D-2018-0054 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2018-0054
10276 V1ROINIA SWAN PL CUPERTINO,CA 95014-2025(31646003) DANE'S SWIMMING
POOLS
SANTA CLARA,CA
95050
OWNER'SNAME:MIYAMOTO JUDITH A TRUSTEE DATE ISSUED:07/18/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-53 Lie.4791311
Contractor DANE'S SWIMMING POOLS Date 02/2812019 —BLDG ELECT—PLUMB
I herebyaffirm that I am licensed under the provisions of Chn ter 9 —MECH x RESIDENTIAL_COMMERCIAL
p p (commencing
with Section 7000)of Divistan 3 of the Business&Professions Code and that my
license is in full farce and effect JOB DESCRIPTION:
DEMO POOL AND SPA(118 SF)-FOR LANDSCAPED PURPOSE
I hereby affirm under penalty of perjury one of the following two declarations: ONLY
have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued, Sq.Ft Floor Area: Valuation:$20000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: O anti on,y'Iype:
and state laws relating to building construction,and hereby authorize 31646 003
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue aj inst a - ity I o segue ce of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the ppjjc nt ers n a will comply with all non-point
source re gyl section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 07-18-2018 Issued by:Kim Dunbar
Date:07/18/2018
OW ER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS•
following Lavo reasons: All roofs shall be inspected prior to any roofing material being installed.If n out is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sce.7044,Business&Professious Code)
2. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sce.7044,Business&Professions Code), Basic:07-18-2018
I hereby affirm under penalty ofperjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. 1 have and will maintain 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. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have rend the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Cade,Sections 25505,25533,and 25534.1 will
permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9,12 and the
s. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Cade,Section 25532(x)should I stare an handle hazmrdous
shall not employ any person in any manner so as to become subject to the material,Additionally,should I us quipment or devI s which emit hazardmns
Worker's Compensation laws of Colifomia.[f,after making this certificate of air contaminants as d"dned b th 3 . A.Ir ua I,Mnn neat District 1
P g will maintain compliance with'.
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
SignatureLicensed
Date 07-18-2018
Professional