00110111 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADURESS: PERMIT NO.
20865 PEPPER TREE LA 001101. 11
OWNER'S NAME?: APPLICATION SUIT DA'I'S;
TONG, JOHN 11/21/2000
PHONE; SANITARY NO. CONTROL NO.
QQ BUILUINC I'ERMII'INFO
4,O 0 AI1CH1'CEG'f/BNGINEI?It
If1.DG EL13C1PLUMB MECB
LJ 1=1 CI 171
LICENSED WNTR
o N Job Description
0 I— p n
L_ 1 hereby nffrm IM1m[.In licensedd inths S ander pnwisinn.c or Chapter 9(commencing
�ml_J with Sectinn710011 of Division)of do lfucincus and Pmfcuinm Cudaandmyfccnc DEMOLITION OF SWIMMING COOL
mu overload mr•el.
ad I.in iccoce Gins.T— Lie.a
6 u. )ale Cnntmcmr
fi. ARCHICEC'I'S DECLARATION
al t= g 1 unJemmnA my plane shall be used as public nean6 •�� �
x�<i /
m600Licensed Pf:
OWNER BUIL DIiR DECLARATION
nthereby rl n hat l Ill d Contractor's I 1 lin he
following
(_2 ISx,i 911315 Business ro f is Crude:Any ay re„ D
G wh cl t, mire num hr. 1 fish P' y.uuunm
that henlicensdjum.nrc to the rhovisiosor the
he Contmmtinolilcse Law(Chtemcnr
that(commencing
it SAuaol to the Divi,im.medomrannes License Paea,iums(Chapter 11 Sq. FL Floor Area V:t$6
or that see is exempt with thomn mB@ of Division J of the Itu ed ex and ion.Any i t Crdc) $6000
or mm io is31.5 bIany applicant
and the has.s for the alleged the exemption.to Any t Mn.ion
of Section 7113 n by hanclo l doll rot a permit eubjccls the applicant to a civil pewhy
ornnt mere man f.e nnnarea d�llar,1551xt1. APN Number Occupancy Type
El 1.a. cor m
me ppmlyo oty enggoyee wBh wages as nutrenlivens;rolo apenaatia,,, 3-991.2010. 00
will do thewink,and the roomm I.not intended rte elfured Int sale(Sec nest.
nuam«and pror,,vion.Cee, the Cotnewha,Liarm Lw dotes nor apply it aro Required Inspections
o.net of pnny Who builds or improves domain.and who ares such work.himself
rfer through his own employee..provided that such mnpr,vaocms arc not intended or 103 — UFER
offered for.ale.IL however,the(wilding or improvement i. ,,to within one year of 104 — REPA R
comp
theh Id Tlh theb J fp proving that he not or
""r rpm. r 1 ) 107 — POOL/BONDING
�l f11 I' perr I ,i,cly onaa,kac,wahl d Doan" 301 — ROUGH PLUMBING
.o nFncr thc.pn ieol(see 7194.Business d I f:: m.Code'.1 fM1 Contractor's
License Law des not apply to an owner of oneWrty who funds or impmva.dotter. 304 — ROUGH ELECTRICAL
and who conioses for such pojecrs with a cm ounortal licensed perwanr m the
ernlr ,or.ueen.eLaw, 502 — FINAL PLUMBING ENERGY
❑Ills .nnpr under .B.4 PC Err lhism '
Dr 503 — FINAL MECHANICAL ENERGY
In<reby:dWn in npennalty or efJ rulN Dl:cLnxn'I'1ON 506 — GAS TEST
)N B CUMI'IiNSA
ry moonhe following dori,coionc 510 — FINAL PLANNING
❑ 1 have and will m main a Cenifcum of Convert or self-insute fee Worker's 511 — F I NAL POOL
Compensation. as provided for by Section 37M of the Lower Code. for the
performance of de work for which this lemlit is issued. 516 — FINAL BUILDING
❑1 Love and will nonetain W..on,n Cntnpcncariou msmance.a,resumed by Serum. r
1710 0 the Lubar Cady for the D,donuancc of rhe work fm which this pcnull i.
sued.My Worker's Compensation Insurance Gamer and policy number are,
Cartier. Policy No.:
CEiRTIFICAI[ON 01;HXEMPIION FROM WORKERS'
COMPENSATION INSURANCE;
phis seclion need nal be completed if he permit is for one hundred Jollun
151000 or Ian.)
1 cenily for in the perfnr us.o.or he work for which Ibi,permit i. ,.ed.I
.hall bol employ any pecom a any banner so as to teconte.object m the Wi,dees
compcnsminn laws if California.Date
Applicant
NOTE ICE TO APPLICANT:If.alter milking this Cur ilicnr<of Esanptiun,you should
hs creme subject In the Workers ComM1,nc:nion pnrvisiom of the Luhry Code,moa now
Q 0 kenh vah eonply wim...h pr A sinnc err this peal shall he deemed revoked,
Fori CONSTRUG'I']ON LENDING AGENCY
CI hereby affirm that dere is a construction lending agency or the pe fornrance
of rhe work for which this Penn is issued(Sec.3097.Civ.C.t
C Q lender's Nmnc
Q Z Lenders AJdres,
V 1cenily that I have road mi.c uppl kation and arae mar ncc above information is
4. ELI c rrie,I agrcu m eontply with all thy:ued<oura oni nin,a.and nn c law.relating
Q (� In building<on,roonon,and hmeby uathori'ic repreentative%or t his city m enter upon
the ov,v,nenlinncd pmpcny for impcnion purlo,ccs.
(We)agree in save.indemnify and keep hrnde.n the City of Cupertino against
'n liabilities.judgnemc,costs and expenses which may in any way accrue against said
U Y chym wenn ohne graminp of di.pctmil.
APPLIt VT IINDERSTANDs ND WILL.COMPLY WI'fIIALL INON-POINr Issued by- DilIC
NOh CL nr( IONS..
c S ll LI OV Y:
s'tgtwmm rot Appl'eantlCamm tier Date Re-roofs
IIAZARD(IU.'M, 1 :RIALS DISCLOS UILE
Will
ncenpplicum,it forum guccuprnl a,w:or handle hanmluuc nomrial Type of Roof
as refusal by the Cupertino Municipal Cole.Chapter 9.13,and the Health and Safely
Cede,Section 25532(.)?
❑Ye, CINo All roofs shall be inspected prior to any roofing material being installed.
Will the appllcsnn or Atmos building execupmr use equipntem or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
emir h t,in,oils all..mnramiman,as defined by the Bury Area Air Cnallry Management
niwtden all new materials for inspection. Applicant understands and will comply with
�1 LD yes CNo all non-point source regulations.
1 have mad the Inardou.matenal.requirements under Chapter A95 of the
California Health R Safety Code,Sections 25505.25533 and 8534.1 understand that '
it the building docs on currently have a mount,hat it is my asrymsibil fly m ami f,the
ofpain of the rtwirem• .which must be met prior to Issuance of a Cmilicam or
h e pane.' - t[-2A-00 Signature of Applicant Date
w net nr authorimd ager Dme All roof coverings to be Class sBss or better
OFFICE