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00120047 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: © b 1 2,00 BUILDING ADIf IiSS',06 LINDY PL SCHAUMANN PLUMBING iMITME—ATIN000120047 OWNERS N"9ERTIS RON 1495 LAIJRELWOUD RD APPI.ICAIION SOL}1,)4:!i7/2017121 PHONE: L� SANITARY NO. CON'I'kOI,NO, (408) 986-9044 Q BUILDING PERMIT INFO O ARCfBTI;CI'/F.NGINEER: BLDG ELECT PLUMB MECH W F i.w O I-1 1=1 lu <y H= Lon that LICENSED keens d under p DEhm,of 10N osV.o Ibombyarhrnth:nlamRacn,dmndergm„i.mnaorcnapteror mmenang Job Description F=ew with Scott 170c0)ofo ' 3 t heR \ine..:y�y re�i�n \r .;lri'mv reen..e T,NSTALL WATERHEATER ce E i,is ran rofo t —/ V a �f- Lieensc .Ic.N X O Dom C / anincna W3 1llbe SD Publics (n�0 g 1 understand mY plan„hall to uxA as public records mii: 0.a.,p O Licenced Into snion:d ct OWNER BUILDER DF.CLARAI'ION X= I hereby anlrm than 1 ant exempt front,he Conlrucmr's License Law for the C z¢ ollnwing reason.Section 7031.5.Bm,incw and i'mfu.to.1,Code Any city ur cnumy S which requires a Permit to consume,che,improve,demolish.or repair any structure ce i6� prima,its issuance.also requires the applicant forsuch Permtnn the a signed statement mat he ishcenmdpmsuamIt,roeprmiam..aIthe Comanetot•,LieenceLoc Cha,wrI) S Ft. Floor Area Valuation (commencing with Section 70(111)of Divi,inn 3 of the Budnesuml Professions Code) y' - S1 or that he is exempt therefrom and the lists for the alleged exemption.Any viomtion of ScaWn 7031.5 by any uppllnml or it,......I a:bir<Is mu applicuat to a civil penally of not more than five hundred dollars P6500) APN,I511�ru¢ 11. 00 .Occupancy Type ❑Ito sof the propurly.o any con,loycos with wages a,dwir Bolo c,I pe.eatinn, will do he work,and the sm a nye is not intended or nlfe¢d Iny sale(Sec.TITO. Business and Pn i Win haCds or impDo ov,lihasi n,nw License do s such worklniit°xkkr 106 — SEWE�IiV wfEWES tetnar TI through his r prover of edfor his own employees.t provided that such improvementstis%oture on Intended or — I onafd for,ale.IL however.me noddmgmm,Provemem is,sial within one year of 202 UNDERFLOOR FI_LIMHING aaplednn.ntenwnor-mrdderwideo,othebonlenofpro,ingm:nnodh'n"'build "r 01 — ROUGH PLUMBING impose far parptsa oI It.). ln ❑1.asowner itthe propcoy.am exclusivelyconmectingwimlicensed contractor p, 3,02 — TUH 8 OR SHOWER Ln enct the project(Sec.70TK Buono and Profession.Codia e Contractor. 502 — FINAL PLUMBING ENERGY ,License[.so does not appy'roan owner of progeny who builds or improves thereon, amI who..,mntem rat a,h pm�enx win,u.ommctm(al solved pasoam m thu 506 — GAS TEST Contractor's Lieenw Iaw. ❑l ver exempt made,See. ,B&PC h„rhis reason 507 — FINAL PLUMBING Owner Date WORKER'S COMPENSATION DECLARATION I hereby anion under pcnully o1perlur,ane of the following declamf ions'. ❑ 1 nuv nal will neahatam a Ccnitioate of(...meat m m16immre ror Worker', Compcnmfinn, as provided III, by Sedans 3700 of the Labor Code. 1'o, the perhumancc ofthe work Iia xhich this Penni,k i,med. list ❑I here and will maintain Worker's Compen.smlon In,mmmce,us required by Sect ran • A L ED 371X)of�,hs'ey�Latbor Cmle,fo dte serf,,mmnc ,f he work for which his permit is cJTc �nnlpe 5vatIT' an i_ illort/2 ocr o s 200 VO WCAI ION Op B%LMPIION FROM WORKERS' COMPENSAI ION INSURANCE lysis section need ran he completed Irrhe permit is for one hundred dollars BUILDING f5l Utll or les,.) 1 coil mol in the pc,h nnan o of the work for which this permit is eonod.I .hall an employ any person in any nmnner so v,In become subject ,,,he Workm, Compensation Law,of Cdifomia.[)me A,fi,au NO TICE 1'0All]'IdCAN"1':IL after nal,ing he,Cen111ame of Uornign I.You should become,object m the Worker:,Conngenm,ion puss,inns of rhe Lbor Cee,you must O Q fanhwim cnntply with such prnvtetnm nr ml,Permit.hall h demned revoked. ' z H r^ Chat fro is a I LENDING eading CY IYs 7 Irk In,ndfmn that is A nn,s (Set. tanning agency Int the performance y a1'Ise wink lin which this pend,is IsmcJ(Set.31197,civ.C.) t0. Lender's Name 7 z z Lender.nenre.5> U C I ccnify that I have read this application and.rate that the above mromudon is I;I....m con..ly want;dl any And county ordinances and stare laws relating O (� m Inildingconarrodmt mal terchy amI loo re,rc,it, aicrolthis city a,enter anti �„ W fhe above.mennnnd Not IT,for inspeaicr purrysse,. rI„n y (We)agree In uvc,mdetnn' an keep famous,the Cdy of Cugcnntu ugainxr Vi Iran' ,s judgments. 'rots ural gem 'which m;ry in any way accrue nguins,sulA (,) "L Ci in msequensx n gm t gg d his pennit. A .( UNDER ST S 1)WILL COMPLY WITH AL1,NOP W NT (12 - r 1 1.ATIO s /�� Issued by: Dale ;nay or Applicantic no, / Hope Re-roofs HA7, DOUS MATERIALS DISCLOSURE Will the applicant m future building accupmr store or handle hmadous mmerid Type of Roof VS delined by the CuPenino Mmticipel Cdc.Chapter 9.13,and the Health and Satny CIAO.Seen I2554(.0 OYo 0N All roofs shall be inspected prior to any roofing material being installed. Will thea"knon of l inmrc nnilmmgoxcupanl use cgntpnrcn,at demes.which If it roof is installed without first obtaining an inspection, I agree to remove emirhvamous aircnmammams as defined by the Bay Area Air Vuali,yM ragenent Dwrien? all new materials for inspection. Applicant understands and will comply with El Yes 0N all non-point source regulations. 1 have read the hvardous materials mquncri m.c under Chapter 695 of the CAllt'ornto ficin lh&Sol t Gxic.Sc is 255115,25533 and 25534.1 malt rmnd that - ifftehuild, •do es nor cunently ha e a term hat it is my responsibility to unify the ae"n , , rcgoiminsn4 whit t ur ct prior n,ismanee of a C mfr a of 'cups Signature of Applicant Date 7 �O n m.nn onaed:ngent - Date All roof coverings to be Class "Q"or better OFFICE '