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BUILDING DIVISION PERMIT
BUILDING ADDRESS: ROYAL POOLS INC OF SANTA MK* 0 6 0 9 0 219
0860 HANFORD
rER'S NAME: PERMIT ISSUE DATE
BEN CHOUPAK 22 8 CAMDEN AVE
PHONE: SANITARY NO. CONTROL NO.
408371800
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRA(:1UtCb Ut:LLA tAI IUN
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and uns Code, and my license is
in full force and efs!
License Class Lic. #
Date Contractor
CHITECTS DECLA
1 ZndcrsZ.,d my pans shall he used as public recordx
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for the
following reason. (Section 7031.5. Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractors u -
cense Law does not apply to an owner of property who builds or improves thereon, and.
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
I am exempt under Sec. B & P C for this reason
—wner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
V
have and will maintain Workers Compensation Insurance, as required by Section
700 of die La Code, Cor the performance of the work for which this permit is issued.
Wor C pensation sura and Policy n)umbner�arc:
Came ) � olicy No.:%D�ay ��
CERTIFICATE OF EX ON FROM WORKERS'
COMPENSATI NINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($ 100)
or less.)
I certify that in the performance of the work for which this permit is issued. I shall not
employ any person in any manner so as to become subject to the Workers Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Namc
Lenders Address
I certify that I hav read Chia application and state that the above information is
correct. 1 agree to comp with al(tity and county ordinances and state laws relating to
building construction, nd hcrcby aulhOn7e rescntatives is city to enter upon the
above-mentioned pr rty for ihspection rposes.
(we) agree lb save,*cmnify kee ile the City of Cupertino against
liabilities, judgmclits, costs and expen, wh' in y way accrue against said City
in consequence the ting of thj3 perm'
APPLICANT RSTANDS /( L CO PLY WITH ALL NO O
SOU ERE ATIONSS}
I HDOUS MA ALS DISCLOSURE /
ill the applican r Cu buil ' cupant store or handle hazardous material
de ncd by the Cup ino al dc. Chapter 9.12, and the Health and Safety
//Section Section 25532( )7
❑YesNo
Will the applic future building occupant use equipment or devices which
emit hazardous air c ntamin is as defined by the Bay Are -fir Quality Management
District? f
❑ Yes
1 have re the hazardousterial tremen ndcr Chapter 6.95 of the Califor-
nia Health & S ty Cadc, Scction¢25505 533 and 34.1 in
that if the building
does not curie fly 've a tenan at it 15,�fa
o ihility to notify the occupant of th
rc uircmcns must be riot w Certificate of Occu an
q PP
Ar .l ___1 It �C oG
Job Description
NEW INGROUND SWIMMING POOL & SPA
Sq. Ft. Floor Area
Iwo
Issued by:
Re -roofs
Type of Roof
Required Inspections
Valuation
Occupancy
7
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better