01100107 CITY OF CUPERTINO NF ';I'
BUILDING DIVISION PERMIT ;'CONTRACTOR`IORMATION:;°
BUILDING ADDRESS: PERMIT NO,
21043 CHRISTENSEN DR SCHAUMANN AIR CONDITIONIsIG, 01100107
OWNER'S NAME: APPLICATION SUB DATE
BAO DAVID H AND FUNG L TRUSTEE HEATING & PLUMBING INC 10/19/2001
PHONE: (408) 428-0640 SANITARY NO. CONTROL NO.
O O ARCHITECLENGINEER: BUILDING PERMIT INFO
m _ BLDG ELECT PLUMB MECH
I7 H LICENSED CONTRACTOR'S DECLARATION Job DesCCI tlOn
y I hereby affirm that l am licensed under provisions of Chapter 9(commencing
u� with Section7000)of Division Sof the Businesrand Ponfic.sip.miCIade,and my license REMOVE/REPLACE FURNACE .
mm "lease Nie Qx1- (70000 BTU)
C 6 License Class Li<.M 7
1 3 Dam Contractor
.E O ARCHITECT'S DECLA l
1 undemand my plans shall be used as public records
j }
i K pO Licensed Professional
' o• �' OWNER-BUILDER DECLARATION
m 1 hereby affirm that 1 am exampt from the Contractor's e:Any
Law f r r
C Z Q fall g reason Pani on] 5 Business and Professions Code Any coy ,or re
O which requires a Permit t construct.alcor,improve demolish,or repair any arm rare
� .pnamuensed p-alsorequ rcs th ishm,o for such pemdvLicensle Ae aw,(Cha mem -- __.. . ....�..._ __ .._..___.__._..__.
=its
step licensed p r ant tdlhe t,a cions of me the Busife add Po Law,(Chapter) 'N p Ikq 7[ oo Area a ; :g,r'S ValuallOn
(c en g with Sectio 70,80)of Division 3 of the Busifesa and Professions Code) M yam,y4. �f y_�.p� y[`i,L,'k.p.id rt_L,
or no,be is eaempe therefrom and the basis for the alleged e}ampnmi Any violation !
-of Send.]031.5 by any applicant for a permit subjects the appin anuo a dAl Many
l of not mote than five hundred dollars(MOO). APN Number Occupancy Type
.°I;as owner of she property,or my employees with wages as their sole compensation. 301 - ROUGH PLUMRTN
will do the work,and the ode:ureThe C not intended Lice a eredLaw for snot(Secy to a,' 303 — ROUGH M)3�ed{I&Wdlil4ictious gr:�=' '"',T:
will do t andwork, and the
strut The is Contractor's License Law does not apply to an
owner of progeny Who builds or improves thereon,and who does such work himself 304 - ROUGH ELECTRICAL
or ilii gh his own empl y provided that h p ova t 1 intended or
sir etion,O'saae.wme er,the b ming -p t g-m we did not year of 505 - FINAL ELECTRICAL'-f � 1 �..:
completion,me owner budder will have the burden of proving that he did not build or
improve rrn paspore nr agile.). 507 - FINAL PLUMBING !,
._.. _ 508' FINAL MECHANICAL_._
y.
plias owner of me progeny.am extlusively connoting with hcenxA contingms to —
?' conswat the'inject(Sec.7tkW,Business and Professions Code)The Contractor's f i
. .i`: 1i ul
License Lew aces not rapply,suc man owner with
property,who builds seimproves thereon 1 -
. ..,and.who,contrecss{Las pmjceis wM e.cammcmrts)licensed pursuant m me.
' Convactars License Law...
s ❑lam exempt underSc PCfar shin reason IOi' r :ICI3oit
WORKER'S COMPENSATIONN DECLARATION '
1 I hereby affirm under penalty of.pe Jury o e of the following declarations: C D
a
p I ha "and will'mn
nlnta -e Carcdmam of Combed to selfnnsum for Worker's FI ��
Compensation,-at;provided for by Section 37M of the Labor Code, for the
'perforinance of the work for which this permit is issued,.) „ (� ( O C 0 O 01
p I have and will maintain Wo ker s Compenseuon Insurance as required by section O C I A J L _
3]00 of the L bur Cod f tti pini{nau ce of the work'fior which this pemvt is
isw d 1 'i C pe I I a Poly be _
Comer �. .l'ol aY No' w � ,�'w� :{?� - ING
'ryt ,1 CA EMPTIO 10 .WORGLRS 1'�� �'+Z.`L t \ '.tB � AA IF Y''l {: .._ .
