01040038 CITY
BUILDING
VISION
NPERMIT CONTRACTOR INFORMATION:
'
BUILDING ADDRESS: PERMIT NO.
. 10104 CRESCENT RD SWAN POOLS 0104003
OWNER'S NAME: I APPLICATION SUB DATE
.4 5 ,S .WINCHESTER ' BLV 04/1.0/2001 '
PHONE: SANITARY NO. CONTROL NO.
(408) 8156-6893.
C O O GIN1iER:ARCHI FCC'DIiNBUILDING PERMIT INFO
m 2 BLDG 'LECT PLUMB MECH
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LICENSED CON'TRACTOR'S DECLARATION
S�' I herebyform that 1 ani licensed under f Chat 9 Job Description
O> O a prnvi,inma per and
Iinnng P
F v.Fm with Senion]On0)of DivinionJor,heBmincss and Pmfeuions Cdc.end mylicerov
t - nraEroreeanyan 1. / IN GROUND 600 SLI.. FT. GUIDE POOL.
rc w Lifennc I's. 1.:. Llf.N S I Li III V.
o role �b_ Commons
ARCHITECTS DECLARATION -
1 uneemmrJ my plans,hall M used ow Public ria, d,
6 s LlcenseA Pmt'ex,,inlwl
OWNEeseDER DECLARATION
1h ff
by rmtntl I.
ndmp,from he C i t I- , 1 oath,
N
ham. '[- iant
0 whi g .IS i ]Di1511 .' J,, f.. Cd AY ar atop _ -
R rS O wh h e, l l I I '11 r J nch an I' y;ignivil terfant
i3= prioro ii� neums.nuot:oiresthcvisiono(tapplicant he.ConmciteuLilna Uw(Chager9
,htt he is licen,vd pursuanuothe pmvisions of the Commntds Liana lawail,Correct
Sq. Ft. Floor Area Valuation
ren oo he I,g wile hoian'laxn ofhe h.,nn 3 nr a a❑asides,and Pii.Any fail,Gale)
or Sec he is uxenpt any applicant
and the ba,iu fns the has the umnlnit to Any violntian .
,ifnoetmn 7031.5 by any hundred
doll b,r a Pemal,abjran sur applicant m a emit Penahy Occupancy Type
nrnalmarernanr�ennmreaaauaras5an. APN Number
❑I,asowmaof the Pl'aparr ,array empinyce,w'ith wagc,astheirrola fompen,alien, 2 �j
,,If do the wol
rk.and the oamor i,not iaanded or offered for sale(sec.71W4. -
Business and Profcsnions Cede.The Contractor's License law does not apply to an Required Inspections
a.ma of propcny Who builds or improves,hereon,and who dee,such work himself
or through his nun employees,provided than such impmvfinents are net intended m 103 — UFER
onBred for hale.If.I ervo,the building or impfa,cali its,oldw'ahin one year of ,
completion.the ax'nerbuilder will have the harden ofprovingtha,hedid not lsuildor 104 REBAR
mpmve f a,mistose of sal,J.
EI 1.as uflhc prol"Ttya xclmsi-It'cInlradhng villi hrcowd camruceas to - 1.07 — POOL/BONDING
ne
i�,rennetlisrpmjnorace.7614.Duran, and rrivwhion,cede.[Thevesbettte. 301. — ROUGH PLUMBING
mrnae law does not arras,o an awmfr of propcnY was mild,or improves mereon.'
.ad she eatnraft,lot,rich pnljefl.,ith n tm
ronerorl,)Ead p
m.eawcon o the 304 — ROUGH ELECTRICAL
noLive-
CommLiceLaw.
❑Iaaaeaelaplmldo'S.. B&PC to,this reason 5022 FINAL PLUMBING ENERGY
OwnerDate 503 — FIMECHANICAL ENERGY
P'ORKI?R'.S COMPENSATION DECLARATION 506 — GAOpNAL TEST,
1 hereby affirm undo penalty at rj.,,one of tla following dcdamtions.
