05080156 CITY OF CUPERTINO X
BUILDING DIVISION PERMIT CONTRACTQRINFORMATION
,., a:-
BUILDINGADDRESS: LIFETIME POOLS INC PERMIT N005080156
R'S NAME: PERMIT ISSUE DATE
JEFFREY MYERS 910 SAN ANTON 08/18/2005
NE: SANITARY NO. CONTROL NO.
(408) 738-1576
ARCHITECtIENGINEEA: BUILDING PERMrt1NF0
rBLDG ELECT PLUMB MECH
IOp LICENSED CONTRACTOR'S DECLARATION '" ':_.�'
rd F 1 hereby affirm that l am licensed under provisions of Chapter 9(commencing Job Descriptibn
`uf wiNScnion70W)of Division3oflhc Buinusand Prufcssiou Co de nI liccnscis v {/ 1
in fall farce and Circe✓� 2 IN GROUND SPA _1 7 �( o
��? Littpc Cl ` Lic.M
a Dale Contractor G / K S
fl'1 W use DEC �}Y.j,/�a ,UV `(tee
1 ut�flldn�myrylan, 1 W used u pas tic or �+'�p {j {/ ,
,Ofn Vitt k LL LleCnaCJ PnIfC031on0I .ys
i 5 Ost I am exempt
from
DECLARATION a��y
<� 1 hereby alErm Nat I am'xcmpt from the Contractors License Law for IM (� IO/P'lylJa��-£'ta'7
ae O following mason.($codon 7031.5.Business and Professions Cods:Any city or county
which requires a permit to countrouct,alter,improve,demolish,or repair any a raetum $20000
_Z j, prior to its issuance,also requires the applicant for such permit to file a signed eumment
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
y�a (commencing with Section 7")of Division 3 of the Business and Professions Code)or
y $
that W is axempl damefmm and tW basis fm Ne alleged's'mption.Any violation of
Section 7031.5 by airy applicant for a permit writing;the applicant to a civil penalty of
not more Nan fin hundred dollars(5500). r Occupancy Type
0 1,u owner of the pmpcny,m my employees with wagu u thcbsolc compemuon,
will do the work and the swctu a is not intended oro@md forsale(Sec.7044,Business
and Professions Code:The Contmtor's License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who doessuch work himself or through his
awn employees.provided that such improvements are notintended or offered forsaile.IL
however,the building on improvement is sold within am year of completion,Ne owner-
buitdsr will have the Wrden of proving that W did ant Wild or improve for Inrpsve of
sal'.).
❑1.as owner of the property,am exclusively convecting with licensed contractors to
construct the pmject(Sec.7044.Business and Professions Code:)The Contractor's Li. -
come law docs not apply to an owner of property who Wilds or improves themon.and.
who contracts for such projects with aeonvacto(s)licensed Puritans to the Contracmrs
License law.
❑1 am exempt under Sec. .B k P C far this
Date
WORKER'S COMPENSATION DECLARATION
1 hereby M.under penalty of perjury ore of the following declarations:
I ham and will maintain a Certificate of Conscm to self-insure for WorkchCompcn-
urian,as provided for by Section 3700 of the Inbar Code,for the performance of the _..-
work for which this permit is issued. -
❑1 ban and will maintain Workers Compensation Insunram.is required by Section
3700 art the labor Com,far the performance of On work for which this permit is issued.
My WorWfs Co�mp{ensation Insurance carrier and Policy number am
Cartier. �RrE �yN� Polity No.: 15f�i SI `
CERTI— Fl"IIWUEMPIIONFROMWORKERS'
COMPENSATION INSURANCE
(This acarian need not he completed if the permit is foranc hundred dollars(510)
or less.)
1 certify that in the performance of the work for which Nis Permit u issued,1 shall not
employ any person in any manner so as to became subject to the Warkers'Comix,ma on "
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making Nis Ccnifieate of Exemption,you should
become subject to the Worker's Ca rradistion provisions of the laWr Code,you must
Jz foMwith comply with such provisions or this Permit maul W deemed revoWd.
'zO CONSTRUCTION LENDING AGENCY
F IWmhyaffirmdualWrcil.mostmCtinn lcndingagmxYfmtWperfmmmco.f
C' dm work fur which this permit u issued(Sec.3097,Civ,C.)
Q Landcr's Name
z Under's Address
U Q 1 comfy Net 1 have read this application and stain that the above infarmadun is
(L P corms 1 agree to comply with all city and county compares and sme laws mlating to
DU building cmulmction.and hereby amborime ramaxenativss of this city to enter upon dta '
W aMv'-me judgments,
pmpCny for a.,. awhich isL
may
(We)agree a save,indemnify and keep harmless the City of Cupertino against
tZ)Z incoitiesjudgmenke rose and ex thus pxwhich may in any way acmeaSainst said City
U'Z APPLICANT
PLIC NT of the groom g of This fermis.
SOURCE GULDERDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
AUG� 8 20 , Re-roofs
Stgn q acanUContractor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will th'applicam ur fumm building accupnt store orhandlc haemdous mammal
Id.fined by the Cupertino Mune' 1"Cade.Chapmr 9.11,and the Health and Safety
SmUm,25532(x)?
❑y'es � All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainin an ins ection,I a ree to remove
Will Ne applicam or fuwm Wilding mxupam use eyuipmem art devices which g P ghazardous air contaminants u J ocd by tW Bay Area Air Quality Management all new materials for inspection.
m7
❑secs Na
1 have mal the hioaoousmaterials mquiremenu underChxptar6.95ofde Califonalth&Saf lyCde.ShWons 15505.25533 and 25534.1 uMcrsund thatifthe Wilding
not c"ammlyhant Nal it is my.1ruchiliay to notify IW occupant ver the
rcmcats warW mm Prior to issuance of a CCnlficam of MTS 200
Signature of Applicant Date
�—
ower 46a i nd agent Data All roof coverings to be Class"B"or better