04070169 CITY OF CUPERTINO " '• * r -'%' '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:.
BUIMINGADDRESS: LEAHY CONSTRUCTION PERMITNo04070169
ER'S NAME: PERMIT ISSUE DATE
`iMICHAEL
E; SANITARY NO. CONTROL N0.
(408) 605-4805
ARCHITEC(ENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
oOo LICENSED CONTRACTOR'S DECLARATION
<.
C 1 hereby affirm that I em licensed under provisions Of Chapter (c9romancing Job Description
c with Sectan 7IXYd)af Division 3 of O,Bust^rfs�ya^Profession Code,anddyliccusets
inmuym�"derca� te (G INSTALL 14 'X8 ' EXCERCISE POOL
p„aj z Licen�sR�azs L' .
�1=w Dam L,S�,_CanvuCL IN REAR YARD
I-
`pRCHITECI'S lo CLAI A n t
dims tun un my pl nshall he uutlaz rds
owu
iC� Licensed Professional
OW NER-BUILDER DECLARATION
.�i f 1 hcrehy affirm Nat 1 em exempt from the Contractors License law for the
at p 0 fallowing reaznn.(Section
70313,Business and Profession Cade:Any city or county
s'e$ff which requires a permit to construct.altar,improve,demolish.or repair any stmcmm
`I—'^ prior ah its issuance,also requires the applicant for such permit to rile a signed statement
2,< that he is licensed pursuant m the provision of the Contractor's Licertsc law(Chaptar9 Sq. Ft. Floor Area VahY
l®[ QQO
¢�Q (commencing with Seemat 7MO)of Division 3 of the Business ad Pmfeseinns Cook)or
_ Nat he u exempt therefrom and me basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant.a civil penalty of APN Number Occupancy Type
nor..man rive hundred dollma($500).
01,as owner of the property.or my employm with wages Far their sole compensation, 31631024 . 00
will do On work,and the awcsure is not intended or offered far sale(Sec.7044,Business
and Professions Code:The Contactors License Law does not apply in an owner of Required Inspecwi D S
property who buildsi rimproves thereon.and whodoes such work himselfor through his
own employ=,provided that such improvements are not intended oroRcrod forsale.If. JJ
however the building or improvement is sold within one year of completion,the owner- J/
builder will have me burden of proving Out he did not build or improve for purpose of /
sale.).
❑I.as owner of the property,am exclusively convecting with licensed contractors to b�\
construct the pmject(Sec.7(A4.Business and Professions Cade:)The Contractor's Li
arse law does Fiat apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a conuxemr(q licensed pursoam to the Conuecmfs
Lot Ma Law.
I am exempt under Sec. B&P C for this..an
O r Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury me of On fallowat
fallowing declarions:
have and will maintain a CatariConsent Carolina,of Conseno self-inure for Worker's Compen-
amion.as provided for by Section]700 of the labor Code.for Nm
e performance of the
war'for which Nie permit is issued.
0 I have and will maintain Worker's Compensation Insurance.az tcquired by Section
37a0 of the labor Cook.for the performance of the work for which this permit is issued.
My WorkeYs Cnmpenation Insurance carrier and P i number are:
C� Policy No.: ,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
(rnissection need not be completed ifthe permit is intone hundred dollars(SIM)
or less.)
1 artfY that I, p fu ante of m work for wh h m p it 0 issued.l shall not
employ any Pc ruin 1 am u u j ' �1 Workcrs'Compensatian
Laws of Cobb.,
alifo ria. c
Applicant if
NOTICE TO A PLIC :If,after making thisOmificam of I,mption,you should
become object orkttf Compensation provisions of tta Icer Calc.you mon
,JO forthwith comply with such provisions or this permitshail be decmd invoked.
Z�
CONSTRUCTION LENDING AGENCY
j-. 1 hereby affirm mat then is a eonwcsian lending agency for the performance of
lYime work for which this permit is issued(Sec.3097,Civ.C.)
