02050044OFFICE ..
CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
7449 TIPTOE LA
SCHAUMANN AIR CONDITIONIITG,
02050044
OWNER'S NAME:
APPLICATION SUB DATE
SORICH ROBERT M AND VIRGINIA
A HEATING & PLUMBING INC
05/08/2002
PHONE:
SANITARY NO. CONTROL NO.
IdE
(408)428-0640
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I-1
i
LICENSED CONTRACTOR'S DECLARATION
Job Description
5ui
1 hereby affirm shin 1 on licensed under sizions of Chapscr 9lcommencm,
with Section] )ofDivision3oftheBusin[ `�°dProfC,,iCm,CUdC.md.,IiC,00
is in fall fore pe%(
nL4
REPLACE FURNACE (140000 BTU)
w U
n Lic, p
Licence Cln •h7h ✓
Convect
D.ns7e+/ a,
A ITECT'S UEC
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y g
1 undersand my plans shall be used as public accords
Y�
p
Licensed Professional
R
RATION
OWNER-BUILDERr..
he
I hereby affiam aha 1 exempt from the Commcmr•e License Law fur the
ZF M
following rcnroa (Section 1. Business and i Cage. Any city ar county
$5100
3M
�
demolish,
ve. de
which requires n pcnnil re mnslmm, aper. improve, h Permit I or repair any swcwm
Cont.
slts censed the thovisioso far suchperminofile asLrcAsummem
- - -
----- - --Val
sg, FF{{��prf�rga ll 11 -
� j `v i S 1 Zt3.lJ'U.9
Valuation
ti
that heor
ed Section7")fDivision3 c heBusinesLindProswon,Co(Chapter 9
parantrus.
is Schnell o the and Code)
(comme cing
omland the basis Ngedess
(commencing he rimi An, vi
the basis for the allege) exemption Any violation
or that he is exempt therefrom t
cmui
l `•3.
- of Section ](111.5 by any applieam for a permit subjects the applicant m a civil Penalty
applicant for
of Out none he. five hundred d.h.(S500).
301APN"8'H PLUMBIN
r. Occupancy Type
111, as owner of the propcny, ur my employees with wages as their sole compensation,
_
304 - ROUGH E2A01yAd1IMVhPtiOns - • -
will do the work: and the structure is not intended or offered for safe (Sec. 7014,
Business and Professions Code: The Contractor's License Law docs not apply to an
owner of property Who builds or improves thereon, and who dues such work himself
imeaccil
505 - FINAL ELECTRICAL
or through his own employees.pruldIn., warvementeis ndarenot or
' offered )f how hebuilding improvement I n sold within one Year of
- - .... _ . PLUMBING _ .. _. _..
507 — FINAL PLUMBING
omvlenan. the awnm bnalam will na.emefmaam ofproving that hedid na,t build or
aet
improve for purpose of of
508 - FINAL MECHANICAL
the property, a exclusively contracting with licensed ao
O1, as owner me
..
a Contcmrs
construct the project (Sec. 9to Business and Professions Code:) The
pr
"
a improves thereon,
License Law does nm apply loan owner of property who solids m improves lhercan,
License
Fi
.and who conmema,l- wch.prnjats with a mnuanor(s) Iiccnud.pursuonl.m.Nc.
C s Licende IoW.
❑lam eumpt under Sec. .B&PCfor this rtason
1 ma as
Owner " Data
MAY 0 9 2002
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
BUILDING
❑ 1 have and will maintain a Certificate of Conant to self marine for Worker's
Compensation, as provided for by Section 3700 of the Labor Cale, for the
performance of the work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
-
3700 of the Labor Code, for the performance of Ne work for which this permit is
issued M rke's Com cnsetio Insorana " andPolicy number me:
_ ....
cal � roLc (,[37(D ��ia
}` ,�,7t. 1 "• .�Ll t .•. u...-. t `
r) v } 1. I
'I ION
f) CERTIFICAf10N OF EXiFROM WORKERS:
CGMPFSNHON INSURANCE;";
+
"ma; section need not be completed if the permit is for one hundred dollars
($100)or less)
' I certify that in the ofmann the work for which this e issued; I
'shall
anyOnar,
....0 inobject a
nm employ nny Pinson in any manner so as to become nuhjat to the Workers'
Compensalion Laws of Celifomia. Data
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption. you should
"
Become subject the Worker's Compensation or the labor Cade, you must
O
Permit
forthwith comply with such provisions or this permit shall be domed invoked.
coply
+• VI
'' '' CONSTRUCTION LENDING AGENCY
"I
-
�;
hdmby affirm that Were is a consuunidn lending agency for the performance
9
of the work for which this permit is issued (See 309]. Cie C.I
'..
LandName- �. .. .:..
cr's
Iander'1 Address
1Icenifyagree that have read anis application and sem that the above information mion is
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[r
torten. 1 Wilding Con to comply with all city and county
of this city mrnmr upon
m,boecennaved and hereby resent tives and gam laws enter upon
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a {r7
Ne above-mentioned proper orinspctionpepresenatives
propend for inspection puryoses..,
,. y
(We) agree to save, indemnify and keep hm City of no
to
said
VJ
).z
in true a
may against
liabilities, juegmcros: costs end expenses which may in any way accrue against said
City in consequence of the nom orchis pc.if
f'� (/v
CANTUN)ERSTAND'�f OWILLCOMPLYWITH'ALLNON-POIIyT''/
-
APF
Issued by: Dale
y
PG a. IONS. :/+'
ai./�p,V(s
Si t re of Applicana/Comnaor - a
IS
Re -roofs /
HA=IZO RIALS DISCLOSURE
till the Ppljc..( fair. W e' g occupani t r handle hazardou m tcnal
,Type Of ROOF
as d f d by th Cupen n M a p l Code Charter 9 12 and theHealth d Safety
a a s
' tT .f'r , •!' '•�
Code,S t 2552(7)
' '' 'f '
( r s
❑r n i
roofs, shall be inspected prior [o roofing,material being installed.-
_ w""heappTacadarrutu buldr, ccupanta,,equipment r device, which
_All _a_ny
If a roof is installed without first obtaining aninspecDon; 15gree.to remove
ems nauraous air Corona, ams ade0nee by the Bay Area Air Quality Management
District? '.
all _new materials for inspection. Applicant understands and, will comply with
p Ycx "° - '. .,-. '
all non-poinf sourc1; regulations.-
oi
1 have rcatl the huvallous materials rcquimmcnts under'Chzpmr 11.95 of the
California Health & Safety Cade. Senionz 25505; M533 end 25534. 1 undersand that
if the Wilding does not eurtendy have a tenam, that it is my responsibility to notify the-
wvupant a! Ne requirements w ich must he met prior to issuance o Certificates of
Occu
Signature of Applicant _ Date
1
^aufonxed
All roof coverings to be Class "B" or better. ,
agcm
_
OFFICE ..