01010117 CITY OF CUPERTINO
. 'BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BU1LDINO A DDR ESS: t. - ePERMIT NO. v
OWNIiR'S NAME: _11—INTPER CQUAT
- ra Irl-�P1d91_� s AI'PiTA'DONSUB DATE
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-401
HONG' - , 6 Will
SANITARY NO CONTROL NO.
, 1
re0 zo ARCIfITFCI'/ENGINIiER: - BUILDING PERMIT INFO
� Ca .DO '.F.CT LUMB ECH
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5N i LICENSED CONTRACTOR'S DECLARATION Job Description
p z_' ` .1 hereby aBirm rha I um ed anr p
licensdenruisinns of pte
Char 4(commencing
F_Cu with Section70(")uf Divisinitnfthe llusineolind loifessiupsCod.... ny Becton, -
s4 f� in full force and fecr, cell"-1 ll ttl�Jlll.. _
"a` "`" ( ''"" INGROUND' GRANITE POOL/SPA=- '
Date Conow, r - -
w 3 ARCHITECr'S DECLARSI'ION
F a 1 undersand my plan„hall be used as public moods 4
f r
aTj
. p Licensed Profcxsional
OWNER-BUILDER ab the RN'ION
a I hereby afrinn o had I tIn exempt Ilam the Contractor's is LIAny c Law far the -
l'•ZQ fnaiwingremn n.(Sectit)coSL5.0einesnand
or,deoli Code'mild city or roomy
5aF a which rc4uires a pennil to construct,ober,improve,demolish;or rehan any structure _
63c� prior un its i...erne,ate met the opplicatt lir such penoiuo rile a signed aatemem
@w be is licensed pursmnt to the provisions of G,ntmcrors License Lov(Chapicr 9 Sq. Ft. Floor Area 'Valuation
(commencint,wish Sectio 710X11 of Divislnn t of the lia,mcss and Professions Code)
or that he is exempt Ihcretturn and the basis for the nl lened exemption.Any violation.
nl section 703 1 5 by any appliclan for a permit subjects the apps oat to a civil penalty '
"r,lot ore that,rive hundred dentes Whit APN Number OCCLIpan
❑I.ns owmrot he prnperty,nny entpinyces whh wuecsusiheirsnlc olnpvnxmion,
will 0 A rad 11 :B r : rintendedfl red for sale(Sac ]1A4 L,- -
Ban a l Prof :C la I f t -' . , 1 ,w doe, ,nt,ppy man KMqutred wInspections
tos of nest,Will, Ix h l r n1 mvc II and who doers ah work li mself nein li -
or brough lin,own employees.pmvldml that such in'nown ants mo nor Imended or 't••
otfand f"„ale.11:no't'e'. he holding or nnprowomot is %idnn tine Year of 1.03 - UFER
nmpinlun,the ownerhui ern will ham:the heeler of pawing that ne AIA not build nr
mprowforlimpo,aoflle.). 1.04 ,- REBAR .
+ - El 1.us Inviter fl 1 'l 11 i . lye t t' y @ d t f to I t, 107, — POOL/BONDING
.Liuta project(l ]nil P 11 : C 1 ) rh tr C r' -
ce oL,wdeson pplytrn rofpr,penywhat h Il. rnpmvnl,, 301. - .ROUGH PLUMBING .
and who coramei,1'ur such projects with a cnntraaorD),bcersel per, m tl,e
G,ntraeor,Licerw Law. _304 ROUGH ELECTRICAL '
❑lam exennptamlm Sea. ,nm Pcmr this moon, 502 = FINAL ' PLUMBING ENERGY r
Dw""
WORKER'S COMPHNSAT]ON DECLARATION 503 FINAL MECHANICAL ENERGY '.
