05050105CITY OF'CUPERTINO
'BUILDING DIVISION' PERMIT
CONTRACT0WINF�ORMATIQN
.. �CAri2 Semi.,,_ .f n
BUILDING ADDRESS:
SWAN POOLS'
PERMITNO. 05050105
i(
OWNER'SrNAME`,
PERMIT ISSUE DATE
V ),Ir,
r'? WALTER CHAN
349S
PHONE:
SANITARY NO. CONTROL NO,
408 866 -6893
ARCHITECT ENGINEER:
BUILDING PERMIT INFO -
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BLDG ELF PLUMB MEOCH
LICENSED CONTRACTOR'S DECLARATION
I hereby I licensed of Chapter 9 (commencing
w
tl JOdb,;6e c iption
affirm tha am under provisions
with Section 7E(IU)of Divixian 3af NC BUSine vantl Professions Code, and .1 license is
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in full forte and efle "'— r'
INGROUND POOL��
Liccnu CI Liana
Dale - Cuntm"d
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t lr I � ' CHITECTS Dr, luw N "'
' I ndcruand my shall M used es rcmrJS
plans public
Liccnud Professional, a,
DECL ' OWNER-BUILDER ARATION
t I hereby amen that 1 a.
1. cxcmpl from the Cssion& Co License Law for the
following mason. (Section ] and io Cole: Any city county
!(/J® q`1Ry8
demolish. repair any S
ve: de
which tcyussuan Permit di cnnauucL alley, improve;
onsum r. alter.
!i
n Perlin fi tatucmm
prior e, r'6 issuance, also myuihs IM applicant for Colt permit m Bee signed statement
wit pursuant to the of theeBusiness usinor'xnd
Sq. Ft. Floor Area
'�" Valuation
harnmeseing of Division Professions Codtor9-
of Division. of the Codc)of
Prt.
[ eucmpn
I
therefrom and?
etorc rpt Any violation of
that be li and the b ®u for the alleged My
Nat u uempytany
p�
baGi 0 0
•,. Occupancy Type
Section 703[.5 by ury applicant for a subjects the applieanno a civil penalty of
o ap 'Plow m
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nq ma¢than Rva nanamq dollars (SSW).,. . , ..
W).,.
❑ Las owner of the propeny,mmy emplaycu with waguu Heir ale eompensatian,
- Required Inspections
will Newark. Business
Co m; Law bass notapply, tan.
and Professions Cade: ThgContracmr'aLianu Law dots not apply, to an owner of
Pr
q -
pmpenywhobuildsorcdOutasthImprovements who doessuchwart himselfedthrough Ms
hs au not eaMedmplefio.for
cs, ping
owracL
however' be or improvement mid within year of completion, NC Owen
huildc,
builder will have the burden Of proving that he did not build ar improve far purpose of
illhow tho Itrto.Of using Out he iour
tiled.
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❑ 1: as'mmer of be proper, am exclusively eommcting with licensed contractors to
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construct the project (Sec. 7064. Business and prolusions Code:) The Conuactor's Li.
cctue Law dkrcsnon apply to an owner of property who builds or improves Ihemon, and
who commis far such projecu; with a contractor(s) licensed purauanl to Jle Contractor's
License Law.
Q l am exempt under Sec. .B &PC for this mason
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wncr, Do.
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WORKER'S COMPENSATION DECLARATION
1 hereby affmat under Penalty of perjury ant of the fallowing declarations:
I have and will maimint a Certificate of Continuo self-insure for Workcra Compeer
sau.n, as provided far by Section 3700 of the labor Code, for the performance of the
work far which this permit is issued.
1 have and will maintain Worker's Componsadon Insurance, as required by Section
3 of Nc labor Code, far the performavice of the work for which this permit is issued.
My Worker's Conformation Insurance carrier and Policy number mr:
'
Caric4A•i�y�eaGA�= ''Policy No.: 1'g'�i% 4
�kC�M�R EMPION FROM RKERS'
•,'aF$� ION INSURANCE
(This sea ran nood not be completed ifthe permit is rorone hundred doll.(SIM)
,
of loss.)
1 cenify Nay in the acriumtamc of the work for which this permit is issued. 1 shall not
,.Ploy any Noun in any manner so a to become subject o tha Workers' ComPeraadon
Laws of California. Dale
Applicant
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NOTICE TO APPLICANT: If. after making this CeniEeam of Exemption, you should
become subject to the Worker a Compensation provisions of the labor Code, you must
forthwith cannot, with such provisions ar this Permit shall be doomed revoked. "
CONSTRUCTION LENDING AGENCY
I hereby arrom Nat there is a construction lending agency for the Performance of
be work for which this permit is issued (Sec. 3097, Ch, C.) '
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Under'sName
'
Lender's Address
I cenify, Nat 1 have read this application end salt that the above infarmadun is
correct 1 agree to comply With all city and county ordinances and sure laws relating to
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Wilding construction. and hereby authorise representatives or this city to enter, upon the
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above mentioned property for ieumcdon purposes.
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(we) agree to... indemnify and leap harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accmc against said City
in consequence of the grand ng of this Permit.
A ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
U EREGU ON
Re -roofs �% r
01
Signature pplicadvcof ra r Date
HAZA US M IALS DISCLOSURE
Type of Roof
Jl the applicama lure building occupant store or handle hazardous material
applicant
as defined by CuNnino Municipal Code. Chapter 9.13, and the Health and Safety
oJC.S El Yea 2s5J2(a)?
❑vex (�-
All roofs shall be inspected prior to an roofing material being
P P Y g g installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building aecupant tau cquipmcnl or dcvieas which
_..n hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
0 Y
I have mad the haraNnus materials requirements under Chapter 6.95 of the Colifor.
nia Health &SafclyCOda. Sections ISMS. 25533 and 25534.1 understand thn ifthe building
Joca not currently hero a tenant Nat it is my ruponsibieity to notify the occupant of the
require mcn ustbcmclp' utissuanc ra fica@or0.d,.c,
'gnatureofApplicant Date
All roof coverings to be Class "B" or better
Owner o orzcdagcn ,a
v