00110033 CITY OF CUPERPINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER's`nJ515 OAK VALLEY ROAD SWAN POOLS AI'I'LICA'I'UKpllB1)A1033
PHONE: r tiANITARYN ..11 1 V ff NO.
PAR BYONG 1495 S WINCHESTER BI_� ,9 07 to
neo ARCHITECrIENGINFER: BUILDING PERMIT INr0
�+t O O ! 4'03) 666-6893
FILING, F[INC'IPLUMB MCH
z u% LI CENSEDCONrRACIDR'S DIiCLARATION lob Description
7 HO I hereby atlinn ],1 an,leaned under prod,oto of Chapter 9 minualneing
with Section 70X0 of Division 3 of the Purines.and I' fe......Cade and my lie=n,
o.mfull lane and elfsl C�v�gQ
z < Li<conc CLa. 4.1L Li<.« �! V
d Bde— o Contras,,
w d a N ARCHITECT'S 11 CIARATIU �' t
t og deraann „yplut..l.uluatoed.,.Phtnlia,,,,,rols NEW IN GROUND 544 FOOL 8 SPA
Lioeu,d pool'c..iunal
n e. OWNER-BUILDER DECLARATION
vl u, 1 hereby u01nn that I am exempt from the Contracmr's Licenm Low for the
c ? following reason.(Section 7031.5.Bu.ine..and Professions Code:Any city or county
F O amen moldres a permit to canutrva,alter,improve,demalkla.or repair any sfracture
ce prior tons i.ssuame.al.w requires the applicant for such gamine(ilea signed aalement
that henlicensed pursuant it)the provi. oowCommea,r.I.iecnwutw(Chapter 9 Sq. Ft. Floor Area Valuation
fen ing with Soelin i 700))of Division 3 oI Ne R Dims and I'rolc%sons Code)
n In.,,he.,e.ampt Ihnelnnn and the harir I'onhe ullcgcd exemption.Any violation
of Suction 7031.5 by airy applicant fur a p:nnil.ehjole,the applicant to e civil penalty
of not mare than five hundred dollars(S500). - APN Number 0ckePE1 601kype
01,asowver of the pmpcnY,art my cmpmyces witb wages a.tbeir role compenwtian.
Vl
rill do the wad,and the.waur,is not intended or offered for sale(See.701,1,
Iluvinea.:mJ 1'roti'..ions fide:Tim Convonar's LPom.e Lou,d«.Nat appy m an I,equired Inspections
ou r of prapo eny who build.or improvthereon,and who des such work himself 34 2570!16. 0U
or drought his own mnployms.pmvideil shot such oni mvenmms am not intended or
,fend for oda.If hawcsc r.the Handing"I ,pro ent is sold within o e year of
nu ove o,the ownvlb ander will have rite nhadun of proving Nm he did Hol build lir
.......
top,n.e farnumo.eonaled. 103 — LIFER
0I,to,rume,of the property,am e.du.ively oorlumn.,with licensed c.nnracmo to 104 — P.EBA P.
conamet the project(Sm.70,14.Rusineaa and 1'rnfessions Calc:)the Commctor's
Lic<n.e saw does not apply to an owner of property who wilds or improve.thereon, 107 — POOL/BONDING
and who contracts for such projects with a coreamorls)licensed punuanl no the s
Cminmoc,Liem.el.aw. ,oi — ROUGH PLUMBING
❑l stn emoup.untie,See. e a' LE ps 304• — ROUGH ELECTRICAL
Owner WORKER'scoMPDateriostDIscLARAT`(N 502 — FINAL PLUMBING ENERGY
1hereby anirmtinder penalyofpimjurymennhefnlJO Lci�rlioi�,: 2 0l 503 — FINAL MECHANICAL ENERGY
0 1 have and will maintain a cenircam of Consent o,sd6lo.ureq for�W.fjorkers 506 -- GAS TEST
Compmnrlioo, us provided for by section 3700 of the &It, Ic `js 51.0 — FINAL PLANNING
lerli,nnanm of the work ter which this Iennit is issued. 1 11V
Khaeandwilltntimamworker.Co,nmen.a ih,.uranee,a.mnuirmbySecti�on 51. 1 — FINAL POOL
I of Nelahor Code.for Ne peronnttnae of me w...a rot which Iris perms i. 516 — FINAL B,U I LD T NG
m
issued.M�y�Worker'.Conhpen rtion Insurance carrier and Policy number are:
cacroom �oll5ld Policy No.:
CHWII WCAI'[ON OI,EX By In ON I, MWORKERS'
COMPENSATION INSURANCE
(This action need nm be catnpincd it'the permit is for mita hundred dollars
1SI0)orIrn.I -
I moify Nat in the ,if o"ul the work to,,which Id.per nil i. .am,I
.hall not mnploy arty p,,a in any notion,.o a wm
as lcne.object nthe e workehs'
Couniso athm burs of califamia.Date
Applicant
NOTICE TO APPLICANT:If, it,,making his Ceirl of Exemption,you should
became subject w the Worker's Cotnpenmtion provisions of the Luwr Cale,you must
Q forthwith comply with such provisions art this permit.shall be dmnud revoked.
V] CONSRUC'r1ON 1.1IN DINO AGENCY
Ko ; I hcrchy:dlinn Nut there is a eororaction lemling agency list the perhm Cance
of the work for which this pencil is is,tmd(Sec 31117.Co.C.)
Q [,ader'.Name
Z I,.dI Addm.,
V 0 laniy that l have mad this applicmion and state thanhe abuse information is
ia, F. a meel.1 agree it,comply with ell city and county oro inamcs and state lams relating,
Q O
it,buddingcoustruction,and hereby aumurire representative%of Nis city ht enter upon
riteahnve-mcoli obed ptopely form,tel npttmoxcs.
As (we)ngrce to lave,indumalfy cod keep mon le,,Nc City of Cupcnitu agmina
h liabimlcs,judgmeul..=Das and cspeo.cs which may in any stay aanm against said
U 7 City is a,roeyuence of the gmning of lhi..pemdh. - ,/�t� 1
SAPPLICANT OURCER UULATS NAND LI.COMPLY WITH ALL NON INT Issued by: ..Te,_- HI`,7�k—/Cc= Date �� 7 J
of And"antl
so
Oahe Re-roofs
a II , RDOUS MATERIALS DISCLOSURE
will me ap,phe mnunr<neumup;axntpam some nnhauma har:hrnova material Type of Roof
Al ddioed by the Cupeninu Municipal Cuda Chapter 9.12,Elliot the Ilvnlle;md Safety
Ctnlc.Section 25532 a
0Yes 14" All roofs shall be inspected prior to any roofing material being installed.
Will the appliconl or future building a'cupam use equipncm or devmn which If a roof is installed without first obtaining an inspection, I agree to remove
emit hmtarJnuo air cnnnintinams as defined by the Buy Area Air Quality Management
Di.„riv,” all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I have rend Ne lu,nmous tnanthl,myuimnenp undo,,Ch:tptxr 1.95 of the '
California I lcalth is,Sufcy Calc,Smlions 25505,25533 and 25534.1 u ide.aund that
it the wilding dons Hol currently h:ve a lemon ohm it is my—isn.ihility to notify the
hccupvm of It¢ Iuimmenl.wl' n.a w nsl prior m issuance of u Certificate of
o«upaney.
Signature of Applicant Date
All roof coverings to be Class`B"or better
m
own aaoriacaag I Bine g
OFFICE