01100001 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10330 IMPERIAL AVE. ROYAL POOLS INC OF SANTA CLA 01100001
OWNER'S NAME: APPLIC7I0N S B DATE
ILYA STOMAKHIN 2258 CAMDEN AVE 10/01/2001
PHONE: SANITARY N0. CONTROL NO.
4083718000
MOO ARCHITECf/ENGINEER: BUILDING PERMIT INFO
�v BLDG ELECT PLUMB MECI
<< L
LICENSED CONTRACTOR'S DECLARATION
i z_wZ 1 hemhy affirm that 1 ain licenned ander provisions or Chapter 9(commencing Job Description
w_ui 0 Section 7000)of Division 3 of th"usiness and Ponficasions Code,and my license GUNITE POOL/SPA.
in murameana- up.x (587 TSF)
o u iccense
i LL O IC GnmdeL'so
A
ARCHITECT'S DECLARAT
< I undttaand my plans shall 1,used as public rc aids
3 ❑O Licensed Professional
OWNER-BUILDER DECLARATION
-m I hereby anion that 1 an,exempt boo the Co...,'.License law for the
?C
following remar.(Som 7031.5.Bos ass ad Professions Cade Any city or county
which nuintras a permit to conmron alttt.improve.demolish.or prind,anye,maum
$ .pd to is issuance,al q the applicant for such permit fl signed statemem. -_-
- that ha 41 'pit pars i nt t the of Division
n. r he et nt pit Business c n e Law(ind Co s) S Ft Floor Area Valuation '
or m n mg with Smuon,A'an the a n 3 of the legd and imi.Any si Code) t (-1°^ d �,„.n59':. Y a. :y J`7 s { 1 C'ti;
of that he 7 31 Ji b thncfrofi and the basis for the alleged aeicam I.Any violation
'fno mom0ihenfiahomealtdllers($500),tsubfem ere apphcannoaanl pevlry- APN Number 'P.,ivrr.-
Occupancy Type
0 L as owner of the and
the*y,ru my employees with doges offered they r s compensation,
'wdrpgthgworofessi We ode:Thoo,'C not intenctor'& a en aLaw for am(Sec.-7W," 104 - REBAR Required Inspections
'9usineof funs Pry Who
Code:The Contmcmr's License Law ams not wkly ri an
or it..
Whobuilasor ovided of such,andwhoott,.hwa tended lr 107 - POOL/BONDING
or throw h his own tmployms.provided ohm such i empent memx within
nm intended yo.or -` ' - __
-,oRcrtd orfoldlGerbuilr,'he buildinge imen of proving
what within not year of 301 - ROUGH PLUMBING �'+v'c<� ,.c:-'..•.r \G
compinion,the owner-hildcr will have the burden of proving thn he did not buJd m -
improverorpurpoaeorwle.). 304 - ROUGH ELECTRICAL
. .
.TBI heron (Sepens.anBirshmasandPron,gwimran'a Contractor's _. -•502.._- .. FINAL PLUMBING'....ENERGY ih_.� r �'i .....-- - ..'..
License
r the'rosea tape IDw owners and erty,who
Code)The Co:nroreon. - L
Lid L dmsnot for-suapply t r rp penywhal)licesetmprovatto'h 503 - FINAL MECHANICAL' ENERGY
and h turas for-such h 1 n th c macrons)I sed p r ant to the.
pet t Capula p 506 _ GAS TEST - '— - - --- - "-- '-'- '
0 am astiturp,innisec ' Ba?eta ta.arcawn 510 - FINAL PLANNING
511 - FINAL POOL
Ow ,' O�RKER 5 COMPENSATION DECLARATION �J G
516 - FINAL BUILDING
Ihereby affirm underperi lry fpe)ury one o(ae following declinations:' /
0 1 base oil will ma t.in*ii'Certificipsof Conant to self-insure for Workers
'Compensation, as pro d d for by Section 3700 of the Labor Code. for the
performao.. f the oh fu 1'ch this perm t s - N.
