02060031 CITY DI DIVISION
BUILDING PERMIT CONTRACTOR INFORMATION: '
BUILDING ADDRESS: PERMIT NO.
11228 STAUFFER LA SCHAUMANN AIR CONDITIONING, 02060031
OWNER'S NAME: APPLICATION SUB DATE
DENNIS KURAMA HEATING & PLUMBING INC 06/05/2002
HONE: SANITARY NO. CONTROL NO.
(408) 428-0640
G O ARCHITECFIENGINEER: BUILDING PERMIT INFO
ry— BLDG ELECT PLUMB MECH
te
az I= LJ L._J 1_._1
�Nh
z Z m z LICENSED CONTRACTOR'S x DECLARATION Job DESCrIpt10R
O z— 1 hereby alf rm that 1 am licensed under provisions of.xChapter dx. ud.y Iincmg
_t� is ataion]W0)ofDivisionJofineOusincsxnndPmfessionsCJe.andmylicenx INSTALL 3 A/C UNITS
<y�, .x inmllmrce pr f r 7r
rc ec z a License ass G! r Lic.w
a O
,U Dam SDECL r
u�a O fn t NITECT'S DECLA
F— < 1 understood my plans shall M used as public records
f Y
w i p O Licensed Professional
OWNER-BUILDER DECLARATION
w= 1 hereby.(firm that 1 1. exempt from me esson Cas License city
o for the
z'a ron.wmg reason.(Section]071.5.Business and Professions Code:Any city or county' $9000
g
a O
whicht requires a permit re construct,opera improve.demolish.or repair any stmmurc
a.3'—` ' par lo,its issuance,also requires the applicant for such Permit m file License signed aammem.
mahblslicenmd pSeoinivant mshC ofDii.mof the he mucinsadPmf=ions Code) oys, C-,` Or�ey�,Ea 9 A+ Valuation
orbari He Ai innlSeioniin and he boxision ar theBusinessloandion.Anvi Code) t•j s,,t 13(60VJ�tJr Y:V:V.:
or that h4 is 31.5 bi tany ap li and the basis far he allegcd'e4emptibo.Any violaion
mr saron]B71.5 by any nppfcaaforupermiumbjects the vpPlicam macivil penalty ��pplIuummhh��rr
of not marc than rive hundred dollars 16500). 204 APN UNIIEKFLOOR F RI" ." ,. Occupancy Type
D I,us owner of the property,or my employees with wages as their sole compprouicro
will do thework;and the structure is not Intended or offered for sale(See 7144," '
Business nd'P ufessi a. Cm The C.mmnor a License Law docs not apply to an 3 0 3 - ROUGH MEtY� dpMFetions "'r
owner of pno,eny Who buildv build.or' prove merenn and who does such work himself
or thmughhis employees.pmrdedthat such improvements amnotimmrdedon _ 304 ,_--,ROUGH_ ELECTRICAL___ __
----
offered f .-I 'If however:the building- o em<l is sold w thm ane - - r -
o('
ampleBon men nettw lderwunave te burden of proving that he did not LUJd or 505 — FINAL ELECTRI CAL'''` "'\ "t' '- ' •" '
improve for mrpmeofs.m.). 507 — FINAL PLUMBING
lO1 .ow .11n prpcnY am exclusivelyant i g th fared contractors to 508 - FINAL MECHANI CAli e `
1 o ( t theproject IS ]044Business d Professions Love.)The Commcwr s r r
Licenxlzwdoesnotapplytoanownerofpropertywhobuildsorimprove.thereon. 514 — FINAL PUBLIC WORKS'
.and.who cuntmcts.for.such Protects with a conrucmr(s).licenced pursuant in she ._ _._.__ _..__ .. .__._ _. .._.....____....—_.____...__.—. ........_.____._.__...___... ....._.._......_... ..
Cmnmcmrs Lian.e Law .. .
