01050206CITY OF CUPERTINO
BUILDING DIVISION
CONTRACTOR INFORMATI
PERMFUM
BUILDING ADDRESS
PERMIT NO,
P P555 SALEM AV
SWAN POOLS
-01050206
OWNER'S NAMIL
APPLICAI ION SUB DXIR
AIIRIE
E 1495 S WINCHESTER BI
.V 05/31/200J.
PHONE
SAN[ 1'ARY NO, CONI KOL NO,
l
(408)866-6893
`
ARCHITECT'IENGINFER:
BUILDING 1117RMIT INFO
BLDG ELECT PLUMB MECH
1=1 =1
LRU NSIi) CON RACTOR'S DECLARATION
Job Description
1 hereby.pisco;hit Iam licensed under provisions of Chapter 9 lcnoulam ing
will, Section Was)) of Division 3 ofthu Business land Profession. Calc, and my Ikons,
's in fullull—S^ f e^�•a(�
Liecroc CWS.. LiC,N S� l _
IN GROUND 435 SO. FT. GRUNITE' POO F
Dal, (( A
-
ARCIII e DEC
SDECLAr
public cereals 1 understand my plans shall he used as public records
l be C
'
9�
Licensed Pn,fessiunal
OIIILOIiR DI!CLARATION
1 hereby amen thatut I am am eumpl from the Contractor's License, lou the
ny cityor
Calc: Any cin or county
following reasons (region 703 1.5, It. a ter. mal Co
de io
which improve. demolish, or masa any structure
str n s, comaucL alter, improve, demalit
/
eemtil
its Inn I sigma statement
or for m its i to applicant tae won permit 4,
Sq. FL Floor Area
aluu ion
licensed pl al the pro of ice s
License W,omr,
purs;mnt m;hepmviis
mane incin,
ctcr9
Division t. or;he Ilei es and PvdAny i
with i o he
mnhat he iscwith Sitherc Rm basis fou J Any
^e435D
m, surf
enmp.f 1 . ali 1
or that Section 7 31.5 b ;hcrcfrnm and the subjects th 1 farmim,
of any dpelican; In a permit sanies the aPPlicam m n civil pcnvl;y
]1man
APN Number
Occupancy Type
not m..
iv
of not corm man five nanama aanara essaB.
❑L. as owner of the property. or my eu,ployees with wager as their sole compensation.
14 r 1 U'171171
Required Inspections
will Jo Ilie work, nn l the amome is not in rrdcd or ofTered for sale (Sec. flWl.
License Law m
Business and Professions Codl'rhe Contractor s cities no; apply an
ovxrcr of prnpn y Who builds or improves intent, and who does such work himself
kled Impuovc.ncnm intended or
1.03 — UFE R
of through his own employees, prothat such am not
olhodfor odc, if, hawcvcr- the huBding nr inlpnwenent is sold within one year of
completion, the owner-builder will have the burden ofproving that he did not build or
104 — REBAR
Iny,ravc fol'...mo.c of.me.).
107 ---POOL/BONDING
1c L trs owner at p(Sec.7 un, Businivcly ng win n,
Comraenrs
jec d Prole tsk.) Ide Contractor
the project (ace, a, and a,, or
301. — ROUGH PLUMBING
iconstruct
ell,, whobs
nip
.id too ones o any, won) or intpeosca
"for apply ;a:m nwne th
304 ROUGH ELECTRICAL
a c lice l to the
and wnn enn;mes lar such p jec;a with a conwctons) licensed pursuam to fhe
who Contracts
v —
01a�texempt��derSee.B&PCforthisreason
502 — FINAL PLUMBING ENERGY
50[3 — FINAL MECHANICAL ENERGY
Owner Date
WORKER'S COMPENSATION DECLARATION
50E' — Gfl5 TEST
Ilaehynlnm, louder penalty oflmrJmyone ofthe following declarations;
510 — FINAL PLANNING
❑ I bass sal will maintain a Cenifieam of Consent to self-insure for Werke..
