02050169 OF
cl BUILDING DIVIIRoNN� PERMIT CONTRACTOR INFORMATION: -
BUILDING ADDRESS: PERMIT NO.
7535 WATERFORD DR SCHAUMANN AIR CONDITIONING, 02050169
OWNER'S NAME: APPLICATION SUB DATE
JOHN LUCAS HEATING & PLUMBING INC 05/28/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 428-0640
a O O ARCHITECIVENGINEER: BUILDING PERMIT INFO
w_ BLDG ELECT PLUMB MECH
a� 1' ---I 1_"-U CJ L::_]
Z FJv=Ni 3 LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
2 withSection7")ofDivision3oftheBusinessandProfessionsC e,ammylicense REPLACE FURNACE (70K BTU)
Y EJ is in full fart[ao�
z rc 6 Li[cnsy
°'O
duContactor
3 w ARCH111i 5 DECLA TI
t a ON g 1 understand my plans shall be used as public records
w p O Lic<trud Professional
OWNER-BUILDER DECLARATION
w o 1 hereby affirm that 1 a Business
from the Contactors License Law for the
5 z 0 whichfollowing t[aron.(Section 7ons`oualner.and improve,
demolish,
Cade:Any city oructom $5150
E o which requirts a permit m construct,alter.improve,demolish,of repair any stmaurt
ad
up prior..iwi...mice,also xquixs the applicant fresuch psnr%u,file a signed stamment -
can hgislicensed pursuhm,n,theproskinhoof,hvContractor'sLicense Law(Chapter 9 pt ppoli-AA��ea a', ,%'. Valuation
(commencing with Sscgon,701M))of Division S of the Business and erarewdonscode) f,O:n,136:7.0 5'.:
or that he is exempt therefrom and the basis for the alleged eiempdoh.Any violation
of Section 7031.5 by any applicant for n permit wbjecu the applicant to a civil penalty �NT ht,����
ofnotmmx,banevehundred doliata(55oo). 301APNR8,6U'H PLUMBIN I"I. Occupancy Type
❑1,as owner of the properly,ar my empluyees with wages as their sole compen.rmioa,
will do the work.and me structure isnot intended or offered for sale(See.761,1, -
Buaindaa and PrefeWors Code The contactors License Law does not apply to an 304 - ROUGH EI.9-R9 d%QFCIIOn$
owner of property Who builds or improve%thereon,and who does such work himself
or through his own employees.provided that such improvements am not intended or .._... -_ 5 0 5. T FINAL .ELECTRI CAL.
offered for Ulu IL howevel:the building or improvement is sold"within one year of .
507 - FINAL PLUMBING
completion,the owner-builder will have the burden ofproving that he did not build or
improve(orpaip^`aofola')' 508 - FINAL MECHANICAL
--
construct
ter.of Properly.am Business a contracting with licensed contactors to
❑n%rho a e posed(Sec.7044,N sines and eny whona Cml[:)The Conth nor'e �® ,
❑I am excw does not a I man owner th ropcny who builds or seimproves therron, �H
omans.forsuch rottta comrxmr(s).licentsed puruam to.fe 1 F1v' _.._. .. ... .. _.. ... _ _._._ . ..... _. .. ..._ ._.. _..
construct t '
_ pp y e
projects wtM1
Contractors w ' License Law. O
mptunse Loss ..B&P C for his reason
7. Owner Data
_ WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty ofperjury one offe following desti anions: '11Lp1NG'
❑ 1 have and will maintain a Cenific to of Comm to Ulf-insure for Worker's
Compensation, o provided for by Section 37M of tint, labor Code, for the
performance of the work for which this permit is issued.
❑1 hos and will maintain Worker's Compensation Insumace.as tequ'u d by Section
31W of the Labor Code,for the performance of the work for'which this permit is
issued.MyW ke'Com��i%1a�m/oPInsuame carrier and Policy numhcr arc'
CaI�u ..,Policy No.: � _ t• t Ir J+, 7 q+aYa t .1 ,ts.,-. ..
I. CCR'1'IFICATIONOFF,XFMPTIONI,ROI WORKERS'l '• - H...1 '
COMPENSATION INSURANCE'.' ' I -
' rhis seninn need nrn be nnnpincd II the permit is for one hnndred dollars
($I(d)or less.)
"'I'c[nify thw in the performance of tint work for which this permit is issued,1
'shall not employ any Person in any manor so as to become subject toih[Worker' '
Compensation Laws of California.Date
APPlicant - .. ._ _ _._... . .. ._. _ ... ... _.. -. ... ._ .._ ... _
NOTICE 70 APPLICANT:IC after making this C'enifmote m Exemption,you should
nttme m
osubject the Workers Compensation provisions of the Labor Code,you must
Q Q forthwith comply with such provisions or this Permit shall be deemed mist
- CONSTRUCTIONLENDINGAGENCY
' 1 hereby Hrm that fere swctiod lending agency for the padoimancc -
�.Gal the k for which his p t a_sad(Sve.JIN7 Cis.C.)
Lender's
_ Noe
S.
IL, Lothe .Adtl s%
C.7 Q I ce ree to t I cola h all city an a stain that antes aabove'naws i nig
C) E. correct.1 gree to comply with b city and coo Ire ordinances f J state laver elming f
Q.O to building conamcnon:and hereby authorim rcprcxnmtiva of fns city to emerugm
the abnvememioncd property for Inspcn'mn corpuses.
F y (We)agrato savanidnnmry an a keep harmless the City of Cupenino against
Vi liabilitier,juEgmenr.costs and eapense%which may in any way acerae against sail a _102
V Z City in conmyuence of tint gram ing of thin pennir .
- � APPLICANTUNDERSTANDSAIDWILLCOMPLYWITHALLNOV-POINT Issued by: rat Date
SOURCE REGULATIONS.- '
Signature of Applicimuc aostor Uam Re-roofs
HAZARDOUS MATERIdIS DISCLOSURE
Will the applicant or future building occupant snort or handle harardous material Type of Roof _. .._ -- - - - -• ' '-
-usd frurd by the Cupenm^Nfim.i/ci,al Code Chepmr912 codth Health and Safety
Coot, Section 2553'2(.)'. \. . + I : l„ V ? 'i _ i, ,.y F l., t i r _
❑rt,: ^ ' `'' - 'All roofs shall be.inspected prior to any..roofing.material being-installed.
Will the appreamorromrebuildingoeupantuaetcquiomentard.vi«av,hich- If a roof is installed without first obtaining an inspection;I'agree to remove
emit hanrdous air contamiom rdefined by the Bay Arca Air Quality hlana,mum,
Disuic, all new materials for inspection. Applicant understands and will comply with_
O Yes No all non-point source regulations.
I have end he huraNmifs nowink re,mmWents under Chapter 6.95 of the
California Health&Safety Code,Sections25505.25533 and 25534.1 understand thatif the building does not currently have a tenant,that it is my responsibility to notify the
entrant of the regi en nts wh'wh must be met prior to issuane of s C nificam of
° a/A/y/
Signature of Applicant Date .
wn r m a m.,sea a em ` ate All roof coverings to be Class "B" or better
OFFICE -