03090150 CI'CYOFCUPERTINO
B
BUILDING DlvlsloN PERMIT WONTRACTORrINF�ORMATION
BUILDING ADDRESS: SWAN POOLS PERMIT"03090150
47-7 TTNTW PT,
'R'S NAME: 1495 S WINCHESTER BLV. �11A1T Laue onTE
EI (408) 866-6893 SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
?Oo LICENSED CONTRACTOR'S DECLARATION Job Description
I u F 1 Mmby affirm that I am licensed under provisions of Chapter Y(Commcneing _ p
with Seeti 000)of Division 3afthe Bain end Professions Code.and my license is -.
in full ro and of t.
;q? uaemac ,c' LK!.� IN OUN SPA (750 SQ. FT. )
„", Oam Cum for a
f
ARCHITECTS ION
2 to I u�d my plans Shall he me pub ncnN, a •
Licensed Professional
OWNER-BUILDER DECLARATION
<2 1 hereby affirm that I am exempt from the Contractors License Law for the
MO fallowing mason,(Section 103 1.5,Business and Profeuinm Code:Any city or county
<S� which mquirm a permit In construct,alter,improve,demoluh,or repair any Str.emre ED 9 0 0
uZT prior m re its issuance.also requires lbe applicant for such permit m file a signed sulemenl
4r that he is licensed Pursuant to the previsionsnfthe Confucius's LianscLaw(Chapter 9 Sq.Ft. Floor Area Valuation
A1– (commencing with Section 7L00)of Division 3 of the Business and Prefusumm Cate)ser
Othat he is exempt therefrom and de buts for the alleged exemption.Any violation of 35624004 . 00
Section 7031.5 by any Applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom man five hundred do0a.(S50o). -- - --' P Y --- -
(D 1,As owner of the property,or my employees with wages As their sole compensation,
will do Ne work,and me sWqum is not intended or offend for Sale(Sec.1004,But..
and Profess Code:The Contramr9 Licenx Law cont oat apply m an owner ar Required Inspections
property who builds or improves themon,and who does uch work himselfor through his 104 -IUJ – REBAR
own employees,provided that such improvements am not intended oroffend for rare,If. 107 – POOL/BONDING
ING
however,to, rove
e building or improvement is sold within one year of completion,the owner
builder will ban the burden of proving that he did not build or improve for purpose or 301 - ROUGH PLUMBING
sale.).
❑1,as owner of the propeny,am exclusively contracting with licensed commuters to 304 - ROUGH ELECTRICAL
c.mtmct the pmject(Sex.70,4.Business And Profes,iona Cade:)The Camrsemr'a Lt. 502 - FINAL PLUMBING ENERGY
eeme Uw,does nut apply to an owner or property who wiim ar impson,theraan,end, 503 - FINAL MECHANICAL ENERGY
who contracts for such projects with a eonusemr(s)licensed pursuan to the Conuacmr'a
Lkensa law. 506 - GAS TEST
❑ I un exempt under Sm. ,B&PC for this mason
510 - FINAL PLANNING
f ata
WORKER'S COMPENSATIONDECLARTION 511 - FINAL POOL -
Iherebyaffineunderpenaltyorperjuryoneofthefollowingdeclarations: 516 — FINAL BUILDING
1 have and will maintain a Ccni icac of Consent Act f-insum for Workers Comfort.
Luton,a provided for by Section 37W of the Labor Code,for Ne performvtce of the
work for which this permit is issued. -
ave and will maintain Worker's Compensation Inaunnex,a required by Section
TOO of the labor Code,for the pmfarmance of 1M work for which this permit is issued.
M.Wu kers Compensation Imunnce c/a/rticr end Policy num�he'r am:
1 try N:ynum viiia,
CERTIFICATE OF eKEM NFROM WORKERS'
COMPENSA NINSURANCE
(This section need not he completed If the permit is foronc hundred dollars n 100)
of less.)
I certify that in the performance of the work for which this permit is issued.l shall not
employ any person in any manner an As Iu become subject o the Worlmix Compeaation
Law'.(California.Dam
African,
NOTICE TO APPLICANT:If,eller making this Cenificete of Exemption,you should
become subject to the Worker's Compensation provisions or the laMr Code,you must
z forthwith comply with such providons or this pefmttahall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
I hereby affirm that dram is mwnmtion lending agency for the lerformance of
Ya rte. me work or which this permit is issued(Sec.3099,CO.C.)
SJ 0 Iander9 Name
7 z Lender',Address
J Q I certify mat I have reed this application and state that me above informuiun is
y F correct.I agree to comply with all city and county oNinanceS and state laws relating to
U building construction,and hereby authorine representatives Of JOS city in enter upon the
4 ahave-mentioned property(Or inspection purposes.
ti (We)agree to ave,indemnify and keep harmless the City of Cupertino all
y liabilitimijudgmcnts,costsandcxpcnuswhichm in any way Same against said City
;)z in consequence or the granting of phis Permit. 0
APPLICANT UNDERSTA ND W LL MPLY WITH ALL NON-POINT Issued by: Date
E 91ta� a —
J- q"w-
Re-roofs
u of ApplicanUConuazmr Dam
HAZARDO MATERIALS DISCLOSURE Type of Roof
Will theapplinmorfutu building Occupantstore or handle hauJous material
defined by the CupertfMI Code.Chapter 9.12,end the Ncalth and Safety
Otion 35332(x)? All roofs shall be inspected prior to any roofing material being installed.
YmWill the applicanilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Drxuhh.ardous air connefined by the Bay Area Air Quality Management all new materials for inspection.
❑Yes N
I hove read the haaa usmamriels reyuimments under Chapter 6.95aflhcCalifor-
.I.H.102SafetyCode, mo 5(15.25533 25530.I und.rsmnd But iftM Wilding '
dace not c ly havua tenon mat it K'm pomibility m notify tbc.ceupant of the
n ntswhc in ..ocem m.(aePaner. ignatureofApplicant Date
IR
mer cera horind agent D„p All roof coverings to be Class "B”or better