❑ImncaemPtud.cr Sec:'___r"__B&11Cfonhis reason INAp G'G® j `� f:M1 j'•1'+Is
Owner' ' 1 'Dae' ' �s
' WORKER'S COMPENSATION DECLARATION O �QOrs
hereby oR,munder Penalt;ofpe yoneofthefollowingaenlaradons: SUN 2 L
D 1 have and will'mainmin a Cenifcate'of Consent to sff-insum fur Worker's
Compensation, as provided for by Section TIM)1.of the Lobar Code, for the
hich this peBUILDING
S performance of the work fn;wrmit is issrmJ.,
_ O 1 have and will mainioin Worker's Coii euxatiun fnsuimcc,its required by Section
J](NI of the Labor Code,for the performance of the work'for ,huh this Permit,is
issued
My r et:C p eon lnsu - mer and Policy number
Cam tpul yN + " q. , a I} 1sM1 .;'r'.I\'s t•Y", ....,.li
Q CER IFICA1 ION 01'E%EMP110N FROM W
COMPENSATIONINSURANCE "c "" r _ —..,_ ._....
''(This Jeairin need'nnt be completed if the permit is for one hundred dollars •' \ ",I's j ' .f -
01000 'less.)
.1'irdfy fmthe Pe aor a,na ftp skf A htb xpatrona erimrI
eh m but employ a ry person m any my as ro became subject to the Woken I• `
Cpplwwrsbiion Laws or Cnlifomia,hate
if
NOTICE sbOAPo the `fr:9B or Cumpensrouthis Ce".a,i of Labor ion,you s
forthwith
n n1 ct t the Walter. .. p t o p rf th Labor Code d. most
0 � fdnh th comply with h p '.' this
h pc t hall b J d k J
'z. .... ._ ..._... ._. ._._.... ._... ...... . . . .. _ _... — 'V
CONSfRUCTTON LENDING AGENCY I
1hany aftiou that there onyi cu ndng age cy for me,pepiioapmc .. ft
`. oldie ovule for which this permit isd(Sce.7W7C C)
6.�sQ -L'cml Nm _ t . . .._ _.......... ._ .._ . ..__.. .._ _ ._ A ._ __._ _.. ...
LePJ AJJ - ` ,dt
C.7 Icer 1,chatlharmnxarlthrsappwafonand ate mot theinformation's
fz.f•" comdt lagrce t comply with all cit)and county ordinances and state laws mlat ng
0'V
:.buildingc t d and
oyf by m e p t ive of th cry's erect upon
�y W he M1 r t d p p nY f .pen n
E„y IW 1 g s d 'fry ses two 'i[t City rC'p too against /
V] Ch t judgments. t Jing of t two Y 'mY Y 8aina said
U,Z, Cry o sTQNr)cofm g tingof th perm's - �•
SOORCA,NT-UNDERSNS: . ;1 ND WILL COMPLY WITH ALL NON POIYI" ;%
sBURCEREO uLdnDNe: :�, .', ., . � Issued by: Date
Signamc ornrppeittivcontracmr - , Date Re-roofs
. u c t t r(marc bu Idin < pant start '
HAZARDOUS MATERIALS DISCLOSURE
wore pp� g m nndlehuardb.s Genal .Type of.Roof. _ _... _.. ... . m . . - . r ., .
hs def d byrdi Copen no Munici Cod Chapter 9 12and theHealth and Safety
Cale S it o 255a'_mI r .r7 t z Y s t
1
IDy,y. l No ., r
1 1 t + All roots shall be inspected.prior to„any roofing,ma[enal being.installed. ,
- -
N Il the h mo f t bu ld'n occu am x t de ce 'h ch
pP B P 9 P If a roof is itistalled without first obtalmng an tnspecaon; I agree to'remove
emit hrdo tom ren t dmf dbS theBay Arc Air Q Quality Management
7 D t n Y. all new materials for inspection. Applicant understands and will comply with
p alt non=parersource regulations „
1 hme neadnhe hazardous materials requirements under,CM1ap¢r 695 of the
Cr'lifvnia Healm&Sufct,.Code,Secti.ns 25505.25573 and 25534.1 undersand that
if the 1,is ing Joesnut curendy have a tcnnm;mo it sunt responsibihtyro mud,the ”" '-' ""'"_. . . . _...._..
occupant of the requirex
which m .trot us,b pno,to issuance face ifca.of
awner. /A
mnuda � t , ( v. Date .
Signature of Applicant Date
ne a.nro
All roof coverings to be Class "B" orbetter - '