02110061 CITY OF CUPERTINO •- f,.
umLuwc mvlslON PERMIT CONTRAC,T,,,OR"IN'FORM'ATION ; !
BUH1D&2A5Fp41ILLCREST RD LIFETIME POOLS INC PERMIT N02110061
Gwl9Tf9NAC KEDER 910 SAN ANTONIO RD APPLICAIOIISPV (2002
ONE: (408) 738-1576 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
oo y LICENSED CONTRdunder�DEConsofCO� JobDescrip��pi���®
<U SI hereb affirm Nal I am limntid under mvisinns of Cha ter 9(commencingPOOL & SPA l�EA
S
with Senior]fit Bic Division 3nf da Busirggrt nJ PrnfcuinnsCalc.andm license ix
t+< in full fore J ffen /IL
OZ�— Ltecnu Cl Conor SEP 16 2UO3
F:t—p Contractor
SS'J` ARCHITECT'S RATION
C aSy N I undersand my plans shall be used es public recoNs
BUILDING
Licensed w LL p Licensed Professional5 OWNER BUILDER DECLARATION
5y si 1 hereby affirm that I am csempt from the Contractors License Law for the 2 5 0 0 0
m n O following reason.(Section 7031.5.Business and Protrusions Code:Any city or county
a $� which requires a pesmii In construct,alter,improve.demolish,or repair any structure
to prier to its issuance,also mquires the applicont for such Permit to file a signed statement
t?e Nat he is licensed pursuant o the provisions of the Cnntmoor's License Law(Chapter 9 3S116Et6l0a07AM Valuation
(commencing with Section Wast of B
Division 3 of the nsincss and Professions Code)or
�
9 that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section]031.5 by any applicant for a permit subjects the applicant to a civil penally of 1 u APN N99W Occupancy Type
not more Nan eve hundred dollam(1150B. 104 — REBAR
❑I,as owner of the property,or my employees with wages as their ole compensation,
will do the work,and the structure is net intended or offered for Asia(Sec.7W.Business
and Profession CO&The Contractor's License law does not apply to an owner of 301 — ROUGH ections
property who builds or improves thereon,and who dna such work himself or through his
ownemployers.provided that such improvements are not ntended mattered forsake.If. 304 — ROUGH ELECTRICAL
however,the building or improvement is sold within one year of completion,the matter- 502 — FINAL PLUMBING ENERGY
builder will ban the burden of proving that he did not Wild or improve for purpose of
axle.). 503 — FINAL MECHANICAL ENERGY
01,as Owner of the pmperty,am exclusively contracting with licensed contncmrs to 506 — GAS TEST
construct By,project(Sec.7044,Business and Profeaione Code)The Contractor's Lt.
cruise law does not apply in an owner of property who builds or improves Neeson.and 510 — FINAL PLANNING
who contracts for such projects with a contractor(s)limned pursuant to the Contractor's' 111 — FINAL POOL
License Taw.
❑I am exempt under Sec. .B&PC far this tear. 516 — FINAL BUILDING
Owner Dat
14 t WORKER'S COMPENSATION DECLARATION
I hereby affirm unlet penalty of perjury one of tbe following declarations:
I have and will maintain a Certificate of Continuo self-inure for WorkcYs Compen-
sation,as provided Nr by sterna 3710 of the Latin,Code,far Ne Neformartm of Ne
work for which this permit is issued.
❑I have and will maintain Workers Compensation Insurance,as required by Section
37W of the labor Code,for Be performanm of Ne work for which this permit is issued.
My Workers Compensation Insturaatim carmr and Policy number em:
artt r
COMPENSATIONPolicy IT ON4— RI RS'
(This section need not he compllted ifft permit is future hundred dollars(SH0)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall nm
employ any person in any manner so as to become subject o the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you must
OO forthwith comply with such provisions or this permit shall he deemed rcvemd.
Z ► CONSTRUCTION LENDING AGENCY
[—� I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued(sec.3(N].Civ.C.) -
Q Lender's Name
a z Lcmix,'s Address
U O 1 certify that I have read this application and amu,Nat the about information is
(~' comet.I agree to comply with all city and county ordinances and state laws relating to
DU building construction.and hereby auNnnec representatives of this city to toter upon Or
r W than annumi d pmpcny for impaction purposes.
hliabilitiaWjudgm nes.costs nd expenses which maayinr nyhway amnm against raid Ciity /
U z in consegmnm of the granting of this permit.
APPLICANT UNDE ANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Dale
SOURCE REGUL 5. -
e-roofs
Signa mo IicantlComr-Ora
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hazardous material
as defined by die Cupertino Municipal Cache,Chapter 9.12.and the Health and Safety
code,Seccttion25532a)? �N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit hamrdous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes (v�o
I have read the hamNnus materials requirements under Chapter 6.95 of gic Califnr
ofa Health&Safety Coate,Sccuons 25505,25533 rad 25554.1 underamnd Bad if Ne building
does ot ncummly ve a tenant Bon
m i,is my responsibility to minty the oecupnt of the
rcgafmmcuswh mstthe,met poor inissuance(it aCori ftcateofOccupancy, Signature of Applicant Date
Owner ore thoriraJegcm Dat All roof coverings to be Class "B"or better