04080120 CI TY OF CUPERTINO ' a
BUILDING DIVISION PERMIT nCONTRACTOR INFORMATION 'i
BUILDING ADDRESS: SWAN POOLS PERMIT NO.04080120
OWNER'S NAME: PERMIT LbUE DATE
E:
SANITARY NO. O%01_NO.
ARCHITEC(ENGINEER: _ BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
u00 LICENSED CONTRACTOR'S DECLARATION lob Description
F 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
wide Section]Of1U)uf Division Sof NC Business and Paressm.Codc.and my license is
n imm�foaandeifat., A ct INGROUND POOL & SPA
Liccnx Cl ys `�—,a LM.M-
��,� Dam al rr?v 7a7�V- Cuntronor
£O ARCHITECTS DECIA ION j
C 1 undersand my plans shall the used u public necnrds �Ja
LL LKCnSCJ PNICSSIIInaI I/
=p g OWNER-BUILDER DECLARATION `1
ti 0 1 hereby alarm that 1 1. exempt from me Contns Co License law far tW
z p 0 following remain.(Section](OLS,Basle,Improve,
do of h,a, Any city or county
K$ which myuims a permit re cnnswm,alms improve,h Penn x t ri e pair any structure
acv+ pniorm its issuencc,also myuims the applicant for such permiuo Elcasigned statement
Valuation
XFG (commencing with Section]000)of Division 3 of the Business and Professions Code)or
Nat
c he u exempt memfrom and the buts the
for
that he is licensed pursuant to the provisions of the Common's Liccnx Law 9 Sq.Ft. Floor Area alleged Memption.Any violation of wxif,wx. h
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of 3yAPV 9WII30eT 00
not mom than five hundred ddlars(s50n). Occupancy Type
L o tha mr of me proprmchga is omployms with wages u mc'v mle7W,Buzn n,
will da fework.end Ne he Cmaisnoti .kens or offer ed fondle(See.9014,owner
o3
and anywhians bComuilds
The Conuacmn's and
Law arcs not apply to an owner of Required Inspections
owpcny who builds or improves canon,and who ares smhwmk himself edthrough his
awn employers,Provided pgsuchimprovementsart not ear ofdmplatin.forsale.lr-
bmvevcq the building or i e.of 1.em is sold within ane year of mpro a to,thepose Of
builder will have the burden of proving Nn W did not Wild or improve for purpose of
sale.).
❑1.as owner of Use prmmny,am exclusively contacting with licensed contractors to
construct me project(Sec.7044,Business and profusions Code:)The Contsacmrs Li-
cense law does not apply at an owner of property who Wilds or improves memon,and
who contracts for such projects with aconmcter(s)licensed pursuant m the Comrxtota
License taw.
❑1 am exempt under Sec. .B&P C for this ruson
i,.a
er DaWORKERS COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury om of me following declarations:
have and will maintain a Cenufieate of Consent Co self-insure for WorhhCompen-
n,as pmvided for by Section 3700 of the labor Code,for the performance of the
work for which this Permit is issued.
I nave and will maintain Worker's Compensation Insurance,as required by Section
] of the Labor Code,for the performance of on,wo&far which this permit is issued
My Warkets Compensation Insurance carrier and Policy number ane:
Cartier: A•1'a• r t Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Lhissectied need not heeomplemd if the IwMit is foram hundmddollars(SRM))
Mss.)
1 certify that in the performance of the work for which this Permit is issued.1 shall not
employ any person in any manmr an,n to become subject to the Workers'Compcuation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cenificam of Excmpion,you should
become subject Co the Worker's Compensation provisions of the labor Code,you mug
.JZ foMwim comply with such provisions or this Permit shall W deemed revoked.
'Z " CONSTRUCTION LENDING AGENCY
PI hereby affirm that there is a construction leading agency for the Performance of
C4he work fur which this permit is..it(Sac.3097,Civ.C.)
W Q lendcfs Namc
U Lender's Address
VQ 1 ttnify that I have read this applicmian and tux for Jin aW.0 information is
E" correct 1 agree to comply with all city and county ordinances and sum laws misting to
p L7 building eonsuuction,and hereby authodm mpresenatives of this city to enter upon the
Y' almvcmcationed property for impaction purposes.
(We)agree to seen,indemnify and trap harmless me City of Cupertino against
HIiabilima.judgmcnts.costs and expenses which may in any way scenic agamt Mid City p
U Z in consequence of me gaiting of this permit I
"
APPLICANT Nos AND WILL COMPLY WITH ALNON-POINT Issued by: Date
SO REGULATIO ,/
61a— F11,'> Re-roofs
ureof Appll n onuactor T D�—
HAZARDOUS M TERIALS DISCLOSURE Type of Roof
Will da:applicant or future Wilding deception 3Com or handle hvxAous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code.Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Ycs .TiPNu
Win the applicant or(ream building occupant use equipment car devices whim If a roof is installed without first obtaining an inspection,I agree to remove
t ha ardaus air contaminants u defined by me Bay Arca Air Quality Management all new materials for inspection.
ruin?
❑Yes �40
I have cowl me haaallousmatentilsmquimmedts under Chapter 6.95 of me Califor.
ma Hca W&Sdety Code.Secdou,25505,25533 and 25534,I undersand Nati(the Wilding
does not currently haw a Conant that it is my responsibility to handy the meopann of me
mqu' tswmm�mdg men mi anttaaccrdhaamaraupanay. Signature of Applicant Date
t C All roof coverings to be Class "B" or better
or authorincJ 6cm uc