04010127 CITY OF CUPERTINO - t .+d .-s`"€�' "
BUILDING DIVISION - pER CONTRACTOR"INFORMA�jg N
BUILDING ADDRESS: PERMIT NO04010127 4010127
1121 S STELLING RI)
OWNER'S NAME: PERMIT ISSUE DATE
III ryE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: 8UILDING PE_RM ff INFO '
BLDG ELECT PLUMB MECH
0 0 0 0
r�O Zp LICENSED CONTRACTOR'S DECLARATION - d
1 hereby affirm that l am ficensed coder,pprovis)ons of Chapter 9(commencing Job Description
z with geclion pf Dividon 3o(the Busi,51ddProfessions Code.and arylicent is
=a in lull fora on {hcJ.
i8Z License class Lic.0 Ll DEMO THE (E) POOL
Data
Used �. 1
AS HITECI'SDECL RATION CONTRACTOR: RAINBOW POOLS
1 e sand my plana shall ht cud es public rccoNa
5e Licensed Pmfcssi and
3 OWNER-BUILDER DECLARATION
i I I hereby affirm that I am exempt from the Contractors License Law far the
00 following Mason.(S.don IIn 1.5,Business and Professions Code:Any city or county
mwhich mgmrea a permit m construct,Alten improve,demolish,or repair any structure
zi prior as its issuance,also requires the applicant for such perntittu File a signed suament
�o that he tit licensed momanuothe pmvrsinnsof the Conoactar's Licenu hw(Chepar9 Sq.Ft.Floor Area Valuat 38000
(commencing with Section 1(X)07 of Division 5 of the Businessand Pmfcasions Coi
y $ Rat he is exempt therefrom and me basis for Ne alleged esempti ra.Any violation of
Section 7011.5 by any applicant Ear a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollar
❑1,as owner of the property,or my employees with wages as their sole compensation. 3622201Q . 00
tl
will do the work.and the euvaure is not intended or offered for sale(Sea 7044,Business
and Professions Code:The Conaanors License Lew dao not apply to an owner of Required Inspections
pvtpeny who builds orimprows thereon,and who does such work himselfor through his „
awn employ.,provided rhmsuch improvements arc not intended craRered torula.If. G
■
however,the building or improvement is sold within one mSear ofcomplction,me owner. ■ ��I11r�® - rt
builder will have e burden of proving Nat he did not build or improve for purpose of
sale.).
6-3 1, owner of the property,am exclusively contracting with licencontractorsdcontractorsto ggV a� aGy004 t
construct the project(Sec.7045,Business and Professions Code:)The ConlrumIt�A
is Li. 1 G t'
cents law does not apply to an owner of property who builds or Improve themon,and G
who contractor for such pmjeets with o conlactor(s)licensed pursuant m the Contractor's
Licenu Lew. BUILDING
Q 1 am exempt under Sec. .B&P C for mice reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affvm under penalty of perjury Arc of the following declarations:
I have and will maintain a Certificate of Content to self-insum for Worker Compen•
scion,as provided for by Section 3700 of me Labor Code.for me performance of the 1i
work for which this permit is iuucd. t
❑I haw and will maintain Workers Compensation Insurance,as required by Sccuon
3700 of the labor Code.for the pedo...of me work for which this permit is issued. -
yWodcr'aCompensatianlnsunn.cami end Polity number a(,yl
er. policy No.:
JJ ERTIPI COMPENSATION INSURANCEORKLRS'
(This xenon recd not he completed i(th fermis is foroachundred Mllars($lf o
or lcsa)
1 comfy that in the performance of the work for which this permit Is Wrote,l shall not
employ any person in any mannersn u to become Subject to rhe Workeri Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,afar making this CartifCroc of Exemption,you Should
become object to the Worker's Compensation provisions of the Labor Code,you must
.JO foMwith comply with such provisions or this permit shall he deemed revoked.
'�� CONSTRUCTION LENDING AGENCY
[—� I hereby affirm that there is a consuuctinn lending agency for the prrromance,or
lYi the work fur which this permit is issued(Sec.3097,Civ.C.)
