03030064 (2) CITY OF CUPERTINO 0v(��yy*��'.%''E t x�7f�r *ro}a' y:ky7v�A �y�x '
BUILDING DIVISION' - PERMIT
BUILDING ADDRESS: PERMIT No.
SCHAUMANN AIR CONDITIONIN
OWNERS NAME: HEATING & PLUMBING INC PERMIT Ls A
PEGG
E`
(40.8) 428-0640 SANrURYN 13 2 CPoil'T'ROL N0.
ARCHITEC IBNO1NEER: BUILDING PERMIT INFO
f� O PLUMB
REICH
�o Zp LICENSEDCONTRACIOR•SDECWRATION
J 1 hereby afErm that 1 em Ilcen under provisions of Chapter 9(commencing Job Description
with ScpIlan 7gNl)ofDivltion3ofN atvaa and Pmfushms Coegmd my lkcnse is
(y�lame ff PINALED
LIaSt.Cl. 0d• Lle.g ��� � A/C UNIT
n lit m[ RATION p (�'
A0. ITECf DECLARATION .AUG "1 8 2003
1 un a myell d u Puhli rd. -
5
s o I Lice d Pmfeariosnl -
OatNEmBUILDER DECseRATION BUILDING
I hereby.ofErm(Su a n 1 em exempt from Nc Conlnaor1 e:LicenseAny
Law for the�GC whichfollowing maon.Permit
7fD1.4 Business mrPmfesdnnc CMt:Any city ormumy
5$ which rtquirtu n permh to construct.the Blur,improve,donalh permoh,m e a my mamm
_Zr pdamiu issuance.tleu inquires lW applicant(or such permitm rile ulgnM.tsmmcnt ,
G that he is licensed pursuanttotheprovisions OfthmConlnemr'fLcen.UW(Chapter 9 Sq.Ft.Floor Area $ �I��lon
$ (commencing with Section 7000)of Donator,3 of the Businnsmd Profusions Cralor
that he is exempt thcmfmm and the basis for dm alleged exemption.Any violation of w.� 1,.,
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3AffiyI$IIDfOS"O t) Occupancy Type .
not mon Nan five hundred dellen($500),
0 1,as owner of the property,at my employees with wages as their sole compensation, ,.AA
will do the work and themunme Isom Imarrcd aroRered for..1.(See.701 .11011 ea — ROUGH 11 BE
and Pmfaastone Code:The Conuearer's Licence Law does not apply to an owner of '
property who builds or improves thereon.and who doessuch work hlmselforthrough his 1304 ROUGH E ECTR .CAL
own employees,provided that such lmprowments ere not intended oroRered for sale.It. fjpCj — FINAL .ELECTRICAL .
however,the building or improvement Is sold within one year ofcompletlon.the owner.
builder will have the burden of proving Nat he did not build or Improve for purpose of SOS- — F I NAL MECHANICAL
❑1,as owner of the propenY•am exclusively Contracting with licensed contractors to
construct the pmject(Sec.7041,Business and Professions Code:)The Contneur's W- . .
came Law dos nor pply to an owner of property who Wilde m Improves human.ad
who contracts for such projects with a Contrumf(0licensed pursuant to the Contnctml
License Law. -
❑IamexemptunderSee, .B k PC for this ream
Owner Data -
WORKER•S COMPENSATION DECLARATION
I hereby aRnn under penally of perjury oro of the following declarations:
t
_ hew end w111 msinWna Ce rimmof Co=nitowlf.fnamfor Waneri Commn- -
ation,as provided for by section 37M of the Labor Code.for she performance of the
work for which this permit is laved.
0 1 haw and will maintain Worker's Compensation Insurance,as required by Section
370D of the Labor Cade,for No performance of she work for which this permit 41aued, "
y Worker' Compo.it�In5ura roe carrierand P�otlicy number me:
is a— 'dT/F7�E' oil . 2d - - ..•.
camer:�--r— p cYFit
CINTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
IThIs secOon need not he completed if the perealt is fnonehundreddollan(6100)
employ Ne tinthe to anymumof the workfor which Nis permitrlIsseedm Nell not
Lawso any person In any mmeer an a b became subject to the WOrkcn'Compenatim
Lewy of California.Dees
Applicant _
NGrrom subject
APPLICANT:a Our making this Certificate of Labor Exemption,you should
.,Obeeome abject m tic Woh pre hic.or don provisions of be tedr CMB,you most
forthwith comply with such pmvisiens or Nu permit.hatlWdeemM mvrrked..
,zt.~ CONSRUMON LENDING AGENCY
Nr
E' I herby affirm that there its construction lending agency for the Performance of .
tYi> the wort for which this permit Is laved(See.3097,Civ,C.) -
w Q Larder's Name
z L.nder'a Address
U0 I Certify that I hew mad this application and more that the show Information Is
IL F correct.1 agree to comply with all city and County ordinances and sou law.mlating to + . . .. .
OU building construction.and hereby statement mpresenotiws of this city to error upon the ,
W .how-mentioned pmpcny,for Inspection purposes.
Ly, (We)agree to am;indemnify and keep harmless the City of Cupertino against
cn liabilities,Judgments,casts and expenma which may In my way accrue agaial Mid City
C)z In consequence of the granting of this Permit.
t`+ APPLICANT UNDERSTAN ND ILL COMPLY WITH ALL NON-POINT Issued by; l/ /UU1/ Date /
SOUR E ULrTION
�✓ 4"� Re-roofs
y gas urtofApplirmAAZZARDOUSMATERIALSDISCLOSURE Dan Type of Roof
Will Ne applies"or future Wilding=opal store or handle havardoa material
U defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and safely
Ma.SecdnYesr 15531(nPX.-7 All roofs shall be.inspected prior to any roofing material being installed.
❑
Will the applicant or future Wilding Occupant use attainment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
d hanrdnes pin cnnmminants u defined by the Bay Arca Air Duality Management all new materials for inspection. '
imict7
[]Yes nom.N4.�.• -
I hew mad the hmardrms meuriaorcquir menu under Chapurli.95 of the Califnr. �
ilioHo41N♦ESdetyCodc,Sccdua255R5,Z533wd15534.lurKkm rich IfNcadWing -
d not C...11y hew a meant.Net it I.my responsibility to no be •cupat of the
tomorrow chmustW tprior ssuaccofaCenif, we prey. Signature of Applicant Date
ownamanmerimE,gen, nem All roof coverings to be Class"B"or better