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02070185CITY OF CUPE TINO � D Ms's --J o CITY OF CUPERTINO PERMIT APPLICATION FORM APN # Date: Building Addres Fee Group 0 er s Name: Phone #:a 5 - 1q6 Contractor: BCONSTAX License #: -70 19 Contact: Phone #: Ind/Off/Comm/Quasi BUILDING WOG • 3 Applic Contractor: Con. Tax for BQ Zone Fax #: Buildin ermit Info: BCONSTAXH Hotel and Motel Bldg Elect Plumb Mech Job Descriptio Residential: 1i, \& ft;� i Commercial: Sq.Ft. Floor Area: - $/Sq.Ft.: Architect/Engineor: H Valuation: 0 t a<. 6 L] 6 ELECTRICAL Type of Construction: l � �� Occupancy Gz V: vY EnerEy Quantity Fee I Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax -- Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY EnerEy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi - Family Res MECHANICAL BNEWMULTI New Multi-family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL - BNUCONIMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 1 of 3 L -RPR- CITY OF +CUPEkTINO CITY OF CUPIERTINO S G POOL PERMIT APPLICATION FORM o 2 1 7 0 APN # - /% -7 _ - a/ Date: n or ' cc- - Building Address: / 6 U Owner's Name: Phone #: Contractor: License Contact: Phone Applican ontra or: Building Permit Info: Bldg Elect Plumb Mech T ion: Residenti : -w C �C- Z�2C3-�s� ?Lzk ercial: Sq. oor -Area: Ana $ /Sq.Ft.: Architect/Engineer:k ( � Valuation: Type of Construction: Occupancy Group: Qty. if A licabl r Fee ID Fee Description Fee Grou BSWIM Swimrnine Pool BUILIDNG I I BUSLIC I Business License I BUILIDNG I CPO NN0ad 7 5 Fz5 y Q p O Z 0 ,u3a,� Wa a ❑ C -r, � � e C rc 0.3° �y Q C U a�5 �^ E .frr :E >r+ i C6 U- r l- br > CITY OF CUPERTINO ._ ., ,,.s - :._.,.- CONTRACTOR INFORMATION: BUMDING DIVISION PERMIT BUILDING ADDRESS: PERMIT N0, 10390 STOKES AV SWAN POOLS 02070185 OWNER'S NAME: APPLICATION SUS DATE LORENZ DANIEL A AND ANNETTE P 1495 S WINCHESTER BLV 07/29/2002 PHONE: SANITARY NO, CONTROL NO. (408) 866 -6893 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MF,CH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divis(on 3 of the Business and Professions Code, and my license INGROUND SWIMMING POOL & SPA is in full force t. t, r3,14 {q% License Class Lic. q Date Contaaclo ARCHrfECT's DECLA I understand my plans shall be used as public cards Licensed Professional �I OWNER - BUILDER DECLARATION hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county $24000 which requires a permit to construct, alter, improve, demolish, or repair any structure - - - .. - .. - prior to iMissuance,also requires the applicant forsuah permitro ftlen signedstaiement _ 1 r &� R j �, :� r Valuation t43tihTiA licensed ursuant L411se ptuvisjoas of the Contractor's License Law (Chapter 9 (contmeomng lI OQ(1 Division 3 of the Business�agd Professions Code} �,; eei of or mat he �a tkb f the From[ and the basis for the all�jedpgemptjoh. p ay violation Ab' ;.r - ft 1 - of-Section- 7031:5-by any applicant for a pemtitsubjects the applicant to a civil penalty- lofnotmore than- evehundreddollars(sso0), 103A1?N r ;.' ,:I7�tt Occupancy Type M I, as owner of the property, or my employees with wages as their sole compensation, jn4 - REPAR t "will-do -the "Work, and the-5tructure'i3- nor iatended'or offered for sale-(Sec.-104.4, "Business'aiI& Professions Code: The Contractor's License Law does not apply to an - -- - - ' ' -. -. -... - ... ._ I- - --- -; -- .- -.,_ -- 107 - POOL / BOMV d Inspections-- : owner of property Who builds or improves thereon, and who does such work himself 3 01 - ROUGH PLUMBING or thmugb his own employees, provided that such improvements are not intruded or offered tor- sale"- IF,- howevei, [tie Suildtng ai ihtpmvemcnt Is sold within one year of 'tompletion, the owner - builder will have the burden of proving that he did not build or I _ _ 3 O 4 - ROUGH ELECTRI '''I ' P'r ' -' ' ` -';t't V.) improve for purpose of sale.). 