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CITY
t DING nrvESSIONN°
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CONTRACTOR INFORAlATIO
Bul}I�N�YTTINEVILLE AV
LEWIS POOLS
PERMIT NO. 02050096
"A2''it?nAS MIKE AND CORSICK TH
R 160 CRISTICH LN
APU77`Td7:?t%2
ONE:
(408)371-6690
SANITARY NO. CONTROL NO.
ARCHITECtfENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am livened under provision. ofchapter9(commencing
ELECT/PLUMMBIN�°� (SWIMMING POOL)
with Section 7") of Division 3 of the Business and Professions Coca. and my license
fat (tell force tR / -1
Licata s Lic.N STNS I
'
Date 1 �, comm ton
ARCHITECT' CLARATION
I uMe m my pl s s m public redo
JUL 3 0 2002
Licens rofessionel
fi DECLARATION
1 hereby .(firm that 1 am exempt from IM1e Contractor's License law for ac
Oan I am exempt
following rcaun. o Cage: Any city or county
)03 IS.onstru
and Rc,
BUILDING $6000
pmolo re w
which requires Permit to demolish, mpao my swaure
aha, improve, demolish,
t, alter. de
n
prior toits iaauance,also requires file
Thovision for tofilessigned statement
the
3�fft3 D13f;3'At�6i
Valuation
tohe
he pursuant to the me
mmh Pa provisions Lewons
the Bailneslianse
Division Cor9
(rthat he is a with Scuion 7000) ofaaiso the a leged temp Professions Code)
of am he is exempt thbiefiom antl1lhc basis for the alleged cfemptihn. Any violation
'of
Scaion ]031.5 by any applicant fora permit subjects the opplicam m a dull penalty
or not mor<m.n five hundred tlonaf. (1500).
304iPN 1�@6FflH ELECTR
CAL. � Occupancy Type
❑1,asowner oftheproparty. or my employees with wages as their sole compensation.
501 - FINAL ELECTRICAL
ENERGY
-will do the work, and the awctum'is not intended or offered fon sale (Sec. 7044,
Business and Professions Cade The Contractor's License law does not apply to an
[Ions '
Owner of property Who builds or improves thereon, and who does such work himself
or through his awn employees. provided that such improvements are not intended or
Offered for sale. IL however, building or improvement n sold within one year
iof
w
completion, a<owncfWilder will have the burden of proving that he did not build w
n
'
improve Befoe pvspou of tele.).
with licensede
❑1,tr noodle propc.7o Business
construct the project (Sec, and ontractsto
CoeoO The Contm
Business and Contractor's
f r
Law docs nor apply toanowner of
to a who Wilds or improves thereon,
en, who thereon.
a cony
and who contracts for such projem with a rnmnnor(x) licensed pursuant a the
andwho
..... - .. _. ...... _ . _
Commnots Liccnx Lew.
O 1 am exempt under Ser. . B St P C for this season
bumer' Date
WORKER'S COMPENSATION DECLARATION
1 hereby aRrm under Penalty of perryry one of the following declarations:
I have and will maintain Cenificate of Consent to ulf-insum for Worker's
ompensation, u providcl fl.r by Section 3700 of the labor Code, for do
performance of the work for which this permit is issued.
Qtliavc and will maintain Worker's Compensation Insurance, as required by Section
37W of the IaWr Code, for the performance of be work for which this permit is
issued. M Workch Comp♦ensatiOn Insurance carri�er( and PoOilicy number aarre e-
Cartier04! �'' Policy No.: VY%i0
-
RTIFICATION OF EXEMPTION FROM WORKERS';'
o' I
COMPENSATION INSURANCE'
_
(This sidtio r a<d not be completed if the Permit is for one hundred dollars
s' '
(MN) or less.)
I certify that in the performance of 0,e work for which this permit is issued, I .
i.,.
shall not employ any person In any manneryaa�becoOmesubjea m the Workers
Compenxatiotyy� <.(Cp, fo3nia. DtlD, OO��
Applicant ILLY S T .. _
.. _.
