00080002 CITY OF CUPEWHNO
BU11.mrvG DIVISION PERMIT CONTRACTOR INFORMATION: '
'BUILDING ADDRESS 1'IiRAtITN
5 HOLLY OAK DR LIFETIME POOLS INC 0080002
OWNER'S NAME: APPLICATION SUB UA'tE
IRT AND RENEE' 91.0 SAN ANTONIO RD 08/01/2000
ONE: _ SANITARY NO. CONTROLNO.
(408)738-1576
❑pZQ ARCHI'IIiCT/ENCINEER: - BUILDING PERMIT INFO
u C - BLDG ELECT PLUMB 'NECH
IbombyaffrmnotIamlLICENSED icnHNunderprnisonsofChper9(commencing - JobDeseriplion
Fr_I�; with Sectinn](NX)1 of Division3ofthe llusinesn rout Pmlesxinns Cole,;mdm licence
Lcense lass andc815_5 226 S PDOL
s LiLense�C.sl�uce� {Iii r.J.�JJ 1'c p
a S a~ Date_Q �_ .Compactor_
ARCHITECf$DECLARAT
f In
O g 1 understand Inv prone 0,11 be tucd os public mord. -
as
e O Licensed Professional s
S ce ff OWNER BUILDER DECLARATION
,.
H13 1 herehy union thin uta exempt Bunt the Cmulau art License Law for the ;
Z< following reason.(Section 7031.5,Business and Prolessiras Cede:Any city e,county
I m l] which requires a permit to construct,alter,improve,demolish,or repair any seriousre
i3= po t n s 'n< nlasinine,t6, ppl'r nil lt crounim file a,i,nod,marrianat
thallic r 'dpur II ce p fo L t I ' L La (Carl,,,9 Sy. Ft. Floor A
(commencing c J O
a 'ng n6,Secti n 7000) f Division 3 I is Bus!m and) re'. :Corte)
or hot be r.eaempl,homfmm and Ise basis for the alleged escalator.Any vm ictimi -
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally
of creature than five hundred dollar,(4500), APN Number cancy Type
SLusowner nrde,pmpt or an,onanoyecs with wages a.mdrsnic compensation, 36202010. 00 U
will do the work,and the structure is but pleaded ,,offered for sale(see.](4y Required Inspections _
Brice,,and Pmfcsns,ioCode:'re nnu
hCecmr's License Law docs nal npPdy ,,on
caner of property Who builds or improves thereon,and who does such work himself
or through his own employeea provided that such improvements are nor incorrect or 103 — UFER
offered for sale.If,however,rhe building or inhprovemenl is sold within one year of 104 — REBAR
completion,the nwner-hailcder will huva Ilse harden of Proving Ion hu did not build or
imprnvc p,oscu 107 — POOL/BONDING
Fl 1,as owner(if the prb,vony am concloovely contracting with licensed contracro,bo 301. — ROUGH PLUMBING
construct the pjua(Sec.7044,Rusinrss and Pmfessinns Cone:)'I Convector's
License Law dmsnot apply toanowner ofpmpertywho builds orimproves Interim. 304 — ROUGH ELECTRICAL
and who concocts for such p jecls with a contumelious)licensed pursuant to the
CoalrnmrsuclnxcLow. S02 — FINAL PLUMBING ENERGY
❑1 sot accept order See. .B de P C liar or,mawm
Owner Dale 503 — FINAL MECHANICAL ENERGY
WORKERS COMPENSATION DECLARATION- 506 — GAS TEST _
Ihaeby affirm romerpenvlly efperjurynneoflhe fullowingdeelamtio 1,: 510 — FINAL PLANNING
1 I have and will maintain a Cenaicate or Conserv m.elf-insure for worker's 511 — .FINAL POOL
ro
connotation, ae ark for rot by Section 3700 or Be Lance once, for he 516 — FINAL BUILDING
rcornunceof the workfor x rich Iris tisismer.
