01030108 CITY OF CUPERTINO ,.
BUILDING DIVISIONPERMIT.`' , CONTRACTOR INFORMATION
BUILDINGADDResS: PERMITNO.' ':'
21.171'` CAN .WAY LIFETIME -POOLS ,INC. 61.0301r0f1- ' '
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' :RILK',R, 'KA IWAMOTTO. `3'1'0 SAM ANTONIO RD0.3/
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+ PHONE: ' ' - - - - SANITARYNO. CONTROL NO.
' - (408)738-1579
0 C Z ARCHITEUT/ENGINEER: + - _ ' BUILDING PERMIT INFO
BLDG ELECT^s PLUMB •eMECH ^
LICFNSIDCONIRAC1012S DECIARA310N s '
z 5 Job Description +'
oz'�.o Section
mil licensed d n roof 9(' ese � •�' .
Cm hast mw) ffer( Sonne Ba awPmrex< emm and nYl Gana,
�< is bad force d Tree! NEW t POOL &'ySGA6--,r. ,
Wm Licenseems.. SB Lea ,z2o38'z<Contractor , -
w 3 a Dali. - ARCHITECT'S DFCI ,•i i --I .,
understand hyph . hall he used ,public records,dLicensed Professional ' FINALED
9KKu�r
'da OWNER BUILDER DECLARATION
u�3 Ih ny « Intl ml 'ad
e 1 1 1 I r n
foil y IS f ]IRISB df:' Cd AY 'IY - 1Y
which 9
OCT 0.9 2001 {
Dc tt a tfp dIshp' ysmemm
0.3 prix t t : l: q Ih applicantl such Perini, II a igned,t!anon,
meth 1 cep ,I do,pi oor, the c nno Lee Low(Cmpler9 Sq. Ft. Flo Valuation.,
(0 6 it S t 7000)if 3 of did B me IP :Code) DING'; °
or Ihat h, s exe opt tb 1 d 0 bx f the 311egeJ e apt nn Any v'nlul m _ : r-
ofS,ebnt]0315byany applicant f,ap u
it, bjcln thevpplcnot enlpennlry ,
ofact mem man Been dnddnlln,(s5w). APN.Number z " Occupancy ype .
OI vn ut$o[thc propenY nr mYenpllY - th ges ns th ' tpenmi on L O - 2 -
on
off d the k and the t i e tintended offered f 1 (S AC -
Burin,:and Prr*osions
aul' Th Contractor's License
nLose due,dia loan Required Inspections
rsnfpmpmyWha bIds rt o h and who rs work
h r
omroahis awn emplce,.,prboiied mm iono,r one ioneedor . LIFER
ole for sole.If,h the handing iupvement is soldwithin one yout of
103
counple0an,theownr-wend,r will nnGe the burden of the,he did net build or. REBAR. -
_
.
, improve for Pumose nf. I ). J' ` �• -
A07 — :POOL/BONDING '
❑I a her fthe p puny,anot exclusively contracting withh el contractorst
t lh p t(+ 7044 B . t:aad P r y Coolie)TheC t t o 301 — ROUGH PLUlYIB T NG ;
Lmn. 1-4,it....nor upplymannwncrorprapercwho Inld. pasenmereon, ELECTRICAL
and h contracts f such projector with v adiaetov(s)11 n:ed ptrsuaat la The, - .304 .ROUGH
Contractor.License Law. "1 _
°I nex,rnptaaderSee, d' -PCrormiarean.ii 502. = FINAL PLUMDTNG' ENERGY^ ..
Owner Do,, i0 t -' FINAL MECHANICAL ENERGY
+ t WORKERS COMPENSATION DECLARAI ION - •:
�. nny n der Ir rp nor.one urine rmlga r 0E — 'GAS TEST
.. _ 51.01 ;FINAL,, .PLANNING,,' -
❑ 1 h d 'I I t C ri I f C t l : If W k r s
Ca, p -t , posided for by Secone Sect3708 ol the labia,Core, for the 511 - • FINAL POOL
pen Dance of me weak forwnen otic pe err .one¢ '.
516 FIN I BUILDIINGo.
,
ElI hxv,xnJ will 1 ainte n Writer's Cn t p I .bur m q 'red by Se Dna
3700 or the Labor CodiR r the perfnrt c f the work to, h'h'this houl is
ssu,J.My WorkersCnn,canahonfinuface carrier and.Policy mined,aro . -Carrier:STCky-4 COM Policy No: IS�S� - ^• _ - -
- CF,RTIFICA910N )FEXEMP`1'ION FROM WORKERS!
COMPENSATION INSURANCE - - -
(This�sectio t need not he completed if the permit Is for one hundred dollars - +
IS 00)or less) � _ !
9 cenlfc teat In the n if any oro r thews 1 for which subject
permit a issued,I -
+' _ C all.not employ any person In any manner su vx m hcwma mbjem m he Wnrkcrv' -
, Coaiipensetinn Laws nl'Colic nmiu.Uale - ._ _ ,
Appl'cx t
NOTICETOct1 the Wort. -rt k' gth C Cie to fPLater Cooky should
bees bj r MeW Work... np or op !lino Labor Code you must '
Q � fnrdl th cnmplY wish h p m s t ns or th s pu nit shall tic drvuud revoked.
z FSI - CONSTRUCTION LENDING AGENCY � _ ' 3 •''
I herebyafnothuh soconsurecuoulending agency fortleperbrinande _
orthe wurk for which tht perm t is issued(Sec 3097Cie.C.) ,•
S p Loaders Nante
U z
1 derrify that lhsse mad the apple !ion red state that thenthave Ilan tons '
correct.t I agree InCiJulply sv th all city and County arifirchicus and onne laws ocinfing
0 V
tolaildir,cluourallion,and herehymthoi p..ruhnifer,of thiscty to ene,upon
the Fine arlinfilared property f .pmo 'nations.
- - '
•�'p,l ' '(W)
Vhdblt ) dg ,t . h c d 1 mlpe:ne:keIep' hh'nyI :'itany d Y'fcL np ag:'tsyl said
,rdt- - -
r
t
t:•z Cry r
CANT UNDERSTANDS AND WILL COMPLY WITH ALI.NONPOINTSOURce s
5
a' - J7.—29-D I 'Issued by:• ' Date , J��2'�'•�
Pin mmar ])ate Re-roofs
MALA OUS MATERIALS DISCLOSURE
Il theapplent nlfog pt.t or h dl o- , dd.mnteral Type of Roof;
as it by O,Ctpea' h p!Cod Ch II ').12,anld Helll and Safely
Code Serum 255320). • ' ' - ^r .. _
°Ye - L - .All roofs shall be inspected prior to any roofing material being installed.
Will the apia t brute building occapauluseegaipn d nwh,,I, , If ay6cif is installed-without first obtaining an inspection, I agree to,remove
enol h- I : at t .d fined by t B Y Area A Q huy M !agement +
District?y. I Na ' all new materials for inspection. Applicant understands and will comply with
all non-point sonrce'regulations.
1 have read a 0 c
hhazardous t 'ale myu ren 3ma ininder Cluipter
othe
Fluid,k fely S r 25505.25533and 25534 I it Jerouod that
ifbuilding does net currently have nto itis responsibility n notify the
'_ se
teal,at 11 1 e n,whmhmo,,be ri,r run,mrssrorr, ofaCen Mvt r
. q _
„ b
-
+
"Signature of Apphclnt, •,r_ Date -
- D - -Dole' °r ' All roof coverings to be Class "B" or better -
,OFFICE