00080063 CITY OF CUPERTINO PERMITNO.
BUILDING DIVISION PERMIT CONTRACTOWINFORMATION:`
BUILDING ADDRESS:
SANRARY NO. APPLICATION SUBMITTAL DAT
10751 TRESSLER CT. SWAN POOLS 0( 080063
OWNER'S NAME: V D NS`s N/C CONTROL#
PHONL. 1495 S WINCHESTE BLM 08/09/2000
ARCHITECUENGINEER (408) 866-6893 BULDINGPERMITINF zt
x4
p'U
LICENSED CONTRACTOR'S DECLARATION
z f; 1 hereby aRrm Nat 1 and licensed uMcr Provisions of Chapter 9(commencing Job Description
=hod with Section 7")of Division 3 of the Business W Professions Cade.and my license is
m x _ in full torn,arta effect.
sada 1Licx Ossa nvacmr# RESIDENTIAL SWIMMING POOL
53 N
As Shall use DECLARATION -
in I undentaM my Diens Shall W used u public records
`urmo
a a Oo Licensed Professional
OWNER.BITLDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the kLr__s,,
E E O following lesson.(S.U.7031.5.Bmineas W Professions Codc:Any city or county
CC which rcquum a permit m cuamm,edea,improve.demolish,u repair any suuctwc2. S FL Floor Area value
alu tion
3_ prim to its issuance,also rtquimsthe applicant for such pemtiuofileasignedstatement 4'
that he is licensed punumu to the provisions of the Contractors License Law(Chapter 9
(commencing wish Saturn?000)ofDivision 3ofthe Business and!PeorearmneCods)air APN Number fa�Fjcupanc
that W is exempt therefrom for 0.the,basis Ne alleged csamptian.Any vioWa ion v/
Section 7031.5 by any applicant for•pomulsubjects the applicant o a civil faintly of
of mart Nan Five hundred dollen(1500).
❑I.a Dinner Of the Property.or my employees with wages an their solccoropevauon, 3560702izquit$0lnspections
will do the work.W de moxemrc is nm intcrded ca oRemd fm W,,(Sm 7044.Business
and Profeaiom Code:The Contractor's Liana law docs trot apply a an owner of
property who W dots or Improves thanann,W who a0es such work himself or through 103 — LIFER
his own employees,provided that such impmvements all trot inteeded or offerml for
We.If.howeKn ds,building or improvement is sold within me yasr oftarnplwan.the 104 — REBAR
owrmr-Wilder will haws Ne bucker a proving that W did rot build or improve for Pur.
posaofeale.). 107 — POOL/BONDING
❑1,we owner of tW propeny,am exclusively convecting with licensed contractors to ^��. — ROUGH PLUMBING
construct de project(Sm 7M#,Business W Professions Code:)M Contractors U. �+
cannelawdoes""spplytoanowner°fPropmywhoWildsOrirnpmvextheenn.and 304 — ROUGH ELECTRICAL
who contracts for such projects wish a tonmcmda)licensed comment to the Contractors
ucanse row. 502 — FINAL PLUMBING ENERGY
❑1 am exempt under sm. .B&P C for this rcawm
503 — FINAL MECHANICAL ENERGY
Owner WORKER'SCOMPENSATION DECLARATLON 506 — GAS TEST
Ihereby affirm center Penalty ofpnjuryone ofthe following dideamro: 510 — FINAL PLANNING
❑1 have and will rmlow.•Cenifiva of Content m Wf-in.fur Worker Crompton-
Wind,as Provided for by Section 3700 of the Labor Coda fm me performance of she 511 — FINAL P DOL
work for which this permit is issued.
1 have W will maintain Workers Compensation Insurance.as required by Section 51.6 — FINAL BUILDING
3700of me Lobar Code.fix the pedormenee of de work for which this permit is issued.
My Workers Comperwtion Insurume carrier and Polity number au:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This...ored era W complered if ted permit is fortune hundred Mi—(5100)
Or los.)
I certify that in she pedormmc,fine work for which this permit is issued 1 shall
no,employ any person in any manMr so as to become subject o Ne Workers'COmpcn-
smion laws of California.Date
APPlica t
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Wodtaes Compemalio.provisions of me Labor Cade,you must
foMwith Comply with such provisions or this permit shall W deemed tevoked.
CONSTRUCTION LENDING AGENCY
O I hereby affirm the,there is a comouctian lending agency for pedomunm of
z fn she work for which this Formal is issued(Sm.3097,Civ.C.)
F.. Lueders Name
lenders AM.,,
1 certify mat I have rad Ws application and state that the above infortralion is
IY z comm,.)agree to comply with all city and county on inancea W sine laws rclaling 10Z z building conmrc,ion.and emby auNwiu remacnutives of this city to enter upon the
U O above-mentioned property for inspection purpose,
W I~ (We)agree to save,indemnify and kap harmless the City of CupanlDo against
O U liabilities,judgrncns.CmB and expanses which they in any way awe sgaimt said City
} in comae umme of the grenung of this Permit.
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITI I ALL NON-POINT
C.) z SOURCE REGULATIONS.
Si,.of ApplicanJConoxtm Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding Occupant score or handle huardous material Re-roofs
an defined by the Cupertino Municipal Code.Chapter 9.12,W the Helm W Safety Type of Roof
Cede,Station 25532(07 yP
❑Yes C]NO
Will the.,Licentorfuture Wilding mtupant.,a ecO,mem or devices which All roofs shall be inspected prior to any roofing material being
emit haxand.air conuminunu as defined by the Bay Arc.Air Quality Managcmcm installed. If a roof is installed without first obtaining an inspection
District? I aree to remove all new materials for inspection. Applicant
have ❑No
Lha
have read me d.�raouam,teNla mwiamena nede.Gh,Der695 Dfine Cali. 'understands and will comply with all-non point source regulations.
H
funis alth&safety Code.Send.2550S,25533 W 25530.1 urderstaM that it the
building does nu currently have s means,then it is my responsibility on notify the occupenl
Of me m9uiremmtc which must W mel prior to iseuerce of a Ccnificete of Occupancy.
Signature of Applicant Date
Owner u authorieed agent Dam
- All roof coverings to be Class"B"or better
OFFICE