04020171 CITY OF CUPERTINO
BUILDING DIVISION ,. PERMIT � I� Q �L,.,1I''dAm )� Rv
BUILDING ADDRESS: SWAN POOLS P..irNO.04020171
EWS NAME: PERMIT ISSUE DATE
ANDREW MAU -
NE: SANITARY N0. CONTROL N0.
(408) 866-6893
ARCHMO
08 866-
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
ELECT PLUMB MECH
u O O LICENSED CONTRACTOR'S DECLARATION Job Descri t pactRq
¢ 1 Wmby affirm Nal l am licemed under previsions of Chapter 9(commencing p B
< with Section7lN11)af Dlviaion3of Na Buain asn.Agproleasions Coteandmylicorucia .�fr
<� in fullfoce „Ree _ V� SWIMMING POOL �6 O
5iaZ License Cless Wc.p
Deis Can
O
y ARCHITECTS DEC ION U'S A
L `
�y6y understand my plans shall be used es public records ®'
3 LLa Licensed Prefessional •r�
OWNER-BUILDER DECLARATION
1 hereby atom Net 1 am exempt from Ne Contractor's License Law(a,the
0O fallowing mason.(Section 7031.5,Business Old P remad ns Code:Any city or county
K a� which requires a permit to construct,alley Improve,demolish,or mpair any structure
Fzy prior to its imence,also require the applicant forsuch permit to Ole a signed atstemem
< that heulicensed pursuant mNeprovisionsof the Contractor'sLicense law(Chapter9 Sq.Ft.Floor Area Valuanon
$ (commencing with section 7B0B)af Division 3 of NC Business and Professions Code)or
Na
.. t he is exempt therefrom and the basis for The alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit Subjects the APPnnnl to 211101 penalty of 3 MI42Ii►&tbu 0 0 Occupancy Type
not mom Nan Ove hundred dollars($500).
❑Lasowner aNe property,m rayemployces with wages asduhsolerompensatlon,
will do drework.and mestrmcture issasimmmded m offered forsale(Soc.70th.Business
and Professions,Cade:The Conuaclar's License Law docs not apply in an owner of Required Inspections
property who builds or improves maroon,and who does s uch work himself or through his
ownemployers,provided that such improvements am not Intended oroffemd forsele.If,
however,We building or improvement issold within one year of completion.the owner.
builder will pave the burden of proving Nat be did not Wild or Improve for purpose of
salt.).
❑1,As owner of the property,am exclwi0ely..A=Ong with licensed armaemrs to
construct the project(Sec.70,14,Business and Professions Code:)The Connector's Li.
moue Law docs not apply to an owner of property who Wilds or improves themon,and
who contracts for such prejec0 with a contraiAmm)licensed pursuant to the ConuacWYs
License Law.
❑I am exempt under Sec. ,B&P C for this recon
Dam
WORKEWS COMPENSATION DECLARATION
p I hereby Nmt under penalty of perjury caeof the following declarations
❑1 have and will maintain eCertifmate of Consent To self-insure for WorkcM1Compen-
sation,as provided for by Section 3700 of the Labor Code.for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance.As required by Section
3700 of the labor Cade,for On performance of me work for which this mmed,is issued.
My Wor nes m ruation Insurance carter and Policy number am: ,I
Policy N I a��`!O�
CERTIFlCATE OF EXEMPITON FR WORKERS'
COMPENSATION INSURANCE
(This section road not becmnplemd If the Permit Is foreac hundred dollar($100)
oc less.)
I certify that in the perfmmance of the work for which this permit Is issued.l shall not
employ any pco on In any manner as as,In become subject to be WorkerCompensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making Shia CCnlRcm,of Exemption.you Should
become subject m the Worker's Compensation provisions of the labor Code,you most
O forthwith comply with Such provisions or this permit shall be deemed looked.
z tiCONSTRUCTION LENDING AGENCY
[r I hereby atom that Nem is a construction lending agency for the performance of
lYi 7 to work for which this permit IS issued(Sec.3041,Civ.C.)
0a0 Lead.,.Now
7 z Under'sAM.
(�Q 1 certify mal I have mad this application and sum mat the show information is
IL F correct.I agree to comply with all city and county ordinances and sure laws missing to
OU building construction,and hereby sanitarian mplexammuves of this city to enter upon the
above-mentioned property for inspection purposes.
F (We)agree to eve,indemnify and keep hornless the City of Cupertino against
r y liebiliues,judgments.costs and expenses which may In any way uorme against mid City
Of
L) in conucof the^-� his rmit.
APPLICANTUNDERSTANDS tAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGULATI S.
L� Re-roofs
c ofA oanUCantmct D m
HAZA US MATE Ls DISCLOSURE Type of Roof
Will aappliant or future building occupant stow or handle hazardous material
as dcfrned by the Cupertino Mu
el,Code.Chapter 9.12,SM the Health d Safety
de.Section 2553x,)? anAll roofs shall be inspected prior to any roofing material being installed.
- ❑Yea o
Will the applicant or mom poising Occupant se equipment or devima winch If a roof is installed without first obtaining an inspection,I agree to remove
t emit ha'riadous air conlaminaa cfincd by lbs Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes u
IhevemMthehza ousmamrialsmqulmmcnuundcr Chapmr6.95ofineCalifor-
maHcalm&Sa(dy Code, bons 8505,25533 anal 25534.1 maintained Our if the building
docs nos currently ham.larram Out it is my responsibility to notify the occupant of On
requ' which must metp' noi usuccofacciericamcroeN 1. - ignatureofApplicant Date
0 e amthnrix 4smnt Dam All roof coverings to be Class "B" or better