08080069 CITY OF CUPERTINO ' Mt'-
BUILDING DIVISION PERNIIT �,0NTRACTQR I�iFQRN�.TON,
BUILDING ADDRESS: PERMIT NO.
22229 HAMMOND WAY DRUMMOND P
R'S NAME: PERMIT L55(IE DATE
PHO SA CONTROL NO.
ARCHITECT GINEER: BUILDING PERMIT INFO
' BLDG ELECT PLUMB MECH
NEW SWIMMING POOL (18X34) O O O D
fop LICENSED CONTRACTOR'S DECLARATION LNDSCP,RETAIN TLxnN-.1
WALL, n
I mby zMm 1 Am licensed under provisions of Chapter 9(commencing 3 DeSCrlptlOn
heNn
ZZ with Section 7001)of Division 3 of the Bassinets and!Professimta Code,and my licensees
n=y in full fame and tires
License Clans Lie.0
CCn F p Dan: Cantu ton,
7W ARCHITECTS DECLARATION
I t ndmwnd my plans shall W used as public records
JyU
yuor' LiLcveO Profrssianal - .
3 OWNER-BUILDER DECLARATION
i2 1 hereby air.than I am exempt from the Contractors License Law for the
coo following mason.(Section 703 1.5,Business W Professions Code:My city or county
$ which rcquims A permit in connmct.alter,improve,demolish,or repair my atmcwrt
prior in its issuance.aim requires the applicant for such permit to file a signed statement
£ '
"he is licensed purshout 0 ft provisions of the Contractor's Lice=Law(C.Pher 9 Sq.Ft.Floor Area Valuation
y (commencing with Section 7")of Division 3 of the Business And Proleaioos Code)or
$ dot he is exempt therefrom and the basis for the alleged exemption.My violation of
Senior 70315 by airy applicant for a Permit mbjecu the applicant to a civil penalty of APN Number Occupancy Type
An,more dun five hundred dollars(S5a�.
I,uownerofuapmpeny.mmympio wiNwagesut irwlecmpe=Um,
wiBdothewkh dWenmttumiswtinandedoroflcmdfwsa (Srs.70µButircss Required Inspections
and Professions Code:The Contractor's License Law docs rot apply w An owner of fl
property who builds"improves thereon,std who does such work himself ser through his
awn mploym,provided thatsuch improtemrnu are not intended oroRertd forale IL
however,the building m improvment tsmld within one year of oampleGon,Ne owner-
W ilder,will have use burden of proving that he did rot MW or impnove for purpose of
Aske).
W 1.As owner of the property m exclusively conmeding with licensed contranon in
construct the project(Sec.700),Business am!Profesdov Code)The Comraci U.
cera law does not apply to an owner of property who Wilds or improves thereon,and,
who contracts for such projects with A comsmmr(s)Bayed pursuant in rhe Contractors
Liave law.
ameaempt dm Sec. .B&PCfmmi$mAmA
J.� Dao CQ
—WORKERSCOMPE24SATIONDECLARATION
1 hereby aBhm under penalty of perjury one of the following GSIUWons:
IhawandwBlmaintain•Ce fimmof Coventwself-insumfmWwtcriCmWn-
auto,as provided for by Sermon 3700 of the Label Code.for the per..of the
wart for which this permit is iuueC.
❑I have and will maintain Workers Compensation Insurance,As required by Section
37000f the lobar Cade.for the perfomume of the wart for which this permit u issued.
My Workers Compensation huuance carrier and Polity number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
miss secdon nerd rothe completed If use Poem uforom hundred Oil=(SI00)
or less)
1 anifv Nat in the pmfomance We work fos which this Permit u issued.l shall not
mplganyperaon in myon o Obccerne abjectwthe Woskcrs'Cmpenatim
Laws of California Date
App4cant
NOTICE TO APPLICANT:IL after m ung this Ceniftmse of Eacmpuon.you should
become subject An the Wor s Compensation provisions of lie Lsba Cede.you most
�z forthwith climply with such provisiav or this pert"I he deemed nmmkcd.
zCONSTRUCTION LENDING AGENCY
[..t rte., I mmby affirm that them la a eonswction lending agency far the performance of
C4 1W wart Tor which this permit is issues!(Sec.3097,Civ.C.)
Q Lenders Name -
z Lenders Address
U O I aniry that 1 haw mad Ws application ami saw that the above infomunim Is
W P cotmct.l Agra to Comply with ski city and county ordinances and sun laws slating to
pU Wilding censmmdon.and hereby autherim mpnsenuuves or this city in now upon the
W show-mmuaned Property for inspection purposes.
6, (We)agree to sew,indemnify and kap hAsmless the City of Cupcnino against
ti liabilideaJudgments.corts And asperities which may in any way acme against mid City
U in consequence or the Swung of this pemiL
r^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC U TIONS, -
Ail%
� __� O/ Re-roofs
Sighatum of App&anVCOrUrmhOr aide
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant ram or handle hexa dons materia
toed by da:Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
..Semon 25532(e)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yon �PNa
Will the applicant or fuhsa Wilding occupant uc equlpment er devices Mich If'a roof is installed without first obtaining an inspection,I agree to remove
emit haaardou all contaminants As dcftncd by the Bay Area Air QuJity Mmagcmem all new materials for inspection.
District
❑Yat CYRo
1 have real the hvardouss reaterials requirements under Ctupler6.95 of the Califar.
mallesth&SalmyCotic.Saucm25505,25533u M3a.lunh.a Wn ifUc Wilding
dam rot c nay haw a lenam.that it is my responsibility in notify cine occupant of the
reqs with total be mel pdorw issuance Ora CmlficacafOccupancy. Signature of Applicant Date
All roof coverings to be Class'%¢"or better
Winer ser rot se aceto Date'