00120007 CITY OF CUPERTINO
BUILINno DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING Ae,51805 OPK VALLEY ROYAL POOLS TNC OF 5 T/Ta'CLARA001_0®07
OWNEWS NAME: APPLICATIO SpHDbr
MINH LE 2258 CAMDEN .AVE �c/��t/2000
ONE: 4083718000 SAN] NO. CON'IROLNO,
0-7 ARCHUIFECMNGINEER: BUILDING PERMITINFO
kL' HLDG ELECT I PLUMB MECII
v<� I ISI
SNi LICENSFD CONTRACTOR'S DECLARATION Job 'kprlpinny��
00, hcrchy;dfinntontItonI'aenwdunJKpmvirion, Ifclohnr9(o,mmmacing
Nim withSco a71)(ennnaivi,i.,ndofthe Hu,oneo.and rrnfc,ri„n.Cofo.andIlly ueen,e POOI •Y
Qac re.Ji is in full lass and clfKl� OO�2-
c 2 I.icenul Circe , �3 I,ic.a Cl
s E F Dalc 41 .� Gm,ttaelnt ON JUL 2 3 2001
ARCHITECT"e as public records a a}5 I understand my plan.,mill M1e used as public m�oNx
a6 5 l i,cnarl Pt ufcurinnal
do[ry
OWNER-BUILDER DECLARATION BUILDING
1 herchy affirm the I am cmmpt from the contractor.,Licence Law for the
S< ud owing¢asmn(Satins 711.11.5,lousiness and Pmfcs,ion.Co1r:Any city or county
F D wh tJ y nit I ' p I'.dn I' Y 'I hum
a3°�O prion t Iw y 'In pdr,l tl hl It 11 's d.t t mens
'hat he is licensed forand to the promom.of the c t l License La (Chapter 9 Sq' Ft. Floor Area. Val t)�1
(com.nenemg with Section 7000)of Dlviion t of the liminess and Proresvion,Cole) bt4�l/JkJO
,r Nut It,I,call...mn
emrn, .runt thfort e bans the alleged c option.Any%illation
lir Section 7031.5 permit subjects any applicant for a psubjects the applicant to a civil penalty
ornm tome than fire hundred dollars($500). APN Number 7 rnr� Occupancy Type
El 1.hs owner I'll"pmpoK
ury, Italy rn,drys withag
wes m m ,se
ach e enngnnwtimn.
will do the work,and the.structure i,nm intended lir interest for sale(Sec.A144.
Business and Profe„inns Code *11c Conhowur',License Law Joey not apply to an equired Inspections
owner of pmryry Who holds or improves thmcon,and who dtex such work.himxlt 1.03 — UFER
,,,thmuge hon own cmployca.pmv;ded that unh itnpmvunnnts m,not Inteudal or
offered for.ale.H,honor,the building or im anecia m i,.oto within line year of 1.04 — REBAR
o-
ompleti.,n,the nwna'builder will have the bullet,ofpmving that he did not Wild or
n107 — POOL/BONDING
tpro.e ' Pal ).
❑I,aovoeroftire Nopery.amc„m,i,nlycmtrumingstart RKaolcortruatns1. 301 '— ROUGH PLUMBTNG
Lncnwatrua the project(Sec.7044,Haines and Pro&,sbes Cost The Counter.”, 304 — ROUGH ELECTRICAL
Lns nm
aw does ap,lr an own,,of pro,crty won build,n,improve,thereon.
and wilt,contract,fm,nee P,nl<e1a wtnt a anmrue tm(s)fanned pamunnl m the 502 — FINAL PLUMBING ENERGY
Qmhaerse,License Law.
0 l an,exempt under See. .H&1'C for this reason 503 — FINAL MECHANICAL ENERGY
owner Dao506 — GAS TEST
WORKER'S COMPENSATION DECL\RATION ,
nar,nr afrtrm ondm"Indo,t,f ceimr�,nonnne mlwwing d,elttradon,, 51.0 — FINAL PLANNING
C01 1 base and sill mairmin a Cre iBcam of Conwm In wlBin t re for Worker's 311 — FINAL F'OOI.
ompeaadma its pnw;ded for by Section non of the Labor Coale. for the 516 — FINAL BUILDING
perfn mono of the work Ill,waren ors pante;s i'wcd. -
[/�I nave and x'ill mainuin Worker's compensation Insurance,a.required by Sermon
-l7lll)of the InMn Code,for the performance of the work for witch this Itcmni,is
i,wed.My Worker',CnntPenwtinn Bron rare carrieand Tolley nu'/tn� 3�
aerr or.
Cannot: rlf 11l'ION OF I KEMPolicy No.: I�WSROM_&M CN5'l
COMI'INSATION INSURANCE
ofis wetion need not be completed if the pemlil is for one hundred dollars
IS 1110)o,less.)
1 mainly that in the performance of the work for which this permit is issued.I
shall our employ any person in any manner no as to Wrome subject tr he Worker I
Con tpemlaion Laws of Cufiforniu.Du1c
Applicant
NOTICE TO API'LICAN'1':IL after nuking this Cerilicafe of Excmp,ion,you should
hcon
tmc subject ,the Wom
rkce%Compea,inn pmvi,ionf the Laron torp
Code.You
Q O tonhw;lh comply with such provi.iotn lir to ,o
is pennit,h dl be doe nee revoked.
F4 CONSTRUCTION LENDING AGENCY
a
71 hctchy affirm that them i,a forobh tion lending agency for the performance
kT7 of 1h,work n,r which This permit is I,mcd(S,o.3007.Civ.C.)
QLendtt:,Name
= z lender's Address
V Q I mr11'y Ihat I haw turd If,,rppl'aad and olc that Ile Ru ve Intonation i,
n rrecl.1 agree to connply with all city and county ordinances and,tate laws relating -
Q f..) to Wilding construction.and hereby authorlm reprewiII of this city to enter ufan
_ Lk7 the;,bovcmcnlloncd properly for impection pnrwsc,
rent 13( (We)a,.,,to slot.indmnorl,and keep hornless tI,City of Cuprono ngaina
fA liabilities,judgments,cuss and ex,s nwn which may in;Illy way rector against,aid
t.7 Z City in consequence of the granting of this perunit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT Issued by: Date
SOURCE REGULATIONS.
Signature of ApplicaMComramor - Dane Re-root.S
HAZARDOUS MArfRIAI S DISCLOSURE
W'dl heal lit linum minding tw,,rfant store is l,wndm enamors matelot Type of Roof
as defined by the CURrinn Municipal Code.Chl 9.12,and the Health and Safety
Code,Section 25532100!
D Yr, An All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future holding occupant use equipmentordevices which If a roof is installed without first obtaining an inspection, I agree to remove
mil hmardous ter contaminants a droned by the Bay Area Air Quality M....cmem
all new materials for inspection. Applicant understands and will comply with
°Y,. " all non-point source regulations.
I ala read the hanNnus mmeriuln rcyuimnrons under Chapter 0.95 of rhe
Culifmnia I Icalth M Surly Coln,Swtinro 255115.255])rind 255)4,I undmatrnd rant
if lee M1uilJing J.nx not currently havesunt.lhm;l is my tvwpomibilhy ft,notify the
occupant of the mquiren¢nu w ich -be amt prior m isms:u¢e of a Cenificme of
OsC.Pan Signature of Applicant Date
z •00
owner authum ed aged )ane All roof coverings to be Class"B" or better
OFFICE
Ah.,