05080107CI TY OF CUPEWrINO
:y
BUILDING DIVISION PERMIT
CONTRACTORANFORMATION
BUILDING A DURESS:
SWAN POOLS
PERMIT N005080107
OWNER'S NAME:
PERMITISSUEDATE
MTKE & MARY CHARON
149.5WINCHESTER
09/02/2005
!E:
SANITARY NO. CONTROL NO.
408)866-6893
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACnderp DECLARATION
1 hereby ) of hon 1 am licensed under provisions of chapter 9 (commencing2
wih5caion9IXkl7 Of Division JOf the Busircai and Pro(cssinn Code. And myliccnu is
lob Description j� n /A
IHr-'
d mu mm aae er@qt
Lice lea ( S Lit. •
Jq\�VLI„/,/Y�\\,;i
NEW INGROUND POOL & .SPA 1
`tsA Lyn.
,
RE POP ENED (08/22/05) I -11t
Dau - — Contractor
HITECPS DEC ION
I pndcmmd my plans:hon he pard a pun t atmrm
so_Ln05
p❑ (f IFS
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby alarm Liccnu Law for the
n 1 am cacmpe from he Cssions
H It f± jl '`;
reaso o in Code: tiny Or county
following ma<oa (Schon ?Ions.tr Business and
`Vf jL,`�
which ve. de i h.orAny
repair any structure
demoisiLl
requires a permit oc constidims nt
forse,
fi
poor Lo its issuance,alsorcquircnhcapplicant fpr suchpchoil LfIcssignedsummcnt
its the applicant
that he licensed LiccnuLaw (Chapter
Sq. Ft. Floor Area
Valuation
of Division 3 of the Bulinus and Code)
(comate sdc) or
(commencing
exe wsth Section
$30000
n and l
Wt k u tumor Aertfrom and the baso for 0te Alleged exemption. Any violation of
is on. Any
APN Number
Occupancy Type
P Y YP
Section 7031.5 by any applicant for pesmitsubjects the applicant to a civil penalty of
not more Nen Live hundred dollars (S500).
❑ I, As owner Of the property, or my employees with wages as their mile compensation,
will our Ne work gad he structure is net intended or oneaA for sale (Sec. 7044, Buri.
Required Inspections
and profanation Code: The Contractors Litems Law coca an, apply to an owner of
property who builds or improve hereon, and who does such work himself orthrough his
own employ=, provided than such improvements art not intended or offered for mile. IL
however, the building or improvement is sold within one year of completion, the owner.
builder will hate the burd,n of proving that he did not build or improve for purpose of
salt.).
❑ I. as owner of the property, am exclusively contracting with licensed contractors to
consumes the project (Sec. ]Oda. Business and Profession Cade:) The Contractors Li.
came, Law docs not apply no an owner of property who builds or improve Ammon, and
who contracts for such prohch with a emmoctor(s) licensed pursuant o the Commend
License Law.
lamaemptunder Sec. ,B&PCfarhisresson
Own u
Da
'
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pe jury one of Ac following decimations:
I have and will maintain a Certificate of Consent to tilt-insum for WotkersCompen-
saoun, as provided for by Section J200 of the labor Code, for the performance of he
work for which this permit is issued.
I have and will maintainracess
maintain Worker's Compensation Insun, rtydrcd by Section
3200 ofthc labor Code. for the performance ofthe work for which this permit is issued.
My Wprk/cr`x Cmoo'nsmu Iosuma caione'and Policy number aa:
tamer. Yt ` A, R ♦ Polity No.:
CERTIFICATE OF E%FMPnON FROMW R KERS'
COMPENSATION INSURANCE
(This section need not be compleu l if she permit mim.nc hundred dollars (S1001
or Less.)
1 cetdfv that in the performance of to work for which this permit is issned. I shall not
cmplay anyp,mn in any manner mi as in become subjecuo the Workeri Compensation
Laws of California. Date
Applicator
NOTICE TO APPLICANT: IL after making his Certificate of Exemption. you should
became $Object to she Worker's Compensation provisions of he Labor Code, you must
foMwih comply with such provisions or his permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
T hereby affirm that there is a construction lending agency for he performance of
the work fur which this .it u issued (Sec. 3097, Co, C.)
Lender's Name
Lender's Address
'
1 cenify that 1 have orad this application and sou drum the above information is
conom 1 agree to comply with ml city and county on insnccs and nam laws relating an
Wilding conswction, and hereby addiction mprescmatives of this city an cnur upon du
shove -mentioned property for inspection purpoua
(We) egrte to save, indemnify and keep harmless he City of Cupcnino against
liabiliue;judgmems.eosu end expenses which may in any way accrue against said City
in conuquenec of he granting Of this permit.
APPLICANT UNDERSTANDS AND WILL OMPLY WITH ALL NON -POINT
Issued by: Date
SOURCER TIONS.
7-2:-65
Re -roofs
Type of Roof
signature pplicaN A DOUS MAT IALS CLOSURE Dao
Will the applicant or future buildg Occupant mote or handle hazardous material
u defined by he Cupertino Municipal Cock, Chapter 9.12, and she Health And Safety
Code. Section 25532(a)?
❑ Yes
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
Will ret applicant or future building Occupant pat equipment
pP g p y pment or dcvicu which
g
.it h.,aod s air cantrummmas as defined by he Bay Arca Air Quality Managcmcnt
all new materials for inspection.
tinct? ` ^
❑Ycs
1 have real the he ardnusmaarials rtyuiremcnn undcr Chapar 695 of the Cslifor
.to Health & SarcnyCOM, SccAms 25505, 25533 and 25534.1 sande and that if da Wilding
does not currently have a truant than it is my responsibility m mull y he, occupant of the
aqui mnmpnb at to mceor.CcrtifcateofDecPancy.
Signature of Applicant Date
o
All roof coverings to be Class "B" or better
ow apthpriaed
r ton
F%