00080224 CITY OF CUPEKI'INO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRP_SS: PURSUE No.
OWNIiR'S NAME. APPLICAI ION SUB IIAI 1:
PHONE: 10788 sIUNIPER COURT SWAN POOL SAN[(ARY OL NO.
❑re z ARCIHI'RCU iN 1.495 S WINCHES _
�0 0 � 'I I C, BAIRN BLDG r Eel' rLUMB Ml:cn
NSG —, U
�d
gLicbesED covrRAcroR's DIsc1.ARnnoN (408) 866-6893
yb ,ii7rdrmnmotI:m,licensed node„a-kioosorChapter9(coorr,io, JobDeseripnott
oo,t� with Section]fXlll)ofDlvinion 3 or the tra incss and l'mfessin Cial ,and my li¢nw
�¢Y5; ism full force and closer. t II,, _
y C¢ Dicers Class _L_•�' Lic.b_{/_ "till
K S a u nate_i�y,6 Cnntmctor
u.�, ARCH)IIiC1'S DEGLARAI'I
f—on g 1 t ndcntand my,Ions ha ttsed io public,sands
st Z
da
oo Liae^sedProresxh,I,a1 IN GROUND POOL/SPR
OWNIat-RUILDER DECI.ARAUON _
or
I hclahy affirm that I um uxmnpt Gan,the Cn arcon,License Law for the
!' following reason.ISecrioa 7031.5.Business and Professions Code:Any city or ounty
E_C which requites u pcm,il to tlmMmm,.bili.Improve.demolish.01 repair any structure
3� pdonoitsi.ssuance.also requires the applicant fm such pconitto file a signed smtement
a. - that he is licensed nowarnmthe provisions ofthe cantllLi«nseLaw,(Chapter 9 Sq. Ft. Floorreu Valuation
(wmmencing xlrh Seaver 7000fiof Division 3 of he Business add Pmfeusians CWe)
or that he is usrn,pt therefrom and the basis fur the ade,arl exemption.Any violation
of Second 7031.5 by any appreun for it permit subjects the applicant , VI oou
' 'I plly
ornattm,lc than five hundred ddBnrs s5firE 'N LED
APN Number Occupancy Type
01,as owner of the poli arty,or DIY cmpki with rages as their sole a,mpcnvuan.
will do the work,and the arvaure is not intended nr offered rot or, See 76W.
Business unit ProfesvionsCade:The Contractor License Law does ill.j��j'���r1 5 2001 Required Inspections $20000
owner of property Who hard,,,,anpmves thereon,and who does inch,NlMli hwl
,r through his own employee,provided that such inspnwemems an,not intendnl o,
offufal rot sole,II:howevcl:the huilding or impnwmnant Is sold within Inc year of
mnplelion,iu ox..er-hvirder will ha,a the birdcall proving mut he aidBy,gt�r IN 34257005. 00
tnprma n Hnse o �J G+
❑1.us owne,Orme prapacity.or ascbricely contracting with licensed contractors to - 103 - UFER
Liwu
srn the project(Sec 711W.Business and Rnfessiun.Code:)The Contractor's
cense Law does not apply to an owner to prapeny his build,,,,improv`,mares°' 104 -- REBAR
and who contrail for such promo.with a tontranorlsl licensed purmnnn to he
Cootracto;.,Liceo. Law. 107 — POOL/BONDING
01 run cscn,pt under Sm. .B di P C Alt thio rea'eon
Owner Data 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 304 - ROUGH ELECTRICAL
I hereby iffirrn under adulty of Perjury one of the following declarations: 502 _ FINAL PLUMBING ENERGY
0 I base and will Iona am a Ceniflcme of Conttm m Nell-r nre br wotla,s 503 FINAL MECHANICAL ENERGY
C, one color, as P,,,,idad or by section 3700 01' the Labor code, for n,e
parformwnee of dl,work ro,wdeh do,pennif is issued. 506 •— GAS TEST
have sad will mainmin worker:Compenwtinn bestowal,as quiml by Searle. 510 — FINAL PLANNING
J XI of the Labor CWe,for the perfom,ance of the soak for which this I i mit is
issued.MV WorAer'a Cn muaI mmlrana Barrier nod,obey number aqrc: 51. 1 — FINAL POOL
carver.. 4{C _PoblyNo.._31.8_�cl 516 FINAL BUILDING
CIiRI'II:ICATION OPV XI3MP I ION FROM WORKERS'
COMPENSATION INSURANCE
fobia section need not be completed if the permit is for one hundred dollars
'f51 W I nr less.)
I eerily that in the performance of the work for which this permit is issued.1
,hull not ctnpiny any,cram,in ally mmnne,w,as to henmm subject In the Worker,
Gnnpenamion Laws of Cul'dbrnlu.Lure
Applicant ”
NOTICG10 AITLICANT:IL ofar making this Cenificute of Exemption,you should
become subject in the Workefs ns
Compention pnmisione of the Labor Code,you must
Z
C forthwith comply with such previsions or this permit shall be deemed revoked.
F• CONSTRUCTION LENDING AGENCY '
a I 1 work
In,mfinB This there Lv n esued(Sea lending agency for the 1rd'um,w¢c
of the work h,r which this permit in Idunl[Sm.907,Clv.C.1
0. Q lender's ,
a z I<ndsr's Addo AJJres
U C I cenifyrhat l have reirl his applicidill and rate blithe whore mforrol is
lY F cmrca.I agree to comply with all city and county ordinances and.urate laws relating
building enntrncoon,and hereby authorize repreenbnives of this city To enter upon
r W the ad,......untinned pn,pcny far roarer...pureottu.
(We)agree it,save.mdenmilyund keep hannkss lire City of Cupcmmongainet
rA liabilities,judl costa and llfroses which may in any way retire against said
U z City in consequence or the granting of this permit.
APPLICA
GUDERSTSNDS AND WILL COMPLY WITH ALL NON.POINT Issued by:� �
� �7n/7-o^tiCCi Date SJ
Slgomure ofnppftcanvconlmcmr Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the apphcmll or dtola hadding cecnpam entre m handle haramons martial Type of Roof
as defincl by the Cupertino Municipal Code.Chapter 9.11,and the Health unit Safely
CWe,Section 25532(u)^
OYcs 14A 1) All roofs shall be inspected prior to any roofing material being installed.
Will the applicantnr future huddingocaupant Ilse egripmem nr devices which If it roof is installed without first obtaining an inspection, 1 agree to remove
emit hvvardous air corm rrar 1,as defined by the Hay Area Air Quahty Managcment
DNlner; all new materials for inspection. Applicant understands and will comply with
OYa, 0N all non-point source regulatio, s.
I Rae land the be rardons nvtedah rcgairemenrs under Chapter fiYS of the
Ca, ,ora Health k Safely Car,Sections 25505.25533 and 25531.1 undersmW chat
if the building does not currently have a tenant,thd it is my responsibility to notify the j3J_V J
compam of the requirements which moa he mer prior in issuance of a Certificate of
Oloecupaaev' Signat 'e f Applical Date
, auo,o—d a n -hi„�O I roof coverings to be Class"B” or better
OFFICE