00080079CITY•OFCUPERTINO : - PERMIT NO. .
BUILDING DIVISION PERMIT
I' BUILDINGADDRESS, -
rs SANITARY NO. APPLICATION SUBMITTAL DATE
wNER'sN J - ROYAL POOLS INC,.0F SANTA Ct.ARA00080079
PHONC: HI _ A D - - .'2125 8 CAMDEN AVE (] 08/11 /2000 '
ARCHITE T/ONGIN ER .. : 4. " BmomN�l CN i .rRMiPaIm
0' '0'4 "
z o N �'LICENSED CONIRACCORS DECI.ARAnON . + ,'; '^ A •
I hereby affirm that I am hcaued under prm'rsmn6 of Confuter 9 (<omme«mg ,- Job Description. -
Qr�':t-m w,N$ecoon7000)0f1D,v[tn�0n'3�Mdw Boo,ne6/6(�an/dPofes//�tgIiiIQQm Code,aMmyl,anun n -
y.Y J to n111 POtCe Blla-7TOSoZ ,
item p;CONSTRUCT iN—GROUNA.POOL/GUNITE
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C 'SDE LA% N -
5 T retuW m plaanis 1 e untie rc is
aO Wen fe66iovl '
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OWNER -B RDECLARATION '
xo' I hereby atruto that I am exempt from Ne Contractors License Law for, the I ~•t
FD f owing ... (Section 90315. Business and Profneons Cade Any city «county
which eg sees a permit b Conawct, alter, Improve, demUosh or repur any structure
rot Rsismunce,ass Sq. Ft. Floor Area � , 'Va uation
me requires proAk lawn fm Conpemut Le... Law
r9
Nat he is licensed Wreuantathe provtai-neof the C"neutare Ltmnse Lew (Chapter
• (CUrlMerlCing Wldl$«tion]((IU)o(DIV16VOn30(thC BY61M65 Nd Pm(C6s1011x L`Ode)Or ,
Inas he is exempt therefrom and the basis for the alleged exemption. Any viatadan m- - APN Number - ecupanc* fftg X00
Star.. 7031.5 by any applicant (ore permit rubjects the applicant to a civil penalty of.
, r/�
AM more dun Five hundred dollars
Ql, as owner, -(the mapeny,mmy employees with wegaautheirvOlc dompenudan, �- ^1Fi+> +,uilg�In spections'
will dome wmk, and me strucmrc is tat memiled.,.1f ed fm We(Sec .]OC4, Business .3 2`-s '
and Ptofeasimu Code: The Can -smogs License Law dau nm apply An an'owner of
property who builds or impmves thereon, arta who d«s each work himself oe though ,
his own employees. Provided dot such impmvementa are not intended or offered for 103 — UFE R -
uh.If, however, the building orimpmv<mattt is told within one year ofcomplelron, the
ow.].04.,— REBAR
'ner-builder will have the bnMen of proving Out he did nm build or improve for pe "
•pose ofu - - r - '- —
E] L u ownen w of the property non eadueivelY.coneutine with licensed contractors FOOL/BONDING
to '
onawct the project (sec.](l44, Business and Professions COda:) The Contractors Li- 301. — R000H- PLUMBING '
cense law does not apply e w owner of property who builds Or improvex them., and -
'wnowntruefar6-chptirj«Icewise,a<aneacmr(6ni«nrcdpum-.mmdeeanuo-acmta 304 — ROUGH.ELECTRICAL ..
Lianu law.
❑Iamexempt.mlerSec. BRPCfmddsAamm 502 — F'INAL PLUMBING'ENERGY'
Owner Due 503 FINAL 'MECHANICAL ENERGY
WORRER'SCOMPENSATIONDECLARATION • 50E —'. GAS TEST
1 hereby affirm undtt petiWy of perjury one Mile following declarations! -
❑,haveendwillmning.aCeniBcetaorCameattaulf.mb-efmwmkarsCompan- 510 — FINAL ,PLANNING
6ation, as provided for by Section 3700 of W Labor Code, for the performance of me
work (mwhich this permitisismed. ' ' 511. — FINIAL -POOL
❑ 1 have and will 'maima n WAeea Compensation Insurance u equud by Section
3]No f therather me per(oRmece ofthe work forwhch this permit is lawed. - 516 —'FINAL BUILDING
IMy Worker's ��Cj'AmP�rtsea hmraancecamer And Policy pryp
Comer -/ Policy Na yGiL
CERTr7y/(_-ATE- OF MEMFr10N FRO WOR RS'
COMPENSATION INSURANCE
(Thus«ann needrtot becomplaed tfd p 1sPoronehurWWdollau (3100) or Ings.) -
Iccmfythaanmepermarneceofine kfwhichthisme MIAAM'is gL6hdl .y "
not employ any person in any m tier m n a became subject a me Warkm' Cotttpen-
setion laws of Califamia. Date an _ 1
a Applicant
NOTICE TO APPLICANT: If, afar ranking this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Cade, you must
fonhwith comply with such ovisimw or this nniuhall be doomed revoked.
P Y. Pr P
z -
CONSTRUCTION LENDING AGENCY
0 k for
aRrm mermit i iAsued(Sen.3 l7, CN rte O O P
Y f rNe ewe of . ,
0
Boge Y Par( ..
ase work For which this permit is issued (Sec. 309], Civ. CJ
E„ Lender's Name -
�(, lender's Add.. -, '.. .• ,
W Q , I candy Net 1 nave end oris application and sun mut me above iNomodon I,
M c.Mexl. l agree to comply with all city arta county ordinunces and some laws elating to . .
V 0 . building consvocdon, and hereby authorize mpeunutives ofthis city to enter upon the
above-mentioned property far inspection purposes.
W Fs. (WO) agree to save, indemnify and k«p hamtless the City of Cupertino against
- -� (,J liabilidu,judgmcnta, costs and expenses which may in any way acme against said City
inconsequm2 ofinegmndngofthia permit.
.A .ICA UNOF 'rANDS AND WILL COMPLY WITH ALL NON -POINT
SO C . EGULATIO
o Applicand t Data
.
em
HA ARDOU •RIALS DISCLOSURE
dby(epColstn.ramie building «<upanW9.12, handle nazerdoarmertria( Re -roofs
..
Coda, section 032(4)? Municipal eme,enaver 9.Iz, mane realm arta sarey. Type of Roof ' -
❑ yes . Fl No, "
Will the sppfcart or future building oecupant-se equipment or!Av;ceswhdrh. All roofs shall be inspected prior to any roofing, material being:
coutlaurdous air conominuuas defined by the Bay Arca Ah Quality Management installed. If -a roof is installed without first obtaining an inspection
❑Ye=' oNo I'aggree to remove all new materials for inspection. Applicant
haves 0thahe admamamriae understands and will comply.with all non point source regulations..
eye nth under Chapter ftheCali-
�fomo
Has Safety Code, Sections 25505 35333 and 25 5M. 1 undvataM that if the
' buildi d note a tenant don't; At
't, 6ibilay in ify the -pant: s r
ofAiremune which mon 1. e a Cenifc e f c C" r .
a -mo a a ngan ignature of Applicant Date
r , - All roof coverings to be Class "B' or better
,,. OFFICE ."
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