502 - FINAL PLUMBING ENERGY .0)':ilt."nerofthe. property, amexeln5ivelyeon [meting With licensed contractors to _ .5.0.3_.__ _. FINAL— ME' CFI,kNICAL-..ENERGYL.-I.:__._ -_, construct the project (Sec. 7044, Business and Professions Code:) The Contractor's ' �, ; `r'' •- �� ; '1.0 1. 6 GAS License Law does not apply to an owner of property who builds or improves thereon, 5 O - TEST and_Wha cgntracm -for such_projecis -with a- coatractot(s). licensed- pursuant to the- -- Con[ractor's License Law. _ ❑ I am exempt under Sec:•' t' n` 1'' ' ,1 "'�,BkPrC For this retson `,, _ _ t�'� 1r ?:'.:f tl, 511 FINAL POOL 111 „ owner" Date"' i` '' " '" " ?'WORKER'S 516 - FINAL BUILDING I' " COMPENSATION DECLARATION Iherebyafftrmhnderrpepa ltyofpettZy,one,gf.the followingdeclarations: ❑ F have and'w)II maintain'a Celiflicaie of-Consent to self -insure for Workers Compensation, - as provided for by Section 37M of the Labor Code, for the, perform5ttc6 on he {or which this pe=it is issued.• , have and will maintain Worker's Compeosatiud Insurance, as iagiiired by Section of die Libor Code; For the pert» rmance of the work for`which this permit is issued. My Worker's Compensaton Insurance carrieY arid Policy'number {t,., .a .c 1 ,� !, :., r 1, ,.L.,,t ++ .. ...:e,-„ C .4iiier:sr-'�/J1'��,,r,��olic No •r - _ _ __. _,...--,.,_ �—,., ........_......--- '- -"------ --- .,.__.,a. »... _. r, _r. -= _,z = .,n v..v ,. cn.,,ze+,.:•,.r.�snr. .r_.� -- -.4 d?�rt1,y ., 4i ' ,� . V, i t_OERUI T� ATIQN'OF EYEMPTION FROM�,WOl2RERs ti ' xt �•� A is "I.: � 1 - t , . �. :+ � _ • - l comPENSATIONINSURANCE = 'tlt7 °" ..r,_,..,5,.._4 -.. a -,r, • „- - + "'i ° •'(Thls'sOGtiod iiei:d'ndt be completedif the permit is for one hundred dollars j `' 1 �,' ,�t'' i„ �6° �. -... Iu~ - • .'CC•_i i',.. ,•:?1 �iy }3 (5100) orlessJ � , certtf 1 to me ortf�an a of the work'for which [his iihit )s issued, I I 'k ', , . .,, to . �, ..� ,,.. f �.�, _ � , . >x skull not employ •any) persoq'tn any manner, so as to,become subject, to the Worke& i I Co i)>Matlon ` Laws of California. Date A Aliaant ., T N CE TO APPLICANfaf,'aftdrmakrr tfilsCeriificateoFEii h uoh,youshod( he sub act to the Worker's Cum ensation of the Labnr'Code; ydu arcs[ j k p provisions 'fonliwidf core l i wiffi sueh provisions or this permit shall be deemed revoked. P Y P CONSTRUCTION LEND�,IYGAGENCY`. r '1 I,Sertby affirm[ iliat mere is a cbnsiNttibn ]endin'g'agency for the - performance 'of ilie work for which tliis'Qerrnit is issued (Sec. 3097, Civ. C.)• nder`s' llama • - - J Lender s Address ' I certify chat I have,rend this application and state that the above information is aorrecla I agree to comply with all city and County, ordinances and state laws [elating humorize :to building constriicden, and hereby icpreseritatives of t]ii_s city to enter upon the_ above - mentioned property for inspection purposes. _ (We) yg'rGe tb sA4i'andemnyfy end keep harmless the'City'bf Cipemiio against //- habihOes.jttdgments, costs and,expenses,which may-in any way accrue against said City io'consequerfee of the giadd'ng'of rhi5 rmit. 'APPLICANT'U13DERSTANTIS AND 5VIL COMPLY WITH ALL NON =POIP T OVI(CE iiEGL2ATIas:.;t -, :' ;,i r,,,, Issued by: Dat t5(g,,ttuc of A �icpnuCon star. • ,: ''' �, '., _ 1... ' ~' Date ' r �' Re -roofs f i Oun ' t ! l i oc. } �diiheapplieantb�fiuttrebuildiitg «s�' '. • L st re uur b�d liaLi ous matenal - _ a� _.- '1}fp�of_Roof... __.. -- __ .._ .__ ._.- _�_ - -• a_--- . - - = --_ -, _ x d .__..__ ,.. - -_ os as 66iird py the Cupettieo M par', per 9.12: and the Hea)m and Safety ei Cha eiitTe,'secnanz �3 {t) , n,';•1; °,.. 5`,ti4. Sy. •,, - , ,'' ,`'.:�yz 1 ' r t fy o I t i`1p'r 1, i,.S !',lip' j C] Yes 7 0 r r w -1 • A _ .