01030003CITY OF CUPERTINO
iunfntna DIVISION PERMIT
CONTRACTOR INFORMATION: !
BUILDING ADDRESS'.
PERMITNO.
10146 CARMEN RD
SCHAUMANN PLUMBING
AND HEATING01.030003
OWNER'S NAME:
APPLICATION SUB DATE
IMMS JOHN A AND HELEN
�.
1455 LAUREL6100D R
03/01/2001
PHONE:
SANITARY NO, CONTROL NO.
(408)986-9044
' ARCIETECrfENGINEEIL
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BUILDING PERM] 'I'INFO
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RLDG ELECT PLUMB MECH
I
�J 1=7 C1 CI
LICENSED CONTRACTOR'S DECLARATION
Job D6scrl
1 hereby anion Thal 1 um licensed under pro einas of Chapter 9 (cummencing
P tion
jwith Scdion 7000)of Division 3 of the Business and Protusion, Code. and my her.,,
1'e,_n� �0p�1_
Ciccone CLus
lellrzce
_ l . U Lim. p
Dae
REMOVE 8 REPLACE FURNACE (115 000BTU)
T
Comrcno
be DECIA r
shall
nenun yp.m, shall MuseJmpublic aoMs
use
Licensed professional
OWNER -BUILDER DECLARAHON
1 hereby alum that I am exnnpt from the Contractor's License Law for the
following moven, (Section 9031.5. Business and Professions Cale Any city of atony
which retinues a Permit m eonstuct, cher, improm, demolish, or repair any swduic
pHot ser its i ... arm, a6o requites the applicant hor.wcn haemi, I. file a signed statement
that he is licensed .,as It the pulsions or ore Cm,factors Lice nm Law(Chnpmt 9
S Ft. Floor Area
fl'
Valuation(mmnurncing
with Section70y0) ill ' DiOslnn 3 of the Business and Professions Cale)
or that he is exempt there ions and the basic for the alleged excmptian. Any violation
of Section 7031.5 by any applicant forst permit subjects the applicant m u civil penal)) •
of not mo
an mmi re humped dnlleas(S5(x0.
APN Number
Occupancy Type
01. lum,nerafthn property..,> PIBY - In .,c,tb 1 pc satins
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w m , . A and structure,
wilIl J :still - a no Code: Connector's L does, Iapply loan
t t t ended I offered 'I (ti. 71,14.
owner of n) Who builds or improves thereon, and who su
dues ch walk himself
Prgertrough
his own employees. provided that such i e, ..ccments ore out intended or
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oleand Eor xAv. If. howovw; ma building or lapse iteral is thsold wlmin one year ed
oodelion. e awncr-builder will have the burden of bar he did build
^1 .r 5 8002
JAN
proving nal ser
improve rnr purpose of sale.).
JAN 1 L
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❑ I, as nem+nl nm pmpevty, tun exclusively emnrcIin, won licensed conmactnrs to
.
construct the project (Sec. 71M. Business and Protessions Cale:) The Con emnor's
BUILDING
License Law does not apply to an owner of progeny whit builds or improves thereon.
:
and who storms for ...a projects with a xammmmfs) licensed pufsuunt no the
Contractor, Licence Law.
O 1 am exempt under Sec. , B & P C for tris mown
Owner Date,
WORKER'S COMPENSATION DECLARA'I'R.3N
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I hereby affnn under Penalty of Pe jury one of the fallowing declarations:
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❑ 1 have and will maintain a Cenifcate of Consent to selhicum 1'or Workers
Cnmpensaion, a, provided for by Section 37M of the Lahr Code, for the
perfmntance of me work lir which thin permit M-0
❑ 1 have and will maintain Worker's Compensation Insurance, as raptured by Section
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3710 of the Litho, Cede, rnr the perlirmtnce of the walk far which Ili, permit is
t,xucd M sCmn �Jbnsmm�envarier��;ajid`�P�oohn.�..m�nnnfe, am.
Cees^'-(.: pLVU C�!
CER IIdCAT1UNOESAI 1f WOkKIiRS'
' COMP[NSAI'ION INSURANCE.
INSURANCE
r
(This wain. need nrn be completed] KIM permit is tiro one hundred dollars
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($101)orlcxe)
1 cenify that in the performaner of the work for which this permit is issued, 1
shall not employ any Person in any manner no as to become subject Io the Worker'
CnmEensation Lew,of California. Dum
Applicata
NOTICE 10 APPLICANT: If, after making this Certificate of E.aemptilcm you nnould
bcmme,ubjcd niche Wndcfs Compensmiar pmviatur ofthe Labor Calc, you ..,I
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Gmhwith anamly .In Inch prwisiens or thin palinal ,hull be Jamas) revoked.
CONSTTRUM ION LENDING AGENCY
I nereby aBirnn mat there is a nmstmnian leading ngeney lior the Pcd,),n,nn,c
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of the work fel which thi, pennil n issued (Set. 9197, Civ. C.)
Lender's Name
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IsndeL,AJdress
I certify thnl I alln mal this illoicahrn and clam that the above lot union in
ren. I ague to comply with all city send county am inances and lore law, rehim,
to building construction. and hereby arehnrze reMemrnanlves of this city m enter upon
one ubwe-a celimmd Pmlxny far imeclomparvo
(We) agree, nave adcamiry and keep haroncis the City of Cupertino against
liahilities, judgments, costs and expenses which may in are, way acerae against said
City in con ommirm of the guorm, ai this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POW7
SOURCE REGULATIONS.
Issued by: �� Date
Signature of Appnc:m✓Cnmrctor Dum -
Re -roots
HAZARDOUS MAni RIAI S DISCLOSURE
Will the applicum or Rome luildingoecupan..arm or hmdlc Mexicans material
Type of Roof
as defined by the Cupcnino Municipal Code, Chapter 9.12, and he Health and Safety
Code, Section 2553-(u)P
El Yes ""n
,
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All roofs shall be inspected prior to any roofing material being installed.
' Will he applicant are rnitre banding aethant ane epni,oenm device, which
cndl h:laatJouslar cenlaccnao,a,dclincd by tun Bay Arca Mt Unalhy Management
If a roof is inwithout first obtaining an inspection, I agree to remove
p g
Di°"a'" /
❑Yc, sTM"^r ,
on. all new materials for inspection. Applicant understands and will comply with
P PP
all non -point source regulations.
1 haw read the m a under Clear,Iun ers5 of he
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", Conn. tions 505.2553nls
and255,11. ay mat
Caebriia Health, Sarcuy Cede.Semon,255115at
ifthe building docs not currently have amoans,e, it is my responsibilitymif,at the
it to late)
: eetpam of the x, a.r,au nmsl he mcI pont to isvuunca nl' o Certificnm of
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JhicI,
aner
•L J /PSignature
of Applicant Date .
( raramhmtae Da
All roof coverings to be Class "B" or better
OFFICE