04050141z
Z .C-
CITY OF CUPERTINO
"- * 77"
BUILDING DIVISION PERMIT^CONTRACTaRxTNFORMATION�-;
BUILDING ADDRESS:
SWAN POOLS
PERMIT NO04050141
OWNER'S NAME:
PERMITL$UEDATE
JOE
E:
SANITARY N0. CONTROL NO.
(408)866- 29';
08 66-
ARCHITECTIENGIWER
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 D 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Desc //ll��
bmcbY affirm that I am licensed unde previsions of Ckpmr 9 (mmmeming
with Section )of Oivixion7af NC Busi dPrafcuiom Code. and mylicense is
G1
15th' G I
in full fO eff t.
L1CC ren l
INGROUND POOL & SPA
DaIV Co.
ARCHITECISDECLA N
— —
LOZ I t
hO
1 undcnd my plans shall used as par mounds
nuk
1J0
®@�/��p�yB
Licensed oval
OWNER -BUILDER DECLARATION
1 hereby ffum that 11. exempt from tk Contractors Lkenu Law for the
hereby
® � w IJ
dssiuu Ca de: Any city Or county
following moon. . 10 1.5, Business and Cra
C V
co Improve.
Permit alar. improsu, demolish, m repair any structure
which require a pmmil
r e2i the,
Ort, he its cense¢. alsort1. One tho,isimcanf for such Certranmiuofilnse signed nammcm
Y
thommenccenud puotanua tk pro vision of lk Cmmruess,
Sq. Ft. Floor Area Valuation
dd Protectors; COdc) tar
Code)
(commencingwith Section(ad of Divisions lark Buslnmempa
in. Any
I Net k u exempt tkrtfmm and the buts for Ne alleged cumpdon. My violation of
that
Section 7031.5 by any applicant for a permit ubjects the applicant to a civil penalty of
snm
3 A&B10,0"erO 0 C
not mom dun Rye huMmd dollars (M).
❑ 1, n owner of Ne properly. m my employees with wages u their sole cmnpcnudrn,
will do lie work, and the nmmu a is not intended or offered formle (Sec. 1044, Business
and Profusions COO: The Convector's License Law does not apply N an owner of
Required Inspectio
propeny whobuildsorimpmves thereon, and whodoessuchworkhimulf orthrough his
owneer,due uipnvikd Nattachimpmwmwts»not intended far owner.
however, Ne building or improvement is said within one year of c the owner -
prove for
Wilder will have the burden of pressing that k did not Wild or improv far purpose of
I ®�
salt.).
❑ 1, as Owner of the property, am exclusively contracting with licensed mnvactora to
construct the pmjcct (Sec. 9044. Business and Pmfeuiom Code:) Tk Coatruur's Li
came Law does wt apply to an owner Or properly wk kilds or impmvu thereon, and
who contracts for such pmjcM with a convacmr(s) becmm pursuant to the Canoodles
License Law.
❑ I » exempt under See. . B & P C for Nis reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 krtby ¢Rum under pcvlty of perjury one of Ne fallowing dad»tion:
rl 1 how and will maintain a Certificate ofCumem to self -insure for Wmke4Compan-
sation, u provided for by Section 37M of One Lakr Cade, for Ne pcimmin me of the
.it for which Nis Permit is issued.
❑ 1 kw and will maintain Workers Compensation hwnna, u acquired by Section
377 of Nc labor Code. for the performance of the work forwhich this permit is issued
My Worker's Compensator, insurance carrier and Policy numkn »:
11
'her. A.A.g. Polity Na OF_
CERTIFICATE OF EKEMPITO WORKERS'
COMPENSATIONSU ANCE
(fhu scctim rcdnotkwmpleuJ if Icmtitisforanchundrtddoll»(5100)
or Ica¢.)