Cnder's
Q LeName
=z Le dein Address
U O 1 cenify mat 1 have read this application and sum mat the above information is
ly E-' correct.l agree to comply with all city and county ordinances and sum laws relating to
DU building construction.and hereby authorim hapmunutives of this city to enter upon the
r above-mentioned property for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
i N liabilities.judgments,costs and capcnses which may in any wayaccne against said City
U in consequence err the granting of this permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dat
SOURCE REGULATIONS. ..J
Re-roofs
Sign of Applican✓Contmcmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or future building occupant store of handle havardous material
az defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Ca1c,Scction25532m)? No
All roofs shall be inspected prior to any roofing material being installed.
cYn
Will the applicant or future building occupant use cyuipmcnt or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
s hxamdnus air comaminan dcrincd by the Bay Arca Air Quality Management all new materials for inspection.
doth?
❑Yes Nu
(have uWth his of srtyuimm untkr Chapter 6.Y5 of the Califon
ria Hcalth S ct adc,Ss'L at 5533 25514.1 undcrsmnd trot if tM building
dma no tl�horoatanantth h my nihilitymnuufy to 'cupant the
if en Feb mum be me a,iasa ccafacenB p�cy Signature of Applicant Date
owne aamaacdapep, ,m All roof coverings to be Class"B" or better
SEP-22-2004 16:01 MARK THOMAS CUP 4082535173 P.01i02
kN I T4q`,4!t >
s
DISTRICT MANAGER-ENGINEER in BOARD OF DIRECTORS
a
MARK THOMAS&COMPANY.INC. `' —' WILLIAM A.BOSWORTH
DAVID E.ROSS DR.JOSEPH F.BROWN
JOHN M.GATTO
DISTRICT COUNSEL ��l'4B(ts NEO 1�'h CURTIS B.HARRISON
ATKINSON•FARASYN,LLP WENDELL H.KERR,JR.
HAROLD S.TOPPEL 20833 STEVENS CREEK BOULEVARD,SUITE 104
CUPERTINO,CALIFORNIA 9$0142154
(408)253.7071 PHONE 0 (400)253,5173 FAX
September 22, 2004 File. CSD—MOP
Building Dept. —Cupertino
Community Development Department—Building
City of Cupertino
10300 Torre Ave.
Cupertino, CA 95014-3202
Subject: Residential Pool, Approved Approved For issuing
Owner: Michael& Christine Garvale .goild'Intgl Plumbing Permits
Address: 10180 Blaney Ave
APN: 316-31-024
The following Conditions/Requirements are made:
• Pool sump shall be discharged to drywell. Drywell shall be constructed to City
of Cupertino standards.
• Videotape Inspection of the existing/new Cleanout,Point of Connection and
Street Lateral is required prior to passing The City of Cupertino Final
Inspection. Owner to call District 48 hours prior to video inspection to
schedule a District Inspector. .
Storm water from surface or roof drains, other general surface runoff water or condensate
from any residential HVAC equipment shall not be discharged to the sanitary sewer.
SUPPIIING SANITARY SEWERAGE SERVICE$ FOR: CITU OF CUPERTINO, PORTIONS OF THE CI11ES OF SARATOGA, Sumhiv E, LOS ALIDS AND SURROUNDING UNINCORPORATED AREA$
WWW.C UN a r1i001001 PO rydil III(I.COT
SEP-22-2004 16:02 MARK THOMAS CUP 4062535173 P.02i02
Subject: Residential Pool, Approved Page 2
Owner: Michael &Christine Garvale
Address: 10180 Blaney Ave
APN: 316-31-024
Yours very truly,
MARK THOMAS & COMPANY, INC.
District Manager-Engineer
David E. Ross
CHB: HJP
If you have any questions or need additional information, please call Hayde Pacheco
or Carl Beckham at 408-253-7863.
cc: Michael & Christine Garvale, Owner
TOTAL P.02