04100027 CITY OF CUPERTINO a° �^.- %� "- -'
BUILDINGDIVISION PERMIT CONTRACTORINk.ORMATION .-._..
BUILDING ADDRESS: SWAN POOLS PERMIT NO
23605 OAK VALLEY RD
OWNER'S NAME: PERMIT ISSUE DATE
UMESH MAHAJAN
E: SANITARY N0. CONTROL NO.
(408) 866-6893
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 � 0
coo LICENSED CONTRACTOR'S DECLARATION
u F I hereby affirm that 1 a n BcaIved under provisions of Chapter v(Commencing _ lob Description
`uiN Section?")of Division 3 of de Professors and ProfessiaCode,and my liefooe is _
amu" in fullfoaeantic e NEW GUNITE POOL & SPA (452 SQ. FT. )
j Licence Clas Lk.N
&_(a Dote lnlCanlRClaf
YY".J ARCHnECTS DEC N -
K I undcrsunJ my plans shall he used u mash arords
ic JyU /
LICCrdcI hembyProfesoval /,6/v
3 OWNER-BUILDER DECLARATION
.�nC 1 motto affirm Nn 1 1. exempt from the Cantremoh License Law co the -
pO following motion. ermit ,]Ur'L5,Businessandmpr Profession Code:Any City Of county
$(v which requires a Permit m cnnswct,eltec improve.demolish.or repair any stomure
prior it)its issuance.also requires the applicant for such Permit o file a signed statement
< that he is licensed pursuant to the provisions of Bus Cormixtur's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
csxQ (commencing with Section]0011)of Division 3 of the Business and Prokassinn Crock)or
y $ Nat he Is exempt Ocrafom and the basis for Ne alleged caemp0on.Any vialadon of
Section 7031.5 by airy appliano for a pmmil subjects the applicant to a civil penaby of 3 41PN6�MP_r 0 0 Occupancy Type
not mom than fire hundred dollars(5500). P Y YP
❑I,nownmofthepmpcny,mmyemploycewithwagumt irsolecompenadon,
will do the work and Ne awctua is not intended m offered(onside(Sec.7W,Business
.it Pofcssion Code:The Conlsse,ma's License law does not apply in an owner of Required Inspections
property who builds or improve thereon,and who does such work himself or though his
awn employee,provided On,such improvements are not intended oroResed forsals.TL
however,the building or impovement is old within am:year of completion.the owner-
buildm will have the burden of moving Wt he did Cot build or improve for psoras,or
sale.).
❑1,as owner of the pope.,am exeltionly contracting with licensed Conuacutrs m
construct the project(Sec.]OCA,Business and Profusion Code:)The Contractor's Li
CO..Law does net apply loan owner of p openy who builds or improve thereon,and
who contracts far such projects with acanractor(s)licensed pussuanuo the Convector's ,
License Law.
I am exempt under Sec. ,B&P C for this recon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under pmW ty of perjury one of the following declare ions:
'an
and will maintain a Cenificaa of Consent m self-insure for Worker's Compen- -
scion,as provided for by Section 37M of the Latour Code,for the perfomtance of the
work for which this permit is issued.
Aare and will maintain Worker's Compensation I...as required by Section
3700 of thc labor Code,for lha performance oflhe work for which this permit is issued. '
My Worker's Compensation
sa
m'penasbwnmre
ation acarrier and Polity b
numer art:
Carrier:A•H•/ -, Policy No.: �LW((2 _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE t
(This seed...d not In completed BOO permi l is fare=hundred dollars(5100)
or less.)
I cenifv that in the perfiumence of the work for which this permit is issued,I about not
employ any person in any mannerm as be become subject o the Workers Compenaadon
Laws of Califomia.Data
Applicant
NOTICE TO APPLICANT:If.after making this Ccnifscaa of Exemption,you should
become subject on the Worker's Commcnation provisions of tha Lahnr Cade,you must
O forthwith comply with such provision or this permit shall ba deemed revoked.
z'h CONSTRUCTION LENDING AGENCY
PThereby affirm that Bea is aconsuuctien lending ageney for the performance of
a r1 the work for which this pa nit is issued(Sec.303].Civ.C.)
W� A Lender's Name
= z Lender's Add.
V O 1 certify that I have read this application and slate that the above information is
IL f-' correct.I agree to comply with all city and county ordinances and state laws relating to
0 V building comounion.and hereby autlmrfaapasenmirs of this city to enter upon the
0. ahoveam,ofcs.judgm Properly for inspection wuThsma
(We)agree to save,indemnify and keep harmless the City of Cupertino against 1
UZ inconoo,ol eeofO,costs and cxyenhisspe which may in any way attoc against said City l//
Z A PLICANTUN UNDERSTAng0fNDS
AND WI. Issued by. Date
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
S=REGU TIONS.
s rt ter
�� Re-roofs
ptenvCon m a
X D.b MATERIALS DISCLOSURE Type of Roof
Will the o Cupertino
ter(muni building occupant start or handle harudoe materitl
u defined by Nc Cupertino Municipal Code,Chapter 9.13,and the Health and Safety
otic.Section
7dws255J2(a)? >4 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
haverdous air contaminants as dcrined by the Bay Area Air Quality Management all new materials for inspection.
Ct?
❑Yes u
I have read the harallous materials requirements under Chapter 6.95 of the Califor.
ealth&SafctyCade.Sections 25505,25533 and 25534.l understand that if the Wilding
not cmrcmly hove a mnanl that it is my responsibility m madly Ba Occupant of Ne
tswhichmu mel bf iuuanccafaCcm0cawofocc ancy. Signature of Applicant Date
rmautharir' agenl ate All roof coverings to be Class "B"or better