❑l lune and will mainwin Worker's Compensation Insurance,as required by Seem..
3700 111 the Labor Cade,Iia the pol'onnance,of the work lis which this permit is ,.
issued,My Workcr.c Comanon lnsumncc currier aann'dtp policy mother
h� er a
Carrier: �olicyNo,I \"] N.JG75-7 6C7
C17KI'I VICA'I'ION Oil EXEMPTION PROM WORKERS' '
COMPENSAMON INSURANCE
(This anion coed not be canindeed if the permit is for one hundred dollars
(Slip)...less.) '
1 certify that in the Pedmorm a of the war,I f which Ihis permit is issued,I
,ball not employ nor pecum in anYr1 ntanne . nt A 'tytlgcalrlrf•n m the Workers'
Cnnyx'usalionl jv�^'iwi`.
Applimm
NOTICETOAPPLICAbi If,after making this Ceri fieam of Exemption,you should
tons subject to the Wader's Compensation provisions or he Labor Code,you most
Q O forthwith comply w,In such mwisin I,or chis permit shall se chanted revoked, -
z _
�^ CONSTRUCTION sLENDING AGENCY
a 1 hkfor alrtnn this there its wried(Sec. lending agency for the Peefnrmmnee
W of IM work for which the pcnnit is irsncJ(Sec.3097.Civ.CJ
6. Lender's Name
Lw) z Isndcr's Address
r.7 I ceni I it,.,1 have rend this appliatimi and slate that the above Iaformmior is
[� correct.1 agree m comply with all city and county ordinances and dare laws.losing -
0 V to building construction,and hereby authorize representatives of this city to enter upon
�„I W the ubmumensioned property for inspection purposes.
E.I L
(We) give In save,Indnnni ly and keep harmless be Co,or Cupertino urn a,,
rn liabilities.judgments,costs and expenses which may in any way acme against said
(,7 City in consequence of the granting of this .it. -
APPLICANT UNDERSTANDS AND WILL COMPLY WmALLNONPpINT '
Issued by: Date y /�
r
SOURRE UL NS. —� �
Signature of Applicanl/Commctor �C-7)a�re Re-roofs
HAZARDOUS MATERIALS DISCLOSURE.
Will the applicant orfuture building contract slow orhandle lhmamoaanateiA Type of Roof .
as defined by the Cupertino Municipal Cade.Chapter 9.12,and the Hmhh and Safety
Cate.Section 25532mo?
❑Yee ' lam° All roofs shall be inspected prior to any roofing material being installed.
Kill rhe applicam or furore building mcupmt use eyuipmcm or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emir hazardous air contaminants as defined by the Ray Area Air Quality Management
)i,nic, all new materials for inspection. Applicant understands and will comply with
°Ye, all non-point source regulations.
I ku.e read Ise nammou,mmedals myui¢mems ander Chapter 6,115 rine
California Health At S:fety Cole,Semon,255(15,25533 mW 25534,1 understand that
it the M1uilding drxe not cumnty hwcutenanl.that it ix my responsibility notify the -
ex, posh of the mquieemems which mush be me,Poor In issuance of r Cenilione of
�y Signature of Applicant Date
Owner raatnad,<a" of
vS ,� All roof coverings to be Class "B"or better
CITY OF CUPERTINO . 7::
BUILDING DIVISION PERMIT CONTRACTOR'I'N'FORMATI, :r•
BUILDING ADDRESS: PERMIT
5 HOLLY OAK DR LIFETIME POOLS I1` '60080002
OWNER'S NAME: "
APPLICATION SUB DATE
BI ID I KU
RT AND RENEE 91.0 SAN ANTONIO RD 08/01/2000
Ij `ION& i • SANITARY NO. CONTROLNO.
