04110101 CITY OF CUPERTINO' a^ "A �
BUILDING DIVISION PERMIT k�+OLY'-1� v 1ti a"e`"� �✓y - - '
'x SaXzssE'n._ a !•. 3;.�<r4Zt�>s*a. cd:a.
BUILDING ADDRESS: PERMIT NO,.V 4 110 1 0 1
• 22090 RAE LN
WNEWS NAME: PE MIMMUEDATE
—CUPERTINO HILLS SWIM CLUB 11 /17/2004
ONE: - SANITARY NO. CONTROL NO.
ARCHITECDENOINEER: BUILDING PERMIT INPO '�
Loo LICENSED CONTRACTORS DECLARATION --- IObDeSCn Description
I buret,affirm that 1 am Imonsed under p Ions of Chapter 9(commencing . . .. - p
n� im Sad 7000)ofDivi I 3oflhe Busineaa pm
fouiom Cade. dmylicevcis
pp infullm c6`L:_ 1J- ,k,,. QG '� ELECT. SERVICE REPLACEMENT - -
L1�-- Daw � - Cont rot .ei' CONTRACTOR: FISHER ELECTRIC -
=e - RCHf1ECi'9 D�1 '
1 i Pa hal u puNic ds
3 hLL LKCn Caelaaal
gGG atIamcemptOWNER-BUILDER DECLARATION
m I hereby.Hirth roti I em exempt from ti r ConractCo e:My c taw for the
my
02 following moon(Satins RDL3,Business and improve.
demolish.
Cede:MY city or idoom, -
$
which requires•Permit regimes the alteetimPmw,deermitt errerepairsig anyatmmum —
F- STI thatWor iniucenem0.alsuntto requires the visions ntfarserch e Commune to file Law ned
-- —
p < thea he la licensed pursuant the Provisions ntthe Canrecu/s Liccnu live(CMpur9 _ _ Sq.-Ft. FIOOC Area
.g 9 (commencnB with Section 70o0)of DivisionJofthe Busi""••acrd Protessiav Code)or
C� .. that IM u exempt dwrefrom and the basis for 1W singed eaemporm.MY violation of
Section 7831.5 by arty applicant for a permit objects the applicant to a civil penalty of APN Number Occupancy e
Won.i.e.thnw Iandmd dd4rs(gsDm. 35607027 . 00 P yTYP
❑L u mamulk.sol pmPanY,as I.WtnPloym�im xgm u m,(Sen. Business ..
and Pr mcwons and the he Com4nerinLiensere@redfaat apply an ano14.owner
._ Required Inspections
,..,.•,.:.�,:.e,,',t ,.
and property who
cede:The vesdonors License law dam not apply lf rs owmr of .... ; ' .. .� •.. . q p
propertYwW WIIModed th such Improvements
dnmsag wort hinuelforlluaugh his
howmentemPloyw,prag or imuuuhimis soldnuam not lntutlNmoBcred the oficassiwner.
builder
-
.
however.thebuildingthe
ofpmant4Sald Wtidnot Wild of compvfor the awecr-
builder wig have W When of proving thea W did not build m improve for purpose of _
send. '
❑1.as owner of tic property,am caclusively contracting with licensed canmcton in _
com arca the project(Sac.7044.Business and Prof oslom Code)The Connacuses U.
cense Law does not apply to an owner of property who Wllds or improves thereon.and
piss coolness for each pmjecu wim a conuacands)licensed pursuantm the Condmuses
etre Law,
❑Idnexemmundes See. ,B&PCf.tIma n
net Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ea of the following declarations:
1 hew and will mainuin a CeNfcam of Cenxenuo self-Imam from Workers CemPm-
Satian,u provided for by Section 3700 of me Labor Coda,for the perfermance of the
work fee which mix permit I.I..&
0 1 ban and will maintain Wormer Compensation Iasunme,as required by Section
3700 of the Labor Cade,forme pertormant of the work for which this Ptorch is issued. _ . ..
My Wmi a's CamPemation Imuame card.and Paltry number arc:
Cartier. Policy Nu:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cnissmace aced notbecompntdl if to permit Isferam hundred dollen(5100)
ar nae)
1 certify that in the performance or the work far which this permit I.issued.I shall out
emplgany on uY�rjqu�bsaoygexbto the Werken'Campenudon _.
-11.111
A U I
N 7�LLICANT.T, making oris Certificate of Exemption,you should
NW
subject m me Worker's Compemaden provisions of the Labor Code,you must
.J O forthwith comply with such provisions or this Permit Mall be domed mwked.
Z CONSTRUCTION LENDING AGENCY
E.r� I hereby affirm that mem 4 a construction lendingageary for the performance of
C the went,for which this Permit 4 blued(Sac.5097,Civ.C.)
W�Q Lmdet's Name
]z ISMeesAdd.
C) I certify that I have read this application aM slow mu the own information It
W correct I agmen w comply wim oil city and county ardinuces and fain lawn mlNng m
C) Wilding eomruction.and Wmby suho m repmsanutiws of this city in our upon the
W ahove-mentioned Property for impaction Purposes.
5 (We)agree to Saw,indemnify and kap barmiers the City of Cupertino against
wy liabilities,judgmcnlo.emu e and expenses which may in any way Wanagsimt Said City
G
V in APPLIICCANTeof the UNDERSTSTANDS ANDof WILLWWILL COMPLY WITH ALL NON-POINT Issued by: Date t
rSen�on
U N5.
Re-roofs
IiaHA2; r e
HA2; DOUSMATERIALSDISCLOSURE Type of Roof
e applicant or future Wilding occupant seam or handle hd�s materiel
ted Cupertino Municipal Cade.Chapter 9.13,and the Health and Safety
75532(a)7 All roofs shall be inspected prior to any roofing material being installed.
t�e applicant or fmurebuilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
air comeminuu u land by the Bay Ana Air Quality Management all new materials forinspection.
❑Yea Nu
1 havemad the haudnumuedalsmquiremcnu undorChpwrd.95 orthe Califor-
niaHulth&SafetyCoda.Sec am25505,25533wd2553/.lundersand Ihdifde Wilding
Jou not emeouly an a tenant,mu his ney mapommility u Way the eccupent a ma
tequimme m W pdor aneaafICenificatea0ccuon . Signature of Applicant Date
own anthoriva4e ant ave - -- All roof coverings to be Class"B"or better ,