5,11, — FINAL POOL
Compensation. as provided far by Section 31110 of the Labor Code. for Ibe
ispisi....J.
,al ar.mm.e(,finevial, farwldebmermit
.516 — FINAL BUILDING
❑ I haw and will Inainlain Worker's Comal,ma;inn Insurance, as mquimd by Sc nes
3700 of the Labor Code, for the perfia.nnnce of the work for which this permit is
issued. M@yy Wj'a_kk��cr'x CnTT..n-''a�e�n ,nim Insurance cartie, all Pulley numhee al,:
6EA.AA R,1icy No. 1� 12 "�En`(
Cuner:-.Gl-_
CGR'I'IIICATION 01: EX12MIll ION FROM WORKERS'
COMPENSATION INSURANCE
(This section Imcd not he completed If the Kink is for one hundred dollars
151 OUR or less.)
1 cenifY the; min, perforant. of the work for which ;his permit its issued, I
Shull Dol ....ploy tiny lmrsm, in any manner, so as ;o succor subject b, the Warm i
Compensation Laws of California. Dae
Appllcmn
N(YICIi TO APPLICANT: IL ager making (nit Cenilicam of Exemption. you should
b...... suhj,,i to the Wurkt.', Cnmlrcnsatinn pro ofthc Lnbnr Codi,, you moa
-
fonhwith comply with such pat Win., or this permit drill he deemed mvnked.
CONSTRUCTION LENDING AGENCY
I mashy anion Lha them is it aon.an.Ilion leading agency En the perfomrmce
.
of the work far which this panni; is issued (Set. 3197. Civ. C.)
Ltndcr',s Nau m
LenJee'r Address
I eerily that I have read ;his application anti state that the starve information i.
'
cl,rect. I agree to onaply wall all city anti county anlinmmes and nom laws reining
;o Building comtru nion, and hcmbY eu;hmue rearesentau se, of ;his cry to enter upon
in, nhosc mmlnoned propcny for i.upe;ion purimser.
-
(M'e) agree to sox, indemnify and keep harmless he City of Cupertino a mus,
liahill -, judgmcnu..... 1, and cxpe,.srs which miry in any way actual, again" said
-
in comequND of the granting of this LcCO
^T
ANI
AI'1'LICE
Issued by: Date d•(f/
y'
I OLANTANDSANDWILT,CflMP1.YWITHALLNON.1'OINT
rf'BCF. EGULATI NS. �.
�[u idos
Signature of ApplicanAZAR aOU Dec
s
Re-roofs
IIAZABOOalr MATERIALS DISCLOSURE
Will the appu.an;nrmtami,lCge.Chamaomrrhanth h
Type Of Roof
eardoussaeety
m Jcfi nal by lha Ctgmnino Municipal CnJa. Chupmr 9.12, and the Health and Safety
CnJc, Section 255}2(u)]
'Nn
17 va,
All roofs shall be inspected prior to any roofing material being installed.
Will lhe,PpBeamrefmnrcbadtimgaae.pn..f awegripml,ntmde,mr—limh
If it roof is installed without first obtaining an inspection, 1 agree to remove
emir hamrdous air mmansirmms as defirrcJ by the Bay Arca Air Quality Management
District
all new materials for inspection. Applicant understands and will comply with
°Yee w.
all non-point source regulations.
I have main the hwardous materials requirements under Chapter 6.95 of the
California IlnJll, X S;dcfy (].al,. Snnlons 255115, 25533 and 25534. 1 undersnmd but
'
ifthe building does not currently hum a mnanS, that i; is my renpmsihllity to many IIse
t"g,ryml of ter mgnirnmtms which Isco; re mel pain. no issuance of a C'mr.r.m of
S s3k-ol1
Signature of Applicant Date
Q. 1
All roof coverings to be Class "B" or better
owm. lame
arladn,aristi,"al
OFFICE