510 — FINAL PLANNING
l 1 have and will maintain a CcniBcaa of Cnnsem to,elf-insure for Worker',
Cmnpenwahml. a, provided rar by Secliull 3710 at It, Labor Cede. sur In —a 511 FINAL POOL
pellnrmanfenfmcwm newnicltmi,prnmi..i,tam. _ 516 — FINAL BUILDING
❑1 have and will maintain Worms',Cnmpcnvnon Inwmnce,as required by section
3710 of the lalhor Cotte,for the perrommace of the work for which Ibis permit is -
Food.My Wur'eI's C{1uoll ponsial In umnce carrierraand I
icy aunlher ate:C/ ,
me 1 Q-. licy No.: r]L _04O l
CERTIFICATION OII INLM1IITION FROM WORKERS'
COMPENSM[ON INSURANCE
(This.section naval not be emear R d if the permit is far one hundred dollars
IE IIMII it ares.)
I ceaity that in the Performance of the work for which this Permit i,issued.I
,hull not emplay any Persian in any nanncr so ue to scram,subject to ane Worker'
Campcmatinn law,of Calif aria.[)aid -
Apphcant
No cr Of AI'PLICAN'I' Larger making this C,nilisvm of Escapism.you should
Z become wbject to the Worker's Compensation pmvirioms of the Labor Cod,you mus,
Z
Z O forthwith comply with such provisions or this Permit shall be dared revered.
rUD•I CONSTRUCT
Iia IONLENUI NGAGr:NCY
+� reach,to,x1fwhich thin,here Ls u csued(See. Irnding agency for IM1c performance -
af the work fur which this permit is lamed(Sees 3097,Civ.C-1
0. z Lender's Nome
= Z lender's AJJrc,,
CL 0 car 1 cemy that 1 haze o
read this apdicarm real that the above infnnmion i,
met. '
'e. I agree,o comply,wim all city and enumy nNinance,and ante laws relating
to bolding cnmtmcaon,and hereby authnnA,lupicoarelaanf this a,,, I,color open
r� the annvo-mcalio red pn,rrny lar hulwrlan Pupvsrs.
(We)agree n)save.indemnify and keep harmless the City of CaPenina against '
p5 liabilities.judgment,costs and expenms which may in any way acceue again.,,aid
V Z City in came,reare of,he gaming of this prnniL
APP CANT UNIIERS'1'ANDS ANDWILLCOMPLYWITHALL NON'POINT
S 11 : 1 IONS. /' y 46-0 ' Issued by: Date
,Si, aturvofApprranvcoulmrrier_ Dale Re-roofs .
HAZARDOUS MATERIALS DISCLOSURE
Will doe npphcant ar blame building enact ltt,mre m handle ha,ardoax mmcdmType of Ro
a,Jchnd by the Cupertino Municipal Cents,Cbupter9.12,and the Health and Safety
Ede.Section 25532(a)]
[I ye, El No
All roofs shall be inspected prior to any roofing material being installed.
Will the apprtcaa,or waren hand bythe art Bay Area AirQutut Mia,when If a roof is installed without first obtaining an inspection, I agree to remove
s aircnnlamir futse,JcGnd by the Hay Ac ca Airent or
M ices when g p g
I or u ❑N all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
avmad the harrmot,namrial,mlmormmea under Chapter h95'of the
Iii"ce Health R Safety Code.Sections 25505.25533 and 25534.1 undersandtom
IJmgdoc,bol cunelaly have u drom.fl h is my rexrymdni lily for.try the
' nf the rcquimmcnls which must be mm prior m..,rola of a Cenincme of
LwY(0 � Z G D ( Signature of Applicant Date
Own anthori id ,,,a, Da,c All roof coverings to be Class "B"or better-
OFFICE