Igg Q Lendefs Name
.7 Z fender's Addrou
V 0 I certify mat 1 have read this application and!tali that the above Inri mudon is
IA E~w correct.1 agree to comply with all city and county ordinances and state laws minting to
0C) building mnnmetion,and hereby authariu representatives of this city to enter upon the
1st alwvcmentmned property for Inspection purpoua
(we)agree to Save.indemnify and keep haemless the City of Cupertino against
t,.r fAy
liabilities judgments,costs and expenses which may in any way ucoc against Said City
()7 inPn C UNDERSTANDS A
ucnceOf the Rtt
Aconsequence
yAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S URC RE U Nile S. ,r ; '' 7/Ork Re-roofs
y5!'wreo Appl
HAZARDOUS MATERIALS DISCLOSURE Da -1 Type of Roof R
Will the applicant lir future building oecupsm atarc or handle harsNous materiel
as defined by the Cupenhm Municipal,Code,Chapter 9.12,end the Hcalrh end Safety 4
Code,Section 25512(x)9
❑ a installed.
All roofs shall be inspected prior to any roofing material being illed. 11r
Yea �No t
Will the applicant ormambuilding Occupant use equipment ordeviceswhich If a roof is installed without first obtaining an inspection,I agree to remove
mB haardousair contaminants as dullard by the Bay Area Air Qualiry Metagem.t all new materials for inspection.
District?
[D Yea
I have read the hanrdous materials requiremeou under Chapter 6.95 of the Califon
ria Her th.&Safmy Code,Secdmu25505,2553]and 25534.1 understand toot if roc building
does our current,have a.nark Nat is u my rupomihility a nodfy the axupanl of the
requimmen swhich must be mer prior to issuance o(a Cenificaa of Occupancy. Signature of Applicant Date
e nrr.tdagr � All roof coverings to be Class t'B't or better
-1�)42,w.c, �1 'oL cam w. Iaovi d Leve L
! 2 x 0
w- I V\ ?Q-O
CDNVV ��� ��0 7t�r'I ori of Dnvv\o 0t, Si Te d Sere
vrno u e cJ
n e k- 300 'Fe�, Coo F f
PROVED .
A lkOStURtaANOE U1f fl E CRY OH
¢IRTi CC� PnI.;NP CES
>Y$TLE
• � � ON lh (0 ;F e s and spec wand MUST.
etp Il�pt�F .:.�jab at a:l rimes and it is un
Aww'I ft 'take any ctanges or alterations
0 aY. "U'L r✓f`IL-n permission from
ILP 1W ," C iy of Cupertino.
'tg 047X� :f 'hu plan and specifications
IAUL P!;Q1f lha fW;d to permit or to be ar,
wftl 0 ft vilation of any provision#
+xe9Aioawe or State Law,
Poop 6
�CEI'V'E
JAN 2 7 2004
N C>
---------------
0 CITY OF CUPERTINO
0 DEMO Z7
CUPEkTINO PERMIT APPLICATION FORM
• APN# Date:
Building Address:
Zi 5- Sl� llii—
Owner's Name: Phone#:
( I r'e; MS 7 -) 7Q � � �
Contractor: License#:
I �� rooLS S- 19 S7 Li 3
Contact: Phone#:
oEie cr,%Ais `;3399 Leo - `'r -L `-
Applicant/Contractor:
I r Ll
' ing ermit Info:
ld Ele P mb Mec
Job Description: r
Residential: o6,L F Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.: �o
Architect/Engineer: Valuation:
Type of Construction: i Occupancy ro
Y•
i able Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BSEISMICRE Seismic Residential BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG
•
z3 �
Ell .
CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CCINTRACTnR INI C?RMATION
BUILDING ADDRESS: PERMIT NO 04010127
R'S NAME: PERMIT ISSUE DATE
E
JILL KARAMANLTS 127120
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Y00 LICENSEDam tic" d underS DECLARATION
F I hereby Affirm then I am lianud undcf,yyrovisions of Chapter 9(commencing Job DeSCTIptIOh
zly with Section fDi 'sion3af the Busins9Xgnd Prufessiuns Code,end my license is
L<H infulle Cls ao c ✓ DEMO THE (E) POOL FiN�►LED
? License Class Llc.s
Data antra CONTRACTOR: RAINBOW POOLS
e QQ AR HITECTS D RA ION
g W< I d stand my plans shall W used pe public reamda
MAY 21 2004
;ui� Licensed Profcsaional -OWNER-BUILDER DECLARATION
a E I hereby.(Seth on I oro exempt from We Contractor's :License Lew for the BUILDING
KO O following heann: arch t ](131.5,Business and ws,de ori Code:Any tiny s county �a
m which its requires a e,also re construct,alter,improv,h Permit t or repair any structure
prions incensed pursuant
to the the
evisio antsof for such Permit Bunstle aLw statement
Ha thatmecing with
pumuion 700)of previsions of thebe Buamriness nd Proflaw(Chapter Sq. Ft. Floor Area Vanua[WOO
$ (cat he
(commencingxempth Sereion71100m baiiioI ,W the.,adexempton.Aainna Co If '+'
.-
that io is exempt tanrefmm And the aper for be alleged exemption.Any l Penalty
of
Section 7031.5 by any red dent.(a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
nm more men ere hundred aml,ra(ssog). P Y YP
El 1,pe owner of the property,or my employees with wages a their sole compensation, 3622201Q . 00
will do me work, av
and We uctme is not intended or offered for sale(Sm.7044,Business
and Profawlom Code:The Contractors License Law docs not apply to an Owner Of Required Inspections
property who builds m The thereon,and who does such workhimself orlhrough his
own employees,provided thatsuch improvements arc not intended oroRered forsale.If,
however,We building or improvement is sold within one you of camplction,We owner.
