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060200151 4 E F O V U2 CI TY OFCUPERTINO'g''' t BUILDING DIVISION PERMIT CObvTRC(1IiNFORMAT.I01V k: BUILDING ADDRESS: LIFETIME POOLS INC PERMIT No.06020015 -22830 SAN JUAN RD OWNER'S NAME: PERMIT L6IIEDATE QUEEN, CARY 910 SAN ANTONIO RD 02/02/2006 E: SANITARY NO. CONTROL NO. (408)738-1576 ARCHITEC IENOWEER: BUILDING PERMIT INFO BLDG ELECTO PLUMB MECH O LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I em licensed under provisions of Chapter 9 (commencing with Section 7000) ofDM.km 3 of the Buaimss and professions Code, and my license is inuI 0=` MOVE POOL EQUIPMENT/EXTEND WATER LINE 4ndc �•�-038�- Lm.a _ LiecaDam Cmuruwr L/ -6 rIMe IIIWAND NEW LIGHTS ARCHITECTS DECLARATION I understand my plus shall be used as public records Licensed Promsmonal OWNER -BUILDER DECLARATION I hereby stints that 1 am exempt from the Convector', License Lew far the following resson. (Section 703 1.5, Business and Profesiuns Cade: Any city Or county which requires a Permit to convect, ahm. Improve, demolish. or repair any structure prior m its issuance, also acquires the applicant far such Permit to file signed atatemem Sq. Ft. Floor Area Valu that he is licensed pursuant to the provisions of to Camromm's license Low (Chapter 9 (commencing with Section 700M of Division 3 of the Busums and Professions Code) or that W is exempt therefrom and the bels for the alleged evanpton. My violation of Apt I� b Occupancy Type Section 7031.5 by cry applicant for a permit subjects the applicant to a civil penalty of not mom than live hundred dollars ($500). 3 4 221 t�m3 Ger 0 0 0 1, as owner of the property, or my employees with voiles as their sole compensation, Required Inspections will do dhewerk, and the structure imotienled oroRered formic (Sec. 70/4. Business and Profession, Cade: The Conuaem's Liam Law dors ret apply m in Owner of q P prepeny who builds or i mpmws thereon. and who doessuch work himmif or through his Owns employee• provided thalauch improvements are matmeadud mnBemd mosaic. If, e however, the building or improvement is sold within one yeu of mmpletion. the awmr- trdan of proving that he did am build or improve far purpose of builder will have the bu talc.). ❑ 1. u owner of the property, am "elusively contracting with licensed aontracmn to Constroet the project (Be., 7014. Business and Profusions Code:) The Contnemr'a LI - cense Law doe, not apply to an owner of properly -who builds or improve Banner. and \ nacter(liced pursum in the ConvamoM1 who contracts for such makms with amtr)rhe nse Law. Licelaw. ❑lam exempt undo See .B &PCfor thio recon Owner Dam WORKERS COMPENSATION DECLARATION I hereby of sen under penalty of perjury arc of the following deelantions: 1 hawaM will maintain . ceNOcam of Consem in elf -insure for Worteh C.N. sial as provided for by Section 37M of rix Labor Cade, for tho perform Tse of the work for which this permit is lured. ❑ 1 haw and will maintain Worker's Compensation Insurance, as required by Section 370Om the Labor Code, for me perfotmuec of that work far which this permit is Issmd. My Workees compensNnt, Insurance carrier and Policy number art: �/yk�i PolicyNO.:C 40,9- / �! ' Cmrier.-N CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This semim need not becompleted If me permit is foram hundreddollars ($100) or less.) I certify that In the performance of the work for which this permit is Issmd. I shall not employ any person In my manner m u se becomombjut to the WOderYCompensedon Laws of Califomia. Dae Applicant NOTICE TO APPLICANT. IL after making this CeniOam of Exemption, you should become subject to the Worker's Compensation provisions of Be tabor Code. you mus ' forthwith Comply with such provisions or this Permit shall be deemed mvuked. CONSTRUCTION 1 herby affirm this Nem iso for Ube Performance of lending.Civ. ed (Sec. C.) ' me woh for which this pertnil b Issued ]Sec. 7097, Clv. C.) Leader's Name Icndu's Addrrss Lea 1 1 certify that 1 haw reed this application am sue this de show Information is ' COMM 1 agree m comply with sit city and county ordinance, and sue laws relating to building convection, and hereby auflumm representatives of this city to enter upon Ne above-mentioned property for inspection purpose, (We) agree to ave, indemnify and keep harmless the City of Cupertino against j liabilities. judgments. cuts and experts" which may in my soy accrue against said City In consequence of than granting of this permit. RST NDS AND WILL COMPLY WITH ALL NON -POINT ' _ .Z — Issued by: Date EAPPLIC 0 —1P15°t � �' Re -roofs Signuue o(Appi Camommr Dam AZARDOUS MATERIALS DISCLOSURE Type Of Roof Will Be ]leant or futum building ecmpanumro or handle huardam material u defined by the Cupertino Municipal Code, Chapter 9.12. and Be Health and Safety ode. Section 25532()? / All roofs shall be inspected prior to any roofing material being installed. Ye er< [3y_ If a roof is installed without first obtaining an inspection, I agree to remove With lite applicant or (alum building mcupant tae equipment or devices which sal haurdous air comaminanta u dunned by the Bay Area Air Quality Management all new materials for inspection. DisuIll ❑Yes Lino I haw reed Be hvardoes materials requirements under Ch mer 695 of the Csiifor. his Hcaltr&SafmyCode,Sections 255D5,25533 and 25S34. l undemaM Thuifine building do" not currently ban a enant, this it is my responsibility m notify the occupant of me mqulmm nen at x met prior m Issuance of a Cerificae of Occupancy. Signature of Applicant Date 7�r 2 -y ~0� All roof coverings to be Class "B" or better Owner or aunhoriy1d agent Dom Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: a o �� PERMIT # a60/s" OWNER'S NAME: CATY O t) E e5lV PHONE # R&'? 2-4 6- q7 If GENERAL CONTRACTOR L i Fe 'Ti yet Ea /N FAX # � p I am not using any subcontractors:/fe gnature Date Please check applicable subcontractors and c mplete the following information: Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date CITY OF CUPERTINO CUPEIZTINO PERMIT APPLICATION FORM ,o b 02 '00) E- N # 3 q Z — �) — 03 , Date: Building Address: Mailing Address (if different from building address): o -15 �/ ,�v qIV 2 rq Owner's e: �/Z Y a(�Ec%/ Phone #: 3 3 o Z it/ce Contractor: /- I rt=-ri/&IE �Oy�CS //1/G', License #: �' S3 Co tact: Phone: 09 A,'T 97/j Cupertino Business License#: \RUE C_A 401- Fax: So Zi F CITY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM Quantity Fee ED Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMTTIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOWAM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTEVIE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE PbIg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Iastall/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Rein action Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIItHAN A/C Units <=10,000 cf n MECHANICAL BREMAPPLI Apphance Install MECHANICAL BREMBUSWAY .. Remodel Busways ELECTRICAL 13REMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BRENU URNOV Relo Furnace > I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMDMOOD Installation of Hood 1VIECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL CJ 2of3 CITY OF CUPERTINO PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Grou BREMSIGNAD Rmd1 Si Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License ' BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMTTFEE Elec Permit Issuance ELECTRICAL MPERh= Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance I MECHANICAL. / PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 0 3 of 3