04080088 CITY OF CUPER'I'INO
BUILDING DIVISION PERMIT W.CONTRACT ORAN,FORMAT=°ION
IIUILDING ADDRESS: PERMIT NO,
ER'S NAME: PERMIT ISSUE DATE
MIKE F, DEANNA ROANHATIS
ONE: SANITARY OL N0,
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
E=l
Epp LICENSED CONTRACTOR'S DECLARATION O O
ul F❑ I hereby affirm Nat 1 am liccrtscd under prnvixions of Chapter Y(commencing lob Descri
iW wi hs Coen?plltl)of Division Jaf NC Business and Pru(cssiunaC and my license is
In full forcca « JQ
�== "vaCf aLieN FIBERGLASS POOL
n (� n
SFW Da HInvacmr CONTRACTOR: AM& C POOLS OCT �Q ZUO4
�j ARCTECTS RA ION'
Yya C I und¢rsund my plans shall W used as public rtcordx
JaU ppp
o y Licensed Professional I ®� t o
S Oat I am exempt fr mDECLARATION �yp`{�OA
Z I hereby affirm that 1 am exempt from Urc Conracmfs Licensee Law for 100
p o following mason.(Section 7031.5,Business and Professions Codc:Any city ar county
K m which requires a Permit us construct,alter.improve,demolish,or mpair any structure
m poor o its issuance.also require the applicant for such permit 10 file aligned statement
Nn he is licensed pufsuanuothe Pravismm of the Convacwr's license Law(Chapter 9 Sq. Ft. Floor Area Valua
m r (commencing with Section 7000)of Division 3 of the Business and Professions Code)or q" 2 2 5es
c Nat he is exempt Ncrefirm and use basis for the alleged exemption.Any violation of
Section 7031.5 by any applicator for a Permit subjccu the applicant a a civil Penally of APN Number - Occupancy Type
not mole Nan five hundred dollars($500).
I,as owner of the property.or my employees with wages as Rich sole compensation, 32628082 00
will do Ne work and Ne swmute is not intended or offered for safe(See.7 6.Businexa
and Pmfesslmu Cade:The Conmctor's License Law does not apply m an..at of Required Inspections
progeny who builds or improves Nercon,and who doessuch work himself orNmugh his
awn employees.provided thatsuch irepowerrems are not intended oraRered for sale.If,
however.the building or impravement is sob within one ycar of completion.the owner-
builder will have the burden of proving that be did not Wild or improve for purpose of
sale.).
❑I.as Owner of the prapeny,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Businea and Professions Cade)To,Co micmr's Li
cense Law does not apply to an owner of property who Wilds or improves thereon.and
who Contracts for such Pmjecu with a eonmctor(s)licensed pursuant it Or Conradoi s
Lice law.
❑I am exempt under Sec. .B&P C for Nis reaan
Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following d mmaliam:
1 have and will maintain a CerdGese of Consent to self-insure for Worker's Camper
sation,as provided for by Section 37M of dm Laber Code,for Ne performance of the
work for which Nis permit is issued.
1 have and will maintain Wa lim-a Compensation Insurance,as mquired by Section
of one labor Code,for the performance of the work for which his permit is issued.
MY�Wmr er' ore nxation;yeumnce artier and ynu ��tyg� 7
Comdr V� Pali o.: fly3az-zod
CER TIFICATEOFEXEMPTIO FROMWORKERS'
COMPENSATION INSURANCE
GMIS secure recd not W completed if the permit is Room hundred dollars(SHIR,
or Ices.)
1 cenify Nat in the perrormamee of the work for which Nis Permit is issued.1 shall nut
employ any person in any mannerses as to become subject to do Wortrts'Compnuation '
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.arrest making Nis Campeme of Exemption,you should
become subject to Ne Worker's Compensation provisions of Ne Labor Code.you most
.J O front comply with such provision or this Permit shall be deemed revoked.
Z h CONSTRUCTION LENDING AGENCY
(-+^ I hemby aOBrm that Vert is a consuuninn lending agenq Tor the Performance of
CL's
in,work for which this Permit is issued(Sec.3M.Civ,C.)
W Q Lendcr'
z x Name
6. landcr's Adtlmsa
a
U O 1 cenify Nat I ply read this application and some thn the above information is
0 ^� correct.I agree ct comply with all city and county ordinances and sate laws rupong m
CU abovengcotioned construction,and hcmbapeed.isshate i. wi csaf Nissitymcnmrulr^n Nc
�� above mentioned Prola:rly for imPcction purposes.
gy (We)agrees,save,indemnify and keep M1ay in an w City ro Cupensti id City
F'0. liabilities,e) gre 1.soar indcapcnseed keep
may in wayaccmeagalnst said City
U mcansequooce eg g Nis Permit.
^
App
LICA DER T AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE TI N .
') Re-roofs
rgnaturc of AppltcaH ZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will one applicant or future building Occupant mre or handle h iaardous mawrial
as defined by the Cupertino Municipal Code Chapter 9.13.and the HcalN and Safety
dc,Sccuon 35533(a)7 All roofs shall be inspected prior to an roofing material beim Installed.
❑Yea �Na P P Y g $
Will the applicant or future building occupant sac equipment or Jcvicu which If a roof is installed without first obtaining an inspection,I agree to remove
mit haeardnus air conmmina ax defined by the Bay Area Air Quality Management all new materials for inspection.
District?
00 Yep No
1 have read Nc hnnardous materials requimmcnu under Chapter 6.95 of the Califor-
nialicaldr&S ty um35505.355J3a dW34.lunJ m=dNmifde Wilding
Jou not cu ly w ¢ tat Nn it u my mspomihility m noJly th aeupant of Nc
require Ch t ma poor inmWaneeOf.Certireteofacc,anc ignature of Applicant Date
Owner ar aamorized ascot rete^ All roof coverings to be Class"B"or better