builder will have We burden of proving that he did not build or improve for Pon=of
sale.).
El 1,as owner of We property,am excluaiwly convecting with licensed convectors to
construct the project(Sec.7044,Business and Professions Codc:)The Contractor's Li. .
cams Law does not apply to an owner of pmpcny who Wilds or improves Wan on,and
who contracts for such pmjmA;with a contractons)licensed pursuant to We Contractors
License Law.
❑1 am exempt under Sec. B&P C for Wis reason
Data
WORKER'S COMPENSATION DECLARATION
we I hereby affirm under penalty of perjury one of the following decimations:
❑I have and will maintain a CeniBcate of Consent(owl Ginsum far Worker's Compen-
ation,a provided for by Section 3700 of We Labor Code,for me performance of the
work for which this permit u umcd.
1 haw and will maintain Workers Compensation Insunncc,As required by Section
3700 of the Labor Code,for We performance of We work far which this permit is issued. -
yWorkcraCompensationlnsunnmarti and Policy number arc: — �. � '
Seek
Policy Na: ll,f�
E'TIFICATEO CEMPI70N FROM WORKERS'
COMPENSATION INSURANCE 7
ffhr amthei need not he completed if the permit is[Orono hundred dollen nits)
or less.)
1 certify that in the performance or Inc work for which this Permit is Issued,1 shall not
employ any person in any mannersn as to become subject o the Workeri Compematlon
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cadmus,of Eumption,you should
become subject to the Worker's Compensation previsions of the Ichor Cade,you must
.J Z forthwith comply with such provisions or this Permit shall to deemed mwkcd.
'ZOCONSTRUCTION LENDING AGENCY
.F r I hereby affirm that Were is a constnrctian lending agency for the perPormancc of
fl F�-t We work far which this permit Is issued(Sec.3WG.Civ,C.)
W� Q Undoes Name
a z Lender's Address
O 0 1 certify that 1 have head this application and state that We&how infornuiun is
L4 Fcorrect.l agree to comply with all city and county ordinances and star,laws relating to -
U building eonavunion,and hereby authmire representatives of this city to enter upon the
LU eWvcmemiuned pmperty for inspection purposes
(We)agree mean,indemnify and keep harmless the City of Cupertino against
N liabilides,judgments,casts and expensm which may in any way seems against aid City
V ',L in consequence of We granting of this permit
APPL14EA41T UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S RCRE U NS.
—� \ 12-j Re-roofs
natum o AppIi.m/Co ter 0 1,
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will We applicant or future building occup oro store or handle haudous material
as defined by the Cupertino Municipal.Code,Chapter 9.12,and the Health and Safety
Ode Section 25532(e)? "Nt All roofs shall be inspected prior to ally.roofing material being installed.
�llt �Na
Will mea applicant Or(wore building mea ant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
np s p gaiPmen
amt havardnus air conmminanu u Jcfncd by We Bay Arce Air Quellty Manegcmcm all new materials for inspection.
DiavinP
❑Ycs
I have real We baaNnus materials rcquircmcnuundcr Ch.,W,6.95 of the Califor- _
nr Health&Safety CWc,Stedoa 25505,25533 mdM534.1 understand that ifd¢Wilding
docs not curendy haw a tionam Wet it is my rax,am lhitity m nndfy We occupant of on
rcyvircmcn whicM1mu9hcmetprionoissuanccofaCCNB moroa, Pa<y. Signature of Applicant Date
e as ormedagcAll roof coverings to be Class "B"or better