1 century that in the Performance of tk work for which this Permit is issued. I andl not
employ tiny permit In my mMner'. as N keame subject in the Wofkcnat GamperWdan
Laws of California. Dau
Applicant
NOTICE TO APPLICANT: If. after making its; Ccvifieau or Faemption, you should
become subject in the Worker's Compensation provisions of Ne Lebon Cade, you mind
forthwith comply with such provisions or this permit shall k deemed revoked.
CONSTRUCTION LENDING AGENCY
I kmbyaRrm Nat Nert iso cod. lendingagcnry for Ne pambsimxnceof
Nc work for which this Permit is issued (See. 7091, Cie C)
under'Name
Under's Address
I certify, Nat 1 hays rod this
coup and sum thp the above information miting is
collect 1 agree to comply with all city and county ordinances and sum laws raping to
city and
building construction. hereby auNonprposes. Nes of this city to enter upon Ne
oand
a property impaction proposes.
(We) agree to save, indemnify and keep harmlus the City or Cupertino against
liabilities, judgments, coati and caputsea which may in any way accmc against said City
s�
cormaluenco oband
m comequcnec of the graining of this permit.
in
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -PO NT
Issued by: Date
SOURCE REGULATION a
d
I
Re -roofs
Type of Roof
onvacmr
n HAZARDOUS ATERIAIS DISCLOSURE
Adding
e applicant or future occupantstore Or handle harudousmaudal
.'Tell he Cupertino Municipal Code. Chapter 9.13, and the Health and Safety
cotle. ScherBsaz(e)1
Oyer�dfgT(��o
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant Of future building occupant vac equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
mit hazardous air contaminants as defined by thc Bay Arca Air Quality Management
all new materials for inspection.
Distrin9
❑Yes
1 have mad the houdrms maurialsmquimrrcnts undcrCbpmr6.95uftheCdllfOr-
me Health & SafnyCmde, Seedom 355)5.35533 and 8534.1 undcesund Nat lithe building
docs not currently haw a tanann. that itis my responsibility in notify eek occupant of the
mqui wbichmmet ahCemncauol'oc ty
Signature ofApplicant Dale
dam
All roof coverings to be Class "B" or better
ammmria ages
z
Z .C-
CITY OF CUPERTINO
"- * 77"
BUILDING DIVISION PERMIT^CONTRACTaRxTNFORMATION�-;
BUILDING ADDRESS:
SWAN POOLS
PERMIT NO04050141
OWNER'S NAME:
PERMITL$UEDATE
JOE
E:
SANITARY N0. CONTROL NO.
(408)866- 29';
08 66-
ARCHITECTIENGIWER
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 D 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Desc //ll��
bmcbY affirm that I am licensed unde previsions of Ckpmr 9 (mmmeming
with Section )of Oivixion7af NC Busi dPrafcuiom Code. and mylicense is
G1
15th' G I
in full fO eff t.
L1CC ren l
INGROUND POOL & SPA
DaIV Co.
ARCHITECISDECLA N
— —
LOZ I t
hO
1 undcnd my plans shall used as par mounds
nuk
1J0
®@�/��p�yB
Licensed oval
OWNER -BUILDER DECLARATION
1 hereby ffum that 11. exempt from tk Contractors Lkenu Law for the
hereby
® � w IJ
dssiuu Ca de: Any city Or county
following moon. . 10 1.5, Business and Cra
C V
co Improve.
Permit alar. improsu, demolish, m repair any structure
which require a pmmil
r e2i the,
Ort, he its cense¢. alsort1. One tho,isimcanf for such Certranmiuofilnse signed nammcm
Y
thommenccenud puotanua tk pro vision of lk Cmmruess,
Sq. Ft. Floor Area Valuation
dd Protectors; COdc) tar
Code)
(commencingwith Section(ad of Divisions lark Buslnmempa
in. Any
I Net k u exempt tkrtfmm and the buts for Ne alleged cumpdon. My violation of
that
Section 7031.5 by any applicant for a permit ubjects the applicant to a civil penalty of
snm
3 A&B10,0"erO 0 C
not mom dun Rye huMmd dollars (M).