NOTICE TO APPLICANT. If, after making this Cenificate of Exemption, you should
become subject the Workers Compensation provisions of the labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affum that there is a construction lending agency for the performance
of she work for which this permit is issued (Sec. 3097. Co, C.)
Lender's Name -
LcndersAddras
is
1 certify that 1 ave read this application and scam thm the above inaws
relating
cotrecL 1 tug¢ roc . ply and state hoes relating
he all city and county
to miereOr imvees
ioLLandhc byauNOnurcposes. es of Nis city incineration
d
above st in
the above ntio properrymfor ify
S
and kepuryosns.
Is. tug to save. indemnify and keep harmless the City o(Cuperagaist
said
liubiliiies, tee rnts, ash arta exPens<. 'ch may in any way aeerve against said
't.
City in co uence of the granting of t site
APP IC 'NDERSTANDS'AND IL OMISY WTnl ALLNON POINT
sou REG ATI S. -
Issued by: Date
b^
S' marc of pplica uVontmnor Date
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applidant or future Wilding occupant at= or handle harardom mencrial
Type of Roof .
as defined by, the Cupcnioo Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
Oyer. ❑ NO
All roofs shall be inspected prior to any roofing material being installed.,
will the applicant O. future Wilding occupant use equipment or device, which
If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air conuminams a: defined by On Be, Arta Air Quality Management
District?
all new materials for inspection. Applicant understands and will comply with
CI Yes 0 N
all non -point source regulations.
I have read the haxardovi ..,chat, requirements under Chapter 6.95 of the
California Health 3 Safety Code. Sections 25505, 25533 and 25534. 1 understand that
it lie building does not currcmly have a tenant, that it is my respomibil ity to notify the
occupant of the requirements which must be met prior to issuance of a Certificate of
Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or authonxed .,or Date
OFFICE
atn
CITY OF
CUPEkTINO
Ah
tTY OF CUPERTINO 0
PERMIT APPLICATION FORINT
�2
•
Quantity Fee ID
APN # 3 / ct ` 3 0 33
!7 /
Date:
�- 16> — 00-11
APTFEE
Building Address:
�49O ?CmC_ LLQ �Te 4 C- VL-'.
Owner's Name:
t .STLt1 a S
Phone # fig -7' lP
Contractor:
(cvr 5 �OOt_ S
License #:
57C1J5-&7 -
Contact:
�>cra ur Lrw s
Phone #:
O - 3' - 6L?
MECHANICAL
Applicant/Copptrapt= n
Mul PROL5
Fax #: I ,
` ` (le,�
BUILDING
s
Lle
BUILDING
Building Permit Info:
Con. Tax for BQ Zone
BldgElect Plumb ech
BCONSTAXH
Job Description: �-
BUILDING
Residential: � vm va, Iy, C ercial:
Constax — Resi/Mobile
Sq.Ft. Floor Area:
VSq.Ft.:
Elec 600V <= 1000A
Architect/Engineer:
Valuation: 4, or" l
Elec 600V > 1000A ,
Type of Construction:.
Occupancy G up:
.