01 haver aria will mainlnin Wmker's Compensmion Imumnte,as mqumad by Section
31011 the Labor Code err the peRormantt of the work f hmh th permit rs
_Asp My H/(o/kers Co pe t 1 am cxm rand P/o'h/q n mbcr -
emcs'IVS//Q
r 1 E%EMPr10N FftOM,WORKERS 1 e^ C "ser 4,a e I ti
1 CERTIFlCATION OF A,I,ION INSURANCE' ,� I
.. .. .. . S' 1'lil'•-.
IThsi sensori idea rice tic 2nmpleted it tM1e permit is for,one h
oundmtl dollars
`
(SI.)or less)
n +
"T 1 o fy that,in the performontt of the ...rk for which th pdtm t i ',wed'h .-•_�- __._. _ -.. _ ..-_.-.._ _....,,..„.-., _.
shall not mph y maype,,on In any mariner:in.t become wb)ect to the Workers IS C:II. 1] t ,7 .�•C r l't v ,.
Co 'cruces C '
: ..:'A (cunt. ;of CaliforniaCelf mi)D°t.0 ... ,.
"NOTICE TO APPLICANT If,after making this Cmificate of Excmption,yW should •^+,, 't 1.
0 0 becomc subset to the Workers Compensation'providi n i of the labor Cade,you must
forthwith merely widi such provisions or Nis permit shall be domed revoked. 1
I'�" rA :rCONSTRUCfIONLENDINGAGENCY, + ,?' -. _ _ ..
�. 7 ", Nto dee,isaconstruction lending ag,my' th perftmaoce 1 ,,
oracwork f h'hd perm) isued(S 3097C ,C)
•.Lend Ad r _ _ __ a c.
5 z der sAadrt.s L 'r . . .. J:
V 0 �o"ve:I ccnity that 1 have mad this application and sole that the above,oficuraation is
ks'.F n.l agree to comply with all city and county ordinances mid acme laws mlming
0"Utobuildingnmstmetion;hndherebyauthorize representatives ofthiscity inenter upon
W the abnvememioned pmpcny fnr it,peaien purposes.,,•
oks (Wc)o'rfeio sae:indemnif'ead keep haundLihe Citym Cupeninciagainst
0h , liabilities,junk and a nuch rtr; ' 's w f .7 in any way occme against said
U..Z City ono eohorhc i of is ""
A .CANT,I'- L COMPLY WTTH ALC'NONPOINT
S CE R LATI Issued by: Date
as
tb ri a j7(a con tu t in s Re-roofs
pat A I
A DOUGMATERIALSDISCLOSURE t' Re- -
'p morfwurcbu'Idingoccupamit mhandlehuWousmatenal e of Roof._ .-.-.- _-... ..
y perm Mu cip lCad Ch pte 912 arida He hh dSafety -' ISInr '
t -
❑Y }7fry4 oN I lot, aK n�
r _...All,roofs shall.be.inspected,prior to.any-roofing material being installed'--r---
Will h appl' i t r t luddingotu,tilort idetul.ilernato rat' i hichIf a roof Is i idt'alk&without first obtaining Bit'ins ection;: a ree:to remove
tin ds cm .suerdfncdbythBe,Are.Air Quality n' mm all-non-materials
g P B
District? ll
all new mater cels for Inspection,,Applicant understands.and will comply,with ,
❑NO. . p ice regulations.' , .. :n
z 1 ria q rcatl', hazvdo. mose'als rcquoemema ander Chapte 6.95 bf the
Cali(omia Heahhi txs¢G
a.Sac .25505.25533 and 25534.1 undersand the,
ill bu Ice gause
of poem hes anenttl t t is myrcponstbiltyto notify the -
2:•O
u upam Mihe r vire us 1'notion iso f o Cenificate of
" Pa y" Signature of Applicant Date
r . 1
Ownttora a rice' gge,, ,' „ aura _; All roof coverings to be Class"B"or better
OFFICE. . . '