02120089ce i
FO0
uF
a
Hwy
Z
�OaU
tu30
�s
iap0
x ao�
w —h
F2�
�Fc
n�=
1
oz
z0
N
a >_
UO_
OF
Fa
U
CITY OF CUPERTINO
�, "
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION.
. ''AY o A a°voll "I'll
BUILDING ADDRESS:
SCHAUMANN AIR CONDITIONING,
PERMIT NO.
19220 STEVENS CREEK BLVD
02120089
OWNERSNAMEo
HEATING & PLUMBING INC
APPLICATION SUB DATE
H & R BLOCK
12 23 2002
IONE
7408 428 -0640
SANITARY NO. CONTROL NO.
ARCIIITECT /ENGINEER :
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARA'T'ION
Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
l p
with Section 900) of Division 3 o the Business and Professions Code, anA my license is
in (oil la¢ggs, F d e t. „ 6 —3 C/
License C
A/C (4 ROOF TIP UNITS)
Ua'c ' Conuuctyyjj .0 ,.-..
TCIIITIiCrsly3'l.AS AfDON
hdersunJ my plans shall be used a., public mend.
Licensed Pmfcssinnzl
OWNER BUILDER DECLARATION
1 herchy affirm 'hat I am CFempl Gam the Contractors License Law for the
(allowing memn. (Section 7101.5. Business and Professions C(wc: Any city menially
which re,moo, a permit to construe', alter, improve, demolish, or repair any structure
prior m its issuance, alw ¢quires the applicant for,such permit o file a signed stammen(
that Misliecnediamemmrothe provision.of MCan'raelnrauccne Law(Chap'er9
Sq. Ft. Floor Area
$20Y410inion
(commencing with Section 7q0) of Division 3 of the Business and Professions Code) or
Nat W its exempt tMrefrom and me basis Tor Oc alleged eacmption. Any violation of
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
no' mare than five hundred dollars (550(1).
❑ I.rsowner nftM propcny, ar my emDloyas with waguu their axle compensation.
ffActlions
will do the work, and the structure is notimended or offered for sale (Sec. 7W .Business
and Professions Code: The Comenctore License Law does not apply to an owner of
progeny who Wilda or improves thereon, and who does such work himself or IArough his
own employees, provided that such improvements am not ntended oroffexd for aide. If.
303 - ROUGH
304 — ROUGH ELECTRICAL
however. the building or improvement is sold within one year ofcompletion. the owner.
SOS — FINAL ELECTRICAL
builder will haw the burden of proving that he did not Mild or improve for purpose or
aale,l,
507 - FINAL PLUMBING
❑ I, as owner of Be pimpcny, am exclusively contracting with licensed co tercel re to
508 - FINAL MECHANICAL
construct the project (Sec. Business and Professions Code:) The Contractor's Lt.
e Law does not apply to an owner of properly who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant o the Contractors
Fare. Lnw.
0 1 am cacmpl under Sec. . B dr PC for this reason
Ovem, Date
WORKER'S COMPENSATION DECLARATION
ItI hereby affirm under penalty of perjury one of the following declarations:
Fa ' W , /�• LE®
�a�
I ban and will maintain a Certificate of Consent self insure for Worker's Compere
r ,fit
cation, as provided for by Section 3700 of the labor Cade, for the performance of the
work for which Be, permilis issued.
DEC 2 7 2002
1 have and will maintain Worker's Compensation Insurance, at required by Section
3701 of the Labor Code. (or the performance of the work for which this permit is issued.
My Wm1m1'a CC.R:j c'}n^,s'auonl noose aarticrand Policynumbe art:
C
BUILDING
CL'RTIfICNINs
URANCEORp3
(This section need nor Mcompletedl(ihe Nornitis larenchundreddellms VS100)
or less.)
I anify that in the perfumtance of the work for which this ammi l is issued, I shall not
employ any petum in any manner se, as In become Subjectin'M Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT. IL after making this Certificate of Exemption, you should
become Subject it) the Worker's Compensation pros siores of the Lahr Cndc, you most
forthwith comply with such provisions ar this permit shall M deemed revoked
CONSTRUCTION LENDING AGENCY
I berehy affirm that there is a conanietion lending agency for the performance of
the work for which this permit is issued (Site 70A. Civ, C.)
Lender's Name
—�
Landm's Address
lanify that 1 have read this application and state that the above ioftema(ion is
rzcer 1 agree to comply with all city and county oNinances and stare laws relining m
building convection, and hereby authm5x espremnutives of this city to route upon the
shove- mentioned property for inepnxion purposes.
(We) agree to save, indemnify and keep harmless the City of Coleman against
liabilities, judgments. costs and expenses which may in any way acervc against said City
in consequence or the ag of this permit.
n
j
grand
APPLICANT UNDERSTANDS AND WILL COMPLY WI'TII ALI. NON POINT
Issued by: Date
SOUR Cfj REGULATIO
�� ���
—r^c 24^^ ---^
Re -roofs
Type of Roof
eof Apphcanv onlramnr Ic
HALARDOU S MATER INS DISCLOSU RE
Will the applicant or future building occupant store or handle hanrduus material
as defined by the Cupertino Muni ` I Cues, Chapter 9.13. and Oc Ilcalth and Safety
Code, Section 25532(a)
All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
1(a roof is installed without first obtaining an inspection, I agree to remove
Will the applicantnr lworebuildln - open( use equipment or devices which
emit barardous air contaminants az def by the Bay Area Air Quality Management
all new materials for inspection.
District
❑ Yes
havcruadthc rdousmalcriaLsmquircmenuumkr Chapmrfi95ofthe Cali for
building
ilia Healthurentlyhaw tenant,
Oat it to occupier
does no' currently haw a tenant, that it is my mspntsihility ro notify the twvupant of de
a
relpiremr whichmaat•mr pro' to"Atimeracmun, nracupamy.
Signature of Applicant Date
%3 0L-
All roof coverings to be Class "B" or better
nern Wbmieedagen, Da(e