04030213i
Le"
E
CITY OF CUPERTINO
BUILDING DIVISION PERM*
BUILDING ADDRESS:
CORBY GOULD POOLS, INC.
PERMIT NO 04030213
21063 C
OWNER'S NAME:
PERMIT ISSUE DATE
PEARLMAN DALE L AND DARA B
2515 NEDSON CT
004
NE:
SANITARY NO. CONTROL NO.
(650)967-7665
ARCHITECT/ENGINEER: -
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm tot 1 am licensed under provisions of Chapter 9 (commencing
p
wit Section 7") of Division 3 of In Business and Pro essiurt Code. and my license is
Of to I force d IT J7_ �.
Limuandyu�a.�
DEMO OF POOL
_11
Class
CONTRACTOR: CORBY GOULD POOLS
Date Comlrxcmr
ARCHITECT'S DECLA N
T understand my plans shall he used as pub iireenrds
Licensed Profcssinnal
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
(allowing reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, impmw, demolish, or repair any structure
prior o its issuance. also squires the applicant for such permit to file a signed statement
that W is licensed pursmnuo the previsions of be Contractor's License Law (Chapter 9
Sq. FC Floor Area
Valuat"000
(commencing with section 700o)of Division 3 of the Business and Professions Code) or
Out he [s exempt tesfrom and to basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects to applicant to a civil penalty of
not more tan five hundred dollen (5500).
32654005.00
❑T,aaownerortepmpeny,ormyemplomswwwaguaa irrmmmpensaltrn.
Required Inspections
will do to work, and me structure is not intended or offered for sale (See. 7044, Business
and Progressions Code: The Conformer License law dos not apply m In owner of
prapeny who builds or improve themon, and who dom such work himselr or trough his
own employes, provided t usmh improvements ere not intended oroRereA forsak. If.
however me building or improvement is sold witin one year of completion, the owner.
builder will have to burden of proving tat he did not Wild or improve for purpose of
sato.).
❑ 1, as owner of the pmpeny, em exclusively contracting with licensed contractors to
eomtruct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li-
comelawdoesnotapplyua an cmownerofpropertywhosedporimprovesCotton,and.
who for such pmjc<ts wit aconvactoKsl licensed pursuant to to Contractor's
p� / '
Y `.—mole
Law.
License law.
❑lam exempt under See. ,B&PC for this recon
0
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby gain under penalty of perjury one of to following declarations:
1 have and will maintain a Cerifcane ofComent to self-insum for WorkeesCompan-
sation, as provided for by Section 3700 of the Labor Code, for me perf9nnance of the
work for which this permit is issued.
❑ 1 have and will maintain Workers Compereation Insurance, as required by Section
-
37W of the labor Code, far me performance of to work for which mia permit is issued.
s Insurance
My Work pe ion ccar ere and Polity number am:
Carrier. _ X IY �'" 11 " Policy No.: 9( c� 2
CE RTI FI CAM OF EXEM PTION FROM KERWOR SF
COMPENSATION INSURANCE
(Thissectio t need not W completed ifthe Permit is for one hundred dollars ($IN)
nr less.)
I notify Cat in me performance of me work for which tis Permit B issued, I shall not
employ any Person in any manner so Is to become subject to the Worms' Compematim
Laws or California. Dam
Applicant
NOTICE TO APPLICANT: If, after making ibis Cenificam of Exemption, you should
become subject to the Worker's Compensation provisions of din Labor Code, you mug
foMwit comply wit such provisions or ria Permit shall be deemed revoked.
CONSTRUCTION cON LENDTNGAGENCY
1 herby affirm Nat mem is nn lending agency I'nr to Performance of
construction
(Sec.
the work for which this permit is issued (Sec. 3097. Civ. C.)
s
lender's Nene
Lenders Address
j 1 certify Cal l have read this application and sum that to above information is
' Correct. I agree to comply with all city and county ordinances and sum laws relating to
building construction. and hereby autorim mpmurnfi ivcs of tis city m enter upon me
1 above-mentioned property for inspection partings.
(We) egrte to save, indemnify end keep humless me City of Cupertino against
j Iivb' as, dgmcnts.costs and expcmcs which may in any way accmc egamslsaid City
in onseq cc of &tomer agersto
PLICA T ER p ILL COMPLY WITH ALL NO
Issued by: Date
s URGE ATI
Re -roofs
Type of Roof
I Signal fAPPlrcaHAZARDOUS MATERIALS DISCLOSURE rOCohtrfmT Dale
OI to applicant or future building occupant score or handle hazardous nominalas gfi
d by to Cupenino Municipal Code. Chapter 9. 12. and to Health and Safety
cm runn25532(a)' -
All roofs shall be inspected to any roofing material being installed.
❑Yes ONO
prior
- If a roof is installed without first obtaining an inspection, I agree to remove
Will to applicant or future building occupant Isar equipment or devices which
Pit harardom air contaminants as defined by me Bay Area Air Quality Management
all new materials for inspection.
District'
❑Yes ONO
I have read to meordmus materials requirements under Chapterb95 of to Califor-
nia" afmy Cod. Sections 255(15, 25533 m125534. 1 understand tmiftc Wilding
d nut torte ly ass a ¢ran s my rcspomihility m nobly to atupant of to
wissaanr
gmircmentrw g etPn facetinmtenfocmpanty.
Signature of Applicant Date
All roof coverings to be Class "B" or better
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1
IN ACCORDANCE
This set or plans and spe ifica
be kept on the job at all t nes
lawful to make any Chang s of
on same without written term
the building Dept., City of 'upe
The stamping of this plan a d sF
SHALL NOT be held to er
approval b t e violation of any
,f anv City Ordinance or State L
Tzv. r►t:l t Qtavn oft-
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CUPETINO
*CITY OF CUPERTIN*
DEMO
PERMIT APPLICATION FORM
OY 03,o a l-3
Qty. if
Applicable
Fee ID
Fee Descrintion
Fee C:rnnn
BPERMFEE
APN #
Date:
,3 a (� - S 14 - 00S
3-2-3-09 -Z3-O1-I ,
BSEISMICOM
Buildin Address:
BUILIDNG
r IJVWN Qk
--
Owner's Name:
Phone #:
Seismic Residential
QAVA PLAPLMAIDLlOk-
/VS9
Contractor•,
,,,I ore
License #:
U7- Fs`I
Plan Check Fee
Contact:
Ph o #:
Applicant/Contractor:
-U
J -in, n I I-FlEyl
g Permit Info:
Bldg Elect Plumb Mech
escription: ---F,> ti o (J m o
Residential: Commercial:
Sq.Ft. Floor Area:
$/Sq.Ft.:
Architect/Engineer:
Valuation:
N
U
Type of Construction:
Occupancy G oup: '-"
16
D=r� Po
BUILIDNG
Qty. if
Applicable
Fee ID
Fee Descrintion
Fee C:rnnn
BPERMFEE
BIPermit Fees
BUILIDNG
BSEISMICOM
Seismic Commercial
BUILIDNG
BSEISMICRE
Seismic Residential
BUILIDNG
BPLANCHK
Plan Check Fee
BUILIDNG
BUSLIC
Business License
BUILIDNG
227,00