Loading...
03100100 4CIY OF CUPGRTINO t�+v vw;gw A, r �?.ie '+-s�^-s,? rum ;~ r BUILDING DIvISIGN PERMIT CONTRACTOR INFORMATION Z_ INGADDRESS: LIFETIME POOLS INC RERMITN003100100 R'S NAME: 910 SAN ANTONIO RDE' (408) 738-1576 SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH !Oa LICENSED CONTRACTOR'S DECLARATION - C7 O O O ca F 1 hereby affirm iliac I am licensed under provisions of Chapter 9(commencing Job Description !ib wins tion i Wnof Dlvidon3ofthe Businea, Profession.,Cndc,and my license is ta mrml ro ave ermct./_ JO IN GROUND POOL/SPA i Licca los �- it.a _ i D C sem CIIITECTS❑ RATION i y a I understand my plans shall he used as pu he trends iyU 0 Licensed Pmfeuionel OWNER-BUILDER DECLARATION <I 1 hereby affirm that I am exempt from the Contractors License Law for the : 00 following reason.(Section 7031.5.Business and Pmfeszions Code:Any city ear county a`� i m which¢quires a permit to construct,alter,improve,demolish.or repair any structure pnor it)its iamance.alsorequires the applicant fpfsuah permit to file a signed statement < that he is licensed pursuant to the provisions of the Contractor a Litcris,Law(Chapter 9 Sq. Ft. Floor Area Valuation IFo (commencing with Stelmn 74)00)of Division 3 or the Business and Profusions CMO)or 3 Nat he is exempt OcmGom and Ne basis for the alleged exemption.Any violation of 32648025 . 00 Section 7031.5 by any applicant for a permit ubjects the applicant o a civil penalty of APN Number OType not mom than r hundred della.(sSBo). Occupancy Y YP 1,as owner of the property,or my employees with wages as their sale compensation, will do Ne work.and the structure is not intended or offered for sale(See.7044.Business 103 - FER and Pmressions CWc:The Contractors License Law does ret apply to an owner or Required Inspections ptopenywho bunds or improscs contend,and who does such work himselfor through his 104 - REBAR own employees,provided thmsuch imprawments are notmmaded oroffered ruraile.If, 107 — POOL/BONDING however,Ne building or improvement is sold within one year of completion,the comer- builder will have the burden or proving that he did not wild or improve for pumom or 3 01 — ROUGH PLUMBING sale.). I,as owner of the property,am exclusively contracting with licensed contractors to 304 - ROUGH ELECTRICAL Construct the project(Sec.7044,Business and Professions Code:)'I7m Contractors Li- 502 - FINAL PLUMBING ENERGY ecrtse Law does not apply to in Owner of property who Wilda or improves demon.and 503 - FINAL MECHANICAL ENERGY who contracts for such projects with a convacor(s)licensed pursuant to the Contractor's License Law. 506 - GAS TEST I am exempt under Sec. .B 6 P C for this maven 510 - FINAL PLANNING WORKER'S COMPENSATION DECLARADTION ate 511 - FINAL POOL I hereby affirm under penally of perjury arc of the fallowing declarations: 516 - FINAL BUILDING®®® Ihave and will (a,byvection 7M of Consent to Code.far pre Worker's Compere T-8 NAL EC) urian. r provided far mi Section 3700 of the laver Code.for Ne pertormarta of Um a V �f®Q®� work Tor which this Permit is issued. Q ,g ❑1 have and will maintain workers Compensation Insurance,as required by Seeing MAR 2 g? 2004 300 of the labor Code,for the performance or the work for whichthispaarmmit is issued. Myworkcr's Compeut 1 I icy Policy nur_�fJ%D y 7r'lC�/E�lR2rTIPi,CC MPENSATIONurnter am IO ANCEORKERS' ®INIG Y( ds section need not he completed ifine permit is for one hundred dollars($100d ,M less.) 1 certify Nat in the performance of Ne work for which this Permit is issued.I shall nut employ any mason in any manner an as to become subject o the Worker)Compensmion Laws of California.Date Applicant NOTICE TO APPLICANT:If,aper making this Ccnificam of Exemption,yens should become subject to the Worker'a Compensation provisions of the labor CWc,you mug �O forthwith comply with such provisions or this perm it shall be deemed invoked. ZN CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a conztructind lending agency fm the performance of x INC work for which this permit is issued(Sec.30V7.Civ.CJ 21 QLenders Name L Lender's Address Z) z ;J Q 1 cenify that 1 have read this application and sate that the above information is y f-' cmrec.I agree to comply with all city and county ordinances and sum laws slating to V building convection,and hereby emhmiae«pmgmes ativof Nis city to cnsr upon the (We)egse m save,indemnify and keep harmless the City of CupertinOa gainst rg Iititainies,judgmen¢costs and expenses which may in anyway accrue againgsadd City ..) z irc,hWh,enee OfthOgmnringof this no ^ APPLICANT UNDERSTANDS ILL COMPLY WITH ALL NON-POI Issued by: Date SOURCE REGULATIONS. / sign Re-roofs ornrp env actor ❑ ARDOUS MATERIALS DISCLOSURE Type of Roof Will the ap eantmfoture building cecuponuume or handle hasmdous mistrial as defined by the Common Municipal Code.Chapter 9.13,and the Health and Safety caper s 25532(a)? Nu All roofs shall be inspected prior to any roofing material being installed. Will thea applicant or future building If a roof is installed without first obtaining an inspection,I agree to remove pct g occupant esu e.Air Qu eat knots which it weurdnus air conmminants as dcnncl by the Bay Arca Air Quality Management all new materials for inspection. sistrict? p YC' XNu 1 have sad dae havaNgus materials mquismcn¢under Chapter 6.95 of the Califon nil Hcahh ck safety CWc,SCNans 25!15,25533 and25534.1 undersmed dartif the willing does not Currently a tedank dam it u my rctionsibility In why the oacupzm of the mquirementsw stwmetpnurwiagueegf.cenlhcamofOceup r Signature of Applicant Date /19 Ow rt dmhwdagen, Da All roof coverings to be Class "B" or better