02080161s
SWIMMING POOL
PERMIT APPLICATION FORM
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CITY OF CUPERTINO
CONTRACTOR INIFOR ION,:
BUILDING DIVISION PF�. �T
BUILDING ADDRESS:
PERMIT NO.
21130 CANYON OAK WAY
SWAN POOLS
02080161
OWNER'S NAME:
APPLICATION SUB DATE
1495 S WINCHESTER BLV
08/28/2002
PHONE:
(408)866-6893
SANITARY NO. CONTROL NO,
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
J I= L-J L _I
a.
z LICENSED CONTRACTOR'S DECLARATION
Job Descri tion
%hereby affirm that I n 3 licensed f the under pr visions si Chapter 9 (commencing
with Section 7000) of Division 3 of the Busines nd professions Code, and my license
- I NGROUND POOL Cdr SPA ( 12 S Q . FT . )
is in full for eff
Li use Cia ...
to Con
ARCHITECT'S DE RATI N
I understand my plans shale be used as public records
sed Professional
i OWNER - BUILDER DECLARATION
n I hereby affirm that I am exempt from the Contractor's License Law for the
"
C following reason, (Section 703 t S, Business and Professions Code: Any city or county
$25000
which requires a permit to construct, alter, improve, demolish, or repair any structure
» priortoitsissuance, alsorequirestheapplicantforsuchpermittofileasignedstatement
-- ,... ..„ _„ ..,.. _.. __..._� ..... •,._.._... _, _...... ...
�
Valuation
that'he'is licensed pursdam'tb,the provisions of the Contractor's License Law (Chapter 9
(cotrsmenc°ing with Section 7060) of Division 3 of the Business and professions Code)
6�Q� G-. y tlfil
or that'he is exempt theirefron ands the basis for the alleged exeriiptton. Any violation
-o£ Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of,not more'than five hundred dollars ($500).
10 3APN FRWr
Occupancy Type
0 I, as owner of the property, or my employees with wages as their sole compensation,
°.
107 POOL /BOMT1b1Gd Inspections
will do the work, and-the structure Is not intended or offered for sale (Sec. 7044,
Business in !,Professions Code: The Contractor's License Law does not apply to an
" owner of property Who builds or improves thereon, and who does such work himself
301 ROUGH PLUMBING
or through his own employees. provided that such improvements are not intended or
_
,offered for sale. if, however, the building or improvement is sold within one year of
`
304 — ROUGH ELECTRICAL "
completion, the owner - builder will have the burden of proving that he did not build or
improve for purpose of sale.).
502 - FINAL PLUMBING ENERGY
Q I. as,owner of,the property, am exclusively contracting with licensed contractors to
-_ -... _FINAL . IM CIIANI CAL ENERGY
construct the project (Sec. 7044, Business and Professions Code:) The Contractors
506 — GAS TEST
License Law does not apply to an owner of property who builds or improves thereon,
_and whit contracts for.such pxojects.with a.conttactor(s) licensed pursuant to the.
510''-- FINAL — PLANNING
Contractor's License Law. ,
01 am exempt under Sec. , B & P C for this reason
511 —' FINAL POO y ' 1 •'..
Owner ' bate" '
516 - FINAL BUILDING
'WORKER'S COMPENSATION DECLARATION
�- °I hereby affirm tinderpenaityof perjury one of the following declarations:
0 I have and will nuirafahf a Certificate of Consent to self insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance'of the work for which this permit is issued.
aye and wili'mainiain Wbrker`s Compensation Insurance, as required by Section
3700 of the Labor'COde, for the performance of the work for which this permit is
' sssite8.'My Worker's Cosh ensation umnce carrier and Policy number are:
••
C .e Pif Oq
CERTIFiCATION-O EXENVrION FROM, WORKERS'
COMPENSATION INSURANCE
(This'sectidn need not be completed if the permit is for one hundred dollars
(St00) or less.)
I certify than in the performance of the work for which this permit is issued, I
-
shailnot employ any person in any manner so as to become subject to the Workers'
°
Compensation Laws of Caiiforma.'Date•
Applicant
NOTICE TO, APPLICANT: If, after making this Certificate of Exemption, you should
become Subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
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_.. .. ... .. .. ...
. .: :. '"CONSTRUCTION LEND,tNG AGENCY
.. "
y t hereby affirm that there is a constructton lending agency for the performance
q of the work for which this permit is issued (Sec. 3097, Civ, C.)
a Lender's Name .
Lender's Address
'
I certify that I have read this application and state that the above information is
correcx. i agree to comply with all city and county ordinances and state laws relating
to building construction: and hereby authorize representatives of this city to enter upon
41 the above - mentioned propert,yy for inspection purposes.
)« (We) agree to save, indemnify and keep harmless the City of Cupertino against
0!t liabilities, judgments, costs and expenses which may in any way accrue against said
City in consequence of the granting of this permit.
~ APPLICAi i UNDERSTAND : D W' LL COMPLY WITHALL NON- POIdT'
Issued byt Dal('
SOT RCE R 10
T a6z—
ig fAoptic- ctor Date
Re -roofs
RDOUS MA LS DISCLOSURE ,
41911 the appli t or futuie bnitdi occupant store or handle hazardous material
Type of Roof _
" as defined by the Cupertino Municip , ode.. Chapter 9.12, and the Health and Safety
Code, Section 255�2(a)7
, .
CYas No
All roofs shall be inspected prior to any roofing material being installed. .-
.,Will the applicant or 'toKN. cupant use equipment or devices which
If a roof IS installed 'Without first obtaining an inspection,'I agree` to remove
emit hazardous air contaminants the Bay Area Air Quality Management
Distriati
all new materials for inspection. Applicant understands and will comply With
CYes
all non -point source regulations.
% have read the h dons materials requirements under Chapter 6.93W the
California Health & Safety Code, Sections 25505, 25533 and 25534, I understand that
ifthe building does,pot currently b• ve a tenant, that it is my responsibility to notify the
occupant oft a requirements w s must be met prior to issuance of a Certificate o£
Occupaney.
.
Signature of Applicant Date
All roof coverings to be Class `B" or better
r authorized ag t
OFFICE