGN OF E%EMI'TIO FROM WORKERS s^; ..j r Is. 4t�' T 51 t ,'�' ! Y5}i., � ,l . � '
_ .•" C_OhIPENS_ATION INSURANCE t _ ,____,-_, ,.__._. ._ _._.__.._.._..._-_�.- ..
(lTis action need not be completed if the permit is for one hundred dollars , -
(SI00)orlss.)
bu my . m p I m at did kfwhichm perm ti
' ,s d I
ch II t pl Y y P< y ma as m hero a blest t Me Wo k rs
Citrus pcnvm,laws rCal,rom o.Dad
.AIF icmn' :. ,.. ..
APPLICANT
z NOTICETOIf kgm.Cnfct lEiya hind0. i ,16the%;m C t pts ofm L ebrGd you mustQQforth di comply with suchpops r.s ifi the permit shall be deesed
revoked -
F=�
CONSTRUCTION LENDING AGENCY. : ' ' fi♦
I h R by lh tlliamth n t cidig agency for the performance .. ,.1
of the kfthat,'Immi,is,au d Sm.3097Civ C) '
UQ
„0 1 card fy that 1 n read m ppl t o d tam thatth boinformation a
f+.E_ c Tract 1 agree
to ply y with II ' and county rd a i and state refining
It
Q...r) inn W & t t Jh by amts p eimtJ rths cry a,e to upon
.,j.':W the abswe mem once properly for nspemm�purpoxs. -
..E..y' f We)agree io sale,indmostly and keep harmlcsi me City of Cupertino agaima
'tO
liabilities.judgments.cost, d xpcnx h ch y'n any y cru against said V
`..Ia 7-. •Cry in done9 ce of g t g of this
yy LCO y,•
f `.\j'PI ICANT VD'TNSTAVOSAND\t ILL COMPLY WITH\LL NDN-POINY ' ;�
souxta'REu�uLArlow$1 r �s.,. a . ,. Issued by: ��Dat
Signior,of ApplmaMContranor f, ",Dam. ;. '
HAZARDOUS MATERIALS DISCLOSURE . - Re-roors
1'' `;Will ffipiiii-can H firt6re building occupant stort or handle haseckir,an al _.,Type of Roof..._
5y dfndbyfh CremonaM pl,Cd Chpt 9.1 , dth Health adsfty "' "" " "'" --'• •-
CW S 255111 ) _ 1..
❑Yv , Co(N' rrt. - , .. L• .h-,+- y .
All roofs shall be inspected prior to any.roo5ng-material being installed __
NJIm ird applicant future building occupant Bay
yAea pet devices which If a roof is installed'without first obtaining an inspection; I'a agree to'remove
emit h do. onm tva.'dfnenyih 'ByAr, Air Q IryMawg m g p g
District' all new materials for inspection..Apphcag[understands,and will comply with _
all non-poli t source regulations. . .11 ,:,
I have d m haziido s mmen I. i mments u d Chapt r 6.95 of me
Cal f bin a Hi—]'W&Safety Code.Selfirs,s 25505;25533 and 23531 1 understand but
if do building due,ntcmrc tly haveY , t)notify m - - ._. .. __.. .:. .. .. _ .. .. _ .. ....
«Su 1 m rtqu regm nt, ch YD/apSignature of Applicant
roof coverings [o be Class - -
at tt that m
�` cy/�gmu�b t p m issuance.t o Cc f m f
C `a p _ - Dale _ . .
author zed a .. 1:
p..• ss "B" orbetter
OFFICE .. ..