� All roofs stialI_be. inspected_pl or_to any roofing material be d. _ , ,• r Wfll,the a�plicant�or future building occupant use equipment or devices which! _.. ._ If a roof is installed'' without first obtaining an inspection; �I' agiee, to' remove erect hazardous air conlarninan[s as'defined by tote $a` emit yAreaAirQualiry Managemeut d7 all new materials for inspection., and will comply with .',, ❑Yes r{ r " . ,•; `;,- _Applicantund_erstan_ds all non -point source regulations, t,� , 'I havel read'meTi�zar'ous materia)s requirements "under Chapter 5.95 of the eal)Ktarii3 Health & $afety Code'; Sections 25505, 25533 and 25534. l understand that ifthe bvildingdoes not cumentiy'have nant, that iris my.responsibiliiy to notify the ' be ct prior,to isgvatieevYaertificate of aW;;iip Signature of_A_ pplicant Date All roof coverings to be Class `rB" or better r , (Date ;. _ - OFRCE - -- - { 0 u€ aI, a � v FyE"� 0 o�WC E 0 a us ? LU �CC FZ> Cc 3 a �•r .j OC W� �z :u C • U CITY OF CUPERTINO BUMDINGDMSION : ": '' �� � CONTRACTOR]NFO :• ON:; PE IT HUII. DING ADDRESS: PERMIT NO. 10390 STOKES AV SWAN POOLS 02080052 TOME LORENZ DANIEL A AND ANNETTE P 1495 S WINCHESTER BLV APPLICATION Sn DATE 08/09/2002 PHONE • (408) 866 -6893 SANUARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH r — I 'rte LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license ' REVISION--IN HOUSE USE ONLY is in full Force and effect License Class Lic. M ' NO NEW PERMIT ISSUED Date Contractor ,1 ARCHITECT'S DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the following reason. (Secrion 70313, Business and Prufcssions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure ..priorto itaissaancgalsarequimtheappGrant forsuch penoitro file asigned.stvement thatihh' i5licensedptgst )aQttaitGergvisions of the Contractoris License Law ( Chapter 4 (commencipg wady SectioiQ6ft of Division 3 of the urines ;apd �rafPSSions Code) �,1 st Opp-•e{� r t Z ` • �• i r: tq� �.. ?A. > a1Q T` J ~ ^ -3 , l T •r �• `' .i'.Y' a nation or that he-is ekcrhpf Nirif omnp d the basis for the a] a cEdextmpdnm. Any violation ' -of section 7031.5 by any applicant for a the to • , - APN Number .. Occupancy Type permit subjects applicant a civil penalty of.notmore than live hundred dollars (5500), ❑ 1, as owner of the property, or my employees with wages as their sole compensation, , 'will'do the work,-and -the structure is'aot intended or oflcred for sale-(Sec. 7044, Busini8s and Professions Code The Contractors License Law does not apply to an '- — - - - - - ' - - " - - - -. . ' °- -- -' - -- -- --- -- -- -; 1 -:,r - ' -- - -' ---- ---- -- -- 104 - REBAR Required Inspel rions I: , .: r owner of property Who builds or improves thereon, and who does such work himself his 10 7 - POOL/BONDING or through own employees. provided that such improvements are not Intended or ' -offered nr improvement the. er -build fire buTve shhal within one year or 0 -1 - ROUGH PLUMBING ' `-'''� "' '• '-' ' 4r' ion, w completion, the owner- hui[dtr, will have the burden of proving that he did not build or t n improve for purpose of sale -)• 304 - ROUGH ELECTRICAL I, ps ovine {a(,thc ProlxRy, a,;; �x�iusi�eiY snn[raeting with [icerrsed eon[raciarsto _ _ - _ .' __ SO 2___ _..FINAL - "PLUMB ING..ENERGY i:: •' ': �- :• "r:i, � ,.. —. r; •--- -• - - - -� eohsnuet the project (Sec. 7049, Business and Professions Code:) The Contractor's License Law does not apply to an owner of property who builds or improves thereon, 503 — FINAL MECHANICAL T'ENE RGY - oustwho."atractsfor.mch project s. wiwawrurac tor(s) licensed putsuant.to.the .. ..._...