506 - GAS TEST
I hereby ufrimi under penalty”(perjury ane of the follosuing declamtlon,:' s
I has and will maimain .Certificate of Consent m,elf-hrom (a,Wmker)a 510 — FINAL -PLANNING
'
az.and
a; provided for by secretin 3700 of the Labor Code, for the I a 51 1 — FINAL POOL
performance of rhe work for which this phroat is nsu,,4
❑1 have and will national Workers Compensation Insurance,as required by section 516 — FINAL BUILDING
310()of the I��yMl�,r��Gad�he.for thie`Iperformtncc of the work for which this permit is
Cam��MY�SL,SI�n'wnsa1i`In Insurance
No:
l�e,and icy�nher are:
CERTTIFICrAA]IONt(a)`VU bMITIONPROSI WORK1iR3F'tvy-I -
COMPIWSA'I'ION INSURANCE.
(This section need not be completed if the Permit is for one hundred dollam -
05 I00)or leo.) -
I certify that in the perfnmm..c of the work for which this perhat is issued.1
shall not employ any per,nn in any manner,se as to become object to the Worker'
connpematinn Law,of Califnmia.Dane -
Applicant f
NOTICE TIO APPLICANT:If.uBer making this Cedifcnre of Esenption.you should _
Obecome wbjea n,the Worker's Compensation pmviei ms of the Labor Crider you must '
fonhwitllenm_ply with tach IF Imo is or do,pcmeit,hull bedeemed revoked.
r:F.e . 1•
W CONS TRUCTION
Foost ,,NUIN ri on,th CY
a. 5' 1 hereby,duan that lhcrc is a cnnsmun t, Icnding agency fur the perli,mlance ,
of the work int.which Ihix perneit l.v ixmeW(Set,9tY)7,Civ.C.)
W Lender',Name
Pte' z Lender's Address ' -
V �nr I cerdly lbw l Ilove moll this uppllcuJnn nnA stem then tho above int u..oct o is
GL rl wont Iay nnply ,in ell roy nnJ ent ty II mco into lows n4almg '
Q V ro 'II b a lion II awhoir e pr: fvesol 'lyre enterrpo"
'
:.
hhe al f 11so,oyl l cl .T q
y Ov), ly'tlkeep 1 I: the Coy l Culecifinougaiast
V] labii 1 dy t: 1 aspe c, thochuY ill unity VVIL, selow gu rot 111611
V e7� Cly g tecnfd k t golahivp I,e
PPLLy..tttCANTU.y�'1)13RSTANDS,pND WILL COMPLY WITH 0(J N�iN-POINT Issued by:
litSOP�CA t U )IITRNS / ] L� i6•-INT y' Dilte
Ssisnam a of Apphca,tlContmanr - Date Re-roofs • ..
HAZARDOUS MATERIALS DISCLOSURE - r
Will tine ainhh all or(ilium to ilding oc,u,urt ease nr handle hanmJnu,material Type Of fzoof -
as dnlincd by do,Copeman Municipal Gale,Ch the,9,12,mod tbe Heuhh and Suety
Cede,Section 25532(a)1
11Y°` 11"" ' All roofs shall be inspected prior to any roofing material.being installed.
"ID the applicant intomrc haildingo,c'upanl mocyni,ar,ot de✓ms whi,h If a roof is installed without first obtaining an inspection, 1 agree to remove
unit lamrdous air conwnninams as JeFfed by the Bay Arca Air Quality Management P g -
Osvin7 all,new materials for inspection. Applicant understands and will comply with
❑Yes EI No
all non-point source regulations.
1 have reed they Co materials and Chapter6.95 of the -
`f1mCal,mml4dllhsSultyC Ic 25505.25533 itish respond 1 d .rand ohm
5"Pearlldinge his not ore .6 h ofarrant,that t t:t ry responsibility C notify the - -
pam of the rcgmrcmem 'h ch q be act p t wo n c I C ri&ate of
Y.
SCvti,Z f..(_16 Signature of Applicant Date
Owner oramhmked."at Date — All roof coverings to be-Class "B"or better
OFFICE