(408) 738-1376
-POO RCHITECT/ENCINEER: BUILDING PERMIT INFO
z W F BLDG ELECT PLUMB MECH
y auv
i LJ LJI L_J I-.J
LICIheab offrmEh.SEDCOUNensed rude..DECLARATION .Job Description
v rardNoD ica,C ter 9¢ommeneir,nse p
In t-m with Section7000)a Divi.' n3 fthe Business and Professions Cnde.and mylicense
_f is in full force and c t
c z ¢ License Car �� Lic.N Z Z�/ ��, �e �®01.
Date-[y€yy`r [.In. at _ •� m
a ARCHITECT'S DECLARAT
] j I understand any plans slid]]be used as public records
JUN 2 0 2002
z p O Lnensed Pm(epionnl
E:
.,IYi Ort I a-cUILDF.r DECLARATION
W—w 1 hereby altirm that 11. exempt from the Conductor
's Anse Law for the
F¢Q followingreuv,. formi,t ]rasure clon.s and Professions Co de:Any city or county ����®'��
Y F o which requires a permit to conumn,alter,improve,demolish,or repair any structure
��'m pri°no its asuence,also required the applicvnt forsuch pertniun fileaeigned stat,hl
that he is licensed pursuanuo the provisions of the Contractor's License Law(Ch",ar,9 mcreA
Sq. Ft. Floor Area Valu
or that he is xe
commencing with Section]0001 of Division 3 of the easiness and Pmressiona Crane) .G,
empt trrm and me halls for the alleged exemption.Any violation 1 4 Iii YJ
of Section]031 5 by any
upplicant ford permit subjects the applicant .act ,]penalty
of no,moa man Bve hundred dollars(S50p. APN Number Occupancy Type
Ol,as owneroRhe prnpcny,or my employees with wag Ira as iheirsnle compensation, 36202010. 00 '
will do the work,and the structure is nm intended or offered for all(Sec.7044,
Business and professions Code:The Contracwr's License Law does not Imply to en Required Inspections
owner of property Who builds or improves thereon,and who does such work himself
or through his own employees,provided that sa,h improvements are not intended or '103 — LIFER
offered for sale.If,however,the building or improvement is sold within one year of ] Ib4 — RERAP.
completion,the owner-builder will have the burden of proving that he did not build or
improve fdrparposeofsale.). 1,07 — POOL/BONDING
C1 1.as owner of the property,am exclusively contmming with licensed contractors roject(Sto — ROUGH PLUMPING
construct the pec.7044,Business and Professions Code:)The Contractor's
License Law does not apply to an owner at property who builds or improves therem, 304 '— ROUGH ELECTRICAL
and who contracts (or such projects with a contractors)licensed pursuant to the
Ll I dinator'sueende Law" 902 — FINAL PLUMBING ENERGY
Co tat tor,Li ense Sec. ,B&P C for Nis reason
Owner
+ Date 503 — FINAL MECHANICAL ENERGY
WORKER'S COMPENSATION DECLARATION 506 — GAS TEST
.I
I hereby affirm lerpenalty ofperjury one ofthefollowing declarations: '510 -- FINAL PLANNING
�.] I have dad will maintain a Certificate of Consent tr sen-irrm e far Worker's 911 — FINAL POOL.
tl' -' Compensation, as proem far by sereno 3700 of me Labor coca, for be 'SIE — FINAL BUILDING
performance of the•work meIn
this permit is issued.
❑I hove and'will maintain W'orker's Compensation Insurance,as required by Section
37W of the Labor Code,for the performance of the work for which this permit is rf
issued.My Worker's Co. cnsation Inmrance currier e�nd'tPolicy giber are: (�
Cartier - ]icy No.: �aJL.�C7� �`-' /)
` CER'fIPIC TION OP COMPENSATION
INSURANCFIROME WORKERS' PLO
1
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars
(5100)ar leas)
I oenpl that in the n in
ou n the w r which this permit a issued,I a,/t
-shall not employ any person in any mine s a. t o on let m the Workers' Ir
fi
Compensation IU Lvwsyf A,it,
Applicant �_C_7--�)
NOTICE subject
j APPLICANT:Workers
titer making this Cenin,of h L Labor
on,you should
z
became hwithc mply 'I such pr Compensation provisions°hodLeber revoke , must oxo
Z
O forthwith comply with such provisions or this permit shall be deemed revoked.