°- COMPENSATION INSURANCE
GIOSIsneed notheimnphQ ifthepermnis for onehundmd dollars 'r
eaioo'
' (5100)orleu)r - �
1.
VlcentfYthat in the prfo of sthe Winc bor lith th pertnt issued.l v� � ,.c a YiV""Y'r+p i . ..,I',D• '
shall not employ any Pers in any man t-IN COm b)et t thk W rkeis'
p California.'Daie'
Compensation o 'laws f
.
Applicant i ._._. --_-.. . . .
NOTICE TO APPLICANT.If,afro making this C rtificaof of Eaempfo;you"hould '"` sP:vi' - u:'„ ^t
tiecome subject io the Wo ker C mpens 1 n pro i ns
of
th L b r C de,'you mus[
G 0 forth sh ply'di eh pro .ons or this permit shall be deemed revoked. I
V] ,y CONSTRUCTION LENDING AGENCY 31'
A. I hereby affirm that th :b w t I ading Agency for th I rfoim t L., 'a' L, J, ,
F,. Lenders Addrcssr hmspc t ed(5 3097'Ci'C)
z r,.
Ice""'
can f deal
t 1 PF um ordinances e d state law ..•. .-..... . ... . :• .. ...—..' .. .. 1. ..^..........- -_ ._..._..._._. __..._ .
ofm kfor h2
Q Le dors Name
"
h rent It
application dttothat, hove mawstaitiu
kT+O no be I agora'.
comply tin hereby
Au 6 d y s relating
the 2'=gconrw2Fi and heminspeconu represemetives of this city to ether upon
:W the above-mentioned .A.rodeo inspection add
purposes.,, ,,,,,
rya F agree to nave!indemnify end kap ham y in
Ciry of Cupertino ase aid
F % Cliabilities,tyto
9 dgmnce ossa A g of I h h yin any ey acme against said
City n 2 req once of me giant g of ihis Pa.
APPLICANT,UNDERSTANDS AND WILL COMPLY Wf11i ALL'N°N-POINT
1 soURCEREcsuLAnoes P P:9r r - •L.a Issued by: Date
S'gnamre fA iZARDOUSw ATERIALSD(SCLOSURE r
Casoddee mS°WecYItiI othYn e[25p5p3l2 cannnt future°i buN.I.Id.'n1 g a Cuhpeant.m.s�to9�re'd1'.Y2or'ehadndmlee hHazea4NI{thOa_`m 1 sr,tea, roS tiEr S
SarITyPeofR
Foao.'f
na [Y f
v ti6-
!
__All roofs shallbe inspected p
nspected,pnry,o�r to.atsny9h,rro. ofing.matOenal-,being
.installed..---,
nstalled _ . _
ster k�
r LWill me ePplican�or forum building ocevpem use eq 1pmen[or devices.whichIf a roof is instal ledlWithout first obtaining an irispeetiou;'I'agree'to'remove
i ent
cm t heraMous mreo tem nems es defined 6 the Ba Aiea A Q al t Mane em
Di mit] all new materials for inspection. Applicant understands and will comply with
all 'non point source regulations:
'." 1 have rcad'me ha dour'mmenals regmremctits'antler Chepterfi 95'of The 1 ,
if The
building
dos Safety Code,Stenoticant,tit it
and25534..1understand that ;
'-ddiu b'Ioftdcesurrn' 'ly. et 1 that mY largo sbIsy to rich the "' ........ ..... ."... .. .._. _ j
:n
o! pan[of tti quirem t w p issuance of a Cenifica of "
scup nay
.v ,e:
° Signature of Applicant Date
i un be met o to ® - - _ .
!= ow h i �.Cate All roof coverings to be Class B or better
T
. .. OFFICE - - -
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