04050006CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACT -OR INF®RMATION .
BUILDING ADDRESS:
SWAN POOLS
1E11ITNE04050006
R'S NAME:
PERMIT ISSUE DATE
ZHAORONG XIA
ONE:
SANITARY NO. CONTROL No.
(408)866-6893
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
p LICENSEDCONiRACfOR'S DEC ATION
C 1 '" by firm Oat 1 am licensed under provssi f Chap¢r 9 (commencing
'o.Codc.andmyliccucis
Job Description
with S=' of Division 3 of Nc Business and P
i N mu rartea er pct
SWIMMING POOL (CLOSED TO SCREENROOM)
uanmc' ue.a
Dau ConI
ARCHITECTS DECIA ION
—t l sande nd my plans shall he used u puhlic records
U
G Licensed Professional
OWN3 ER DECLARATION
1 hereby .(Sinn um 1 a1. exempt from one GOOtrnslCut License Law for nc
0311 am exempt
o following moon. (Section ]11)15, Business andvedeProfessions Code: Any city or county
0
which requires permit plug improve, demolish, or repair any swnum
prior to issuance, also requires nc applicam forsueh Permit to file aligned suumem
y n re mires the
Sq. F[. Floor re
Valuation
wJ nccbusi
1 )ofDisio.nf
od
businessProfessionsCoda)
(commencingSectionBusiness and Professions Cak)of
$
\ -%
\�
exemttSereion]Oood de,exam;ofrnfthc
oar he is exempt therefrom and dee buss for the Waged exemption. Any violation of
Oat
3 2�DAQ12
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the, applicant a Civil penally of
not mom dean five hundred dollars (5500).
❑ huownm of the property, or my employcu wits wages. Noir salt rompenxtion.
Required Inspections
will do dee work and dee swcture is not intended or offered fonale (Sec, r04., Business
and Pmfasions Code: The Contractor's License Law docs not apply u an owner of
property who builds or improve thereon, and who daasuchwarkhimxlf or through his
awn employca, provided Oat such improvements art notintended croffered foraale. If.
however. the building or improvement is mid within on year of ampleuon, the owner.
builder will have dee burden of proving Nat he did not build or improve for pulp.. of
sale.).
❑ I. as owner of dee property, am exclusively contracting with licensed contractors to
construct Ne project (Sec. ]B4a, Business and Professions Cont:) The Contractor's U.
most, law does not apply to an owner of property who Wilds or improves thereon, and.
who contracts for such podecta with a conincmr(s) licensed pursuant ro the C .... cmri
Lice.. taw.
I am exempt under Sec. . B & P C for this recon
Date
WORKER'S COMPENSATION DECLARATION
1 hereby affne under penalty of perjury one of the following declarations:
I have and will maintain aCenificac of Consent to ulf-inaure for WorkersCompen-
sation. as provided for by Section 3700 of the labor Code, for the Performance of one
work for which this permit is issued.
1 have and ill mai 1. Worker's Compe.auon I. .. a mr,imed by Section37M.fNc
rCodc, for nc performance o(Ne wort for which Nupennit is issued.
My Worker' Compensation Imm�rce cornu and Policy number
A,
Came . Policy No.:2 11
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(phis motion need not beeomplmed if the permit is for one hundred dollars (Sim)
if, taxa)
I eerufy Out in the perfmmdnec of NC work for which this permit is issued, ) shall not
employ any person in any manner so as in become subject I. the Wmken' Compcnsauan
Laws of C.1imrnot. Dau
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation previsions of the Labor Code, you mum
Z forthwith comply win such pmvivocis ar this permitmiall M deemed revoked.
0
CONSTRUCTION LENDING AGENCY
I hereby aBirm Nat Nee is a construction lending agency I'or the performance of
> the work for which this permit is issued (Sm. 309], Civ. C.)
Lender's Name
Lender's Address
z
0 1 cerely Nat I have mad Nis application and au¢ Nat the above information u
-
correct 1 agree to comply with all city and county ordinances and mute laws miming on
jbuilding construction. and hereby aunorim mproentatives of this city to enecr upon N.
oho arvA p opcny for iupccuon purposes
( I agree t eve, indemnify and keep hannlas the City of Cupertino against
A liabilitime,' dgments,eas andespensa which mayio anyvnyaemuea,stiumsald City
,Z in quince ofthe granting ofthis permit.
^ A (CANT UND STANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
RCE REGUL ONS
Re -roofs
Type of Roof
t arum rf Ii.,/C.. Itur
HAIIARDO 5 MATEIALS DISCLOSURE
Will de applicant Of factum building occupant more or handle hvardous material
Oefried by arc Cupertino Municipal Code. Chapter 9.12, and the He.10 and Safety
c. Section 255J2(a)?
All roofs shall be inspected prior to any roofing material being installed.
Y..
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant o mare building Occupant use equipment lir device. which
it hazard... air emiuminants u &fiO.d by the Bay Arca Air Quality M .... cmanl
all new materials for inspection.
District?
0 yes
I have mad Ne hnardn smaurials requirements under Chapter 6.95oftheCalifor-
7dan.,.Orornl,
Health & Safety Code, Sections 25505, 25533 and 25534.1 undersand Nat if de Wilding
—
ve I Nat itis my responsiM1ility m nuly Oc...form afnc
sw t npriorwi a Cc 0(dCC14fCdICO(IXCupNCy
Signature of Applicant Dale V
a
All roof coverings to be Class "B" or better '
own
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