❑ 1, n owner of Ne properly. m my employees with wages u their sole cmnpcnudrn,
will do lie work, and the nmmu a is not intended or offered formle (Sec. 1044, Business
and Profusions COO: The Convector's License Law does not apply N an owner of
Required Inspectio
propeny whobuildsorimpmves thereon, and whodoessuchworkhimulf orthrough his
owneer,due uipnvikd Nattachimpmwmwts»not intended far owner.
however, Ne building or improvement is said within one year of c the owner -
prove for
Wilder will have the burden of pressing that k did not Wild or improv far purpose of
I ®�
salt.).
❑ 1, as Owner of the property, am exclusively contracting with licensed mnvactora to
construct the pmjcct (Sec. 9044. Business and Pmfeuiom Code:) Tk Coatruur's Li
came Law does wt apply to an owner Or properly wk kilds or impmvu thereon, and
who contracts for such pmjcM with a convacmr(s) becmm pursuant to the Canoodles
License Law.
❑ I » exempt under See. . B & P C for Nis reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 krtby ¢Rum under pcvlty of perjury one of Ne fallowing dad»tion:
rl 1 how and will maintain a Certificate ofCumem to self -insure for Wmke4Compan-
sation, u provided for by Section 37M of One Lakr Cade, for Ne pcimmin me of the
.it for which Nis Permit is issued.
❑ 1 kw and will maintain Workers Compensation hwnna, u acquired by Section
377 of Nc labor Code. for the performance of the work forwhich this permit is issued
My Worker's Compensator, insurance carrier and Policy numkn »:
11
'her. A.A.g. Polity Na OF_
CERTIFICATE OF EKEMPITO WORKERS'
COMPENSATIONSU ANCE
(fhu scctim rcdnotkwmpleuJ if Icmtitisforanchundrtddoll»(5100)
or Ica¢.)
1 century that in the Performance of tk work for which this Permit is issued. I andl not
employ tiny permit In my mMner'. as N keame subject in the Wofkcnat GamperWdan
Laws of California. Dau
Applicant
NOTICE TO APPLICANT: If. after making its; Ccvifieau or Faemption, you should
become subject in the Worker's Compensation provisions of Ne Lebon Cade, you mind
forthwith comply with such provisions or this permit shall k deemed revoked.
CONSTRUCTION LENDING AGENCY
I kmbyaRrm Nat Nert iso cod. lendingagcnry for Ne pambsimxnceof
Nc work for which this Permit is issued (See. 7091, Cie C)
under'Name
Under's Address
I certify, Nat 1 hays rod this
coup and sum thp the above information miting is
collect 1 agree to comply with all city and county ordinances and sum laws raping to
city and
building construction. hereby auNonprposes. Nes of this city to enter upon Ne
oand
a property impaction proposes.
(We) agree to save, indemnify and keep harmlus the City or Cupertino against
liabilities, judgments, coati and caputsea which may in any way accmc against said City
s�
cormaluenco oband
m comequcnec of the graining of this permit.
in
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -PO NT
Issued by: Date
SOURCE REGULATION a
d
I
Re -roofs
Type of Roof
onvacmr
n HAZARDOUS ATERIAIS DISCLOSURE
Adding
e applicant or future occupantstore Or handle harudousmaudal
.'Tell he Cupertino Municipal Code. Chapter 9.13, and the Health and Safety
cotle. ScherBsaz(e)1
Oyer�dfgT(��o
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant Of future building occupant vac equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
mit hazardous air contaminants as defined by thc Bay Arca Air Quality Management
all new materials for inspection.
Distrin9
❑Yes
1 have mad the houdrms maurialsmquimrrcnts undcrCbpmr6.95uftheCdllfOr-
me Health & SafnyCmde, Seedom 355)5.35533 and 8534.1 undcesund Nat lithe building
docs not currently haw a tanann. that itis my responsibility in notify eek occupant of the
mqui wbichmmet ahCemncauol'oc ty
Signature ofApplicant Dale
dam
All roof coverings to be Class "B" or better
ammmria ages