� 4 CONSTRUCTION LENDING AGENCY �
' Iherehy affirm'bit' is a constmnion lending agency for the performance
W of the work for which this permit is issued(Sec.3097,Civ.C.)
Q
� Lender's Name
{� zLender's Address
WI: 1 acuity that 1 have read this appl'crd r and,tram that ],a ahme inlonnmion is
E.r correct I vgree m comply with all city and county ordinances and sure laws relating
C.> to bui]dingconswetion,and hereby,..formempresentatives°f this citymenarupon
y r� me abdve-mentioned properly for inspection purposes.
0. (We)agree to save.indemnify and keep hmmlessthe City of Cupertino against
cl� liabilities,judgments,costs antl expenses which may in any way vcome against said
(.) City in conscgnence of the granting of thin permit '
APPLICANT UND1jRSTANDS AND WILL COMPLY WITH ALL NON-POINT -
SOURIssued by:. RE ULT NS. ---�_ (Ac ,�� Date
Signature of ApplmaWCormacmr Data Re-roofs
I HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle Notorious material Type of Roof
as del by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(x)?
°Yes ?&1b° All roofs shall be inspected prior to any roofing material being installed.
I '"Will the applicant orFarm biddingoccupant use equipment Or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit haM.Y.m,air contaminants as defned by Ne Bay Area Air Quality Management
3ivtdat?. all new materials for inspection. Applicant understands and will comply with
area
teep.ri
S I have he the herardous materials requirements under Chapter 695 of the all non- oint source regulations.
California Health&Safety Code,Scni°ns 25505,25533 and 25534.1 understand that
if the huilding does not currcmly have a tenant,that it is my responsibility to ramify the
occupant of the requirements which must be met prior to issuance of a Certificate of
Oc
du unay.
�3«�C-� Signature of Applicant Date
Gamonred agent nate All roof coverings to be Class "B" or better
LIFETIME
POOLS, INC. S'n p�°�'
910 San Antonio Road Ca���
Palo Alto, Calif. 94303-4917
(650) 494-7070
(408) 738-1576 n'Q Y
FAX (650) 494-0508
June 19, 2001
City of Cupertino Building Department t7
10300 Torre Ave.
Cupertino, CA 95014
Re: Permit No: 00080002
To Whom It May Concern: CJ 58WQ2�
This letter to give notice that Lifetime Pools, Inc. has completed the swimming pool
at 21405 Holly Oak Road, Cupertino on the above permit number.
• We have been unable to obtain a final inspection.
The customer has been informed that the permit will expire and they will be
responsible for the final and expense of renewing the permit.
Could you please include this letter with the records on Permit 00080002? If you
have any questions, please don't hesitate to give me a call at (650) 494-7070.
incer ly,
�hel c t'0'omble JUN 2 9 2002
L' i e Pools
BUILDIJYG
Cc: Mr. & Mrs. Budig
File
l
Contractor License No. 220382. C-53
LIFETIME
POOLS, INC:
910 San Antonio Road
Palo Alto, Calif.,94303-4917
(650) 494-7070
(408) 738-1576
FAX (650) 494-0508
June 19, 2001
Mr. & Mrs. Kurt & Renee Budig
21405 Holly Oak Road
— - Cupertino, CA 95014 -- - - — ------ — --
Dear Mr. & Mrs. Budig:
This letter is to notify you that your permit will expire on September 20, 2001.
We will be forwarding a copy of this letter to the City of Cupertino Building
Department to let them know we are complete and unable to secure final inspection.
It will be up to you to obtain this final inspection at your convenience and expense.
• The Building Department phone number is (408) 777-3228 and your Permit No:
00080002.
If you have any questions, please give me a call.
Sin ely, .
ellembleon Department
650 494-7070
. Cc: City of Cupertino
Contractor License No. 220382. C-53