-5-06 - - -- GAS-- TES`F- _._ —___. Contractors License Law. 111 am exempt udder Sec. P � Tor this reason 510 - F NA ' f' I L PLANIV�I�G " "', .Ova - -- ' Date " 511 - FINAL POOL WORKER s cOMPFrrsArlON DECLARATION 516 — FINAL BUILDING I hereby affirm under. peachy of perjury, one of the following declararions: ❑ I have and will mainfain a Certificate of Consent to self- insure for Worker% Compensation, as provided -for by Section -3700 of the Labor Code, for the performance of the' work,for which this Qe(mit is jssued ❑ I halm and w)Il'mvnc i6 Wo&erk Cotdpensatirm Insurance, as required by Section '3700 bfthe [abof Cade, for the performance of the'work Tdc which this permit is issued. My Workers Compensation Insurance Carrier maid Policy number arc: ._., __ --- -- ._w.e ....................4.,... w..,.— .__._.W.�.,..�..... __;•1' - .•- ---- --...'_H�,J`} OamiieC ..5 , Yolic No: • ' s•,, CERTIFICATION P17faN 17- -;ry`-' gtir� }t i r �. t.. {��1 `. 1 L,' j 1 : i OF F-7EN FQ,OM'WORKERS.t'•: "COMPENSATION INSURANCE", lr ' '•" ! ° . .. ° -i .''• . ' ` (Reis seeribn need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the'work' for which this pm7rmu is issued, I hall not employ any person is any inanner s'o as to become subject to the Workers' -, `' _ ` "' ' , Compensation Laws of CaOforuia. Date Applicant. ° • . ., NOT}Cl TO APPLICANT: If, afar making this Certificate of Exemption, you should btcome'subject to the Workers Compensation proiriiions of the Labor Mode; yeh must, forthwith comply'with such provisions or this permit shall be deemed revoked. °- - - -' -- -. .._ _ _ - _ __ --- _ _ __ _ _.— _. _.._ -- -_'r' -,- _ -- -- --.- - -- '- ,:•,.: '-.•CONSTRUMON LENDING AGENCY ' •' _ I ;�.__. 1 hereby affirm that there is a constmcdon rending agency For the perfo[maaci ' • r 'Of the work for which this permnit is issued (See. 3097, Civ. C.f LendersNatrie°.:_- Lender's Address - - L certify that I have read this application and stare that the above information is eb*'CL I agree le comply with a)1 city and county ordinances and state laws relating to building eonstructidn;'amld hereby autherim representatives of this city to enter upon the above- mentioned properly for inspection purposes. (We) agme'to save, indeldnify and keep harmless the City of Cupertino against Liabilities, judgments, cosL4 and Expenses which may in any way adore against said City in consequerice of the granting of this permit. M1 , APPLICANT UNDERSTANDS AND WILL wmvLYwrtH ALL NON-POINT r SOURCE REOULATIM4S.� j''' ^, - Issuedby: Date Signature'of,AppbcmtUConlracforT " ,' Date ' , Re -roofs 'HAZARDO(SS IvL4CERIALS DISCJ,OSIIRE ' Zt i&' applicantorttimre_ Wdiegoceupav4s tpreor[randlthaaatdausmaterial .. Type..OfRoof_ - _ - ----- •----- _. _. .�.____ ........... ...T _. „.....,.�,..,.....��.., _.. ds defined by die Cupfrtmo.Municipal Code, Chapter 9.12. and the Health and Safery Cade Sectioh A531�a}3, ° } . ;'e ❑Yes'` L+ All roofs shall be in$pected_pripi_tg ioofing zr�a,Gerial being. nstalled,___ ..)MLI the applicant'or future building occupant use equipment or devices which -any. � If a roof is uis611ed'without first obtaining an inspection; Vagree to remove - emit hazardous air tonlam!nants as defined by the Bay Area Air Quality )vlanagement District? all new materials for inspection._Applicant understands and will comply with 17 Y_ es - 0 N all non -point source regulations.. ` ' I have read the ftaxardous materials requirements under Chapter 6.95 of the •Cailfatnia Health & Safety Code, Sections 25505, 25533 and 23534.1 understand rbak if,time balding does not cu rtndyhave a tenant, drat it is my responsibility to notify the' •_ _ _ .,. . _. _ -.. _.. _ ' occ'upant of the requirements which must he -met priof" to issuance of a Certificate of ' occupipcy' Signature of Applicant_ Date All roof coverings Lobe Class `B” or better. ' 'Owner or authorized agent'• . Date - ° - - - —' .. . - nrrsnr. - .-- - - -- I - - - . - -