1 VIA VVX IoL
•
Quantity Fee ID
Fee Description
Fee Group
APTFEE
EACH STORY OVER 3
HOTELFEE
EACH STORY OVER 3
OFFICEFEE
EACH STORY OVER 3
BAPPLOTHER
Other Appliances
MECHANICAL
BCONSTAX
Construction Tax
BUILDING
BCONSTAX
Ind/Off/Comm/QuasiInd/Off/Comni/QuasF
BUILDING
BCONSTAXBQ
Con. Tax for BQ Zone
BUILDING
BCONSTAXH
Hotel and Motel
BUILDING
BCONSTAXR
Constax — Resi/Mobile
BUILDING
BELEC1000
Elec 600V <= 1000A
ELECTRICAL
BELEC1001
Elec 600V > 1000A ,
ELECTRICAL
BELEC200
Elee Svcs 600V <= 200A
ELECTRICAL
BENERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
BMITIGATR
Res. Housing Mit Fee
BUILDING
BMNEWMULTI
New Multi-FamilyRes
MECHANICAL
BNEWULTI
M
New Multi -family Res
ELECTRICAL
Iof3 LlL/l, 6%
i
(L
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Mai
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CITY
ILDI 6UDPERTON PERMIT
CONTRACTOR INFORMATION:
Bur�f�N �YTINEVILLE AV
LEWIS POOLS
PERMIT No. 02050096
&'A15'�' ff!IAS MIKE AND CORSICK TH
R 160 CRISTICH LN
APPa�CA7Td" 'fff`b2
PHONE;
(408)371-6690
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUM13 MECH
C> LJ L= L
LICENSED CONTRACTOR'S DECLARATION
Ihereby arrrmthat Iamlicensed under provisions ofChapter 9Prommoelag
1 h 7��
ELECT/ PLUMMBIN60 UN( � (SWIMMING POOL)
with Section 7") of Division 3 of the Businessand Pmfcssions Code. and my license
' in full force eIf
License as) Lic. p��
q
Dam Cs Commnor
TION
ARCHITECT' CLFile
1 uncle an my DI s as public Aid
Liccn ro(cssional
OWNER -BUILDER DECLARATION
I hercry .(firm on 1 from the moor's Law for the
An,
�
6 O O O
1..Benne
following a ress : c
]O3L5. Business and Pmfcssions Cola: Any city
$6000
y
requires Permit stcounty
Permit m constrict, ober. improve, demolish, repair any swemrc
t
whichill
— - - --------
- - - - -- - - — - -
file
prion t. ' also q ' th ppI m for such pemut m fl .'gnnl uatemem
3�fft-3 BIB& AQ6�' • ), dr„
Valuation
_
that
thathe d :dl rsuetto theprovisions of the Contmcmrul eLaw (Chapter 9
with Sacti On inion 3 the Business and Professions Code) '-.,I-
(comre cng f(BOB) of of
or that he is exempt theiefrorn and the basis for the allegcU aemption. Any violation
-
- of Section 7031:5 by Any appl team for a Permit subjects the applicant to a civil Penalty
ofaornice ban five hundred dolmm(S5W).
3 APN N%@bTdH ELECTRICAL
"'.. Occupancy Type
501 — FINAL ELECTRICAL
ENERGY
❑I,axawnet ofhepropeny,armyemployeeswith wag<.aahei... lecompen.ati°n,
_
"will dome, work, And the strucwre' is Pot intended or offered for sale (Sec. 7044,
Uuimis and Professions Code: The Contractor's License Law don not Apply m an
owner of property Who builds or improves thereon, and who does such work himself
or thmu h his own employees. provided that such erPea amen¢ me not ;mended or
Por mle.If. however, the buildin tlssolJ within one ear bf-'--_.
'j offcrcd .._ ming y
_
__.._.._..._..__......_.._w.._..g_...p.._._.__{�.__._.____.__. _...__.._—.._,,,..•.1
bmpleion the ownerbuilder will have the buM<n of proving that he did nm Wild or
FINALED „A', \'__
mProvc for pmlau of role.).
❑1, oanwnenSfthc pniperty. um exclusivclY eoniraning withlicenud ttmvucmn In
construct the (Sec. 1011, Business and Professions Codep The Contmetor'a
JUL 3 0 2002
project
License Law does not apply to an owner of property who builds or improves thereon,
•'...�- '.(. I r
.und.who contracts for.such projects with a contmanr(s) hcenud pursuant . to the
Convuctac i-;censelaw;
❑IamcxcmptuWcrScc. .BkPCfonhis rtaaon
-
BUILDING
Lam • ' 1.. .. ,_
Fn WORKER'S COMPENSATION DECLARATION
•
I hertby affirm under pen alty of perjury one of the following declarations:
° 1 hive and 'wilt maintain a CeriBcate of Consent to self -insure for Worker's
Compensation, as provided fee by Section 3100 of the Lobo, Code. for be
Performance of the work for which this pemtit is issued:.,
�ATSe and will maintain Worker's CdPpema i°n Inmance, as Poll by Section
3700 of the Labor Code, for the Performance of the work for which this Permit is
sued M W keR Co� p♦e t 'Insurancec - and Policy number are
Ca'rri QA -1 3.
PEMPTI . , CWW (Jif
RTIFlCACOM OF FROM WORMERS''
F
' COMPENSATION INSURANCE' -
COMPENSATION
muh sen nl necd not be completed if the permit is for one hundred dollars-
(SIOOIorI<ss)
1 c rt fy that in thep<rf a of the ork far which tl pc t cd l
i t
I'll nut employ any Person to any manner�as bec�q,sub)ect to he Workers
'.
s 4
'
Compematian pnyso. yhfS
D��J— O—
,
I
Appbcant. _4t(
NOTICETO APPLICANT If. after making iM1 s,Cen I cats of Ex rapt On, ybu should
._. .... _.. .. .. _... ..__.. .__ _... _ _.. ... _._.. .
become subject mthe Worker's Compcnsationprov softhe Labor Code,younumn
sh
it
forthwith comply with such provisions or this permit shall be deemed revoker.
'
" 'CON STRUCTION LENDING AGENCY
1 lending agency forme pedorman<e
alarm ilia then is i c..ed
'
ofn ork f r - hich let pc t'... ucd l5cc 3091 Cis.
rk fir, Sec.
LendersAddress
1 ecnify and slate ibauhmbove inaws
ave read tall
ice cityand co Peeling
state laws enter
torrcn. 1 agrc ice ply with all city and a "po ordinances of
m gc w ion a dy monxerep vcs ofm lye ¢r upon
pn
S
PW,s
the oho t J pr perty fo n. peer;. purposes,
far
IWe g to sae demnfy and kecph I 1heCty fC peRimbgane
liabilities, d rte cot and a pcnae. M1 y n any w agmna [cid
Cir co ceeoflhegrantngoft sa t-
6l�
APPLIC VDERSTANDS ANI 'IL OMIstY WITH ALL NON POINT"
r Date
Issued by:
SOU r" RHC LATI S /',,,
-
S' aure,°r pplicaMCommaor .. "... .. .:' .. "s' - Date
�,
Re -roofs
-' HAZARDOUS ' MATERIALS DISCLOSURE
' "' W ll iM1e ppI c t n future budding occ p t sl handl h dous material
Type Of Roof
as defined by th Cupertino Municipal Code Ch pm 9 ¢ d the Health d Safety
` r -t
COJe Sect 7553 (a)
' � t t "° t � -' ''t i
i ' t !'
Al] roofs shall be mspec[ed pnor,to,.any roofing,ma(enal being Installed.- ., .,.
,°?"'
wnthc applicant future Wildingoccupantasecgwpm t _e ween
If a roof is installed without first obtaining an inspechon,'I'agree.to'remove
t llallous air contamm to as defined by the Bay Ana Air Quahty Management
Dionn'I
all new materials for inspection. Applicant understand_ s and will comply with
❑Yn - r ;', - oNo t,
'all hon-point'source"regulations, • , v _, , {spa;,r - -
' �1 h." lead be hastdouz m$terials rcquiremcmz under Chapter h95'Of the
_
CA, ifornia Health&S.hr ty Codd,'S6ctions 25505, 25537 end 255Jd. I undcmenJ Ihet .
ifine bdildinB dAll not cuncndy leave arnnant. that it is mY rcsPonsibility to notify the
-'
accbpem of thercquiremenis which musrbc len pddr m issuance of.i Cmifcme of
Occupancy.
I .:'. r .•v. � " .. . , , ;.
of Applicant _ _ Date
„Signature
All roof coverings to be Class "B" oftener
Owner or amhoriud agcPh Dam
.�. '.�::..a ,.• '. _ ..._......�. OFFICE- ......- --.. _._.._...—