06030176 CITY OF CUPERTINO
BUILDING DIVISIONICIN '0RMATI
PERT C01\t>4°l9Q, ,'
BUILDING ADDRESS: SWAN POOLS PERMIT NO.06030176
686 STENDHAL LA
' ER'S NAME: PERMIT]SUE DATE
' RAYMOND CHANG 1495 S WINCHESTER BLV 04/20/2006
PHONE: SANITARY NO. CONTROL NO.
(408) 866-6893
ARCHITEC(ENGINEER: - BUILDINO PERMIT INFO
BLDG ELECT PLUMB MECH
(� i� 0 l5
±oo LICENSED CONTRACTOR'S DECLARATION Job Description
1 hcnby affirm Nat I atm licensed under provisions of Chap cr 9(commencing
viN Seetbn]g1U)of Division3afbc BusiM..and Professions Code.and myliccnw is BUILD NEW INGROUND 513 SQ FT. GRANITE POOL & SP
n in full foroe and c ] -I
Licevc Clas Lie.,
Dam -1 Yn�Co.S=ECr a _
££`4
ARCHITECTS DECLAR ION
S W u I understand my plans shall W used u public acnNS
cot; Licensed Pmfcssional
OWNER-BUILDER DECLARATION
<E I hereby affirm Nal I am emmpt from me Coovamora U...Law for Cuto O following mason.(Section RO Ls,Busineuand Profeasinv Code:Any City or county
$ff which requite a permit to cnntlmc4 alter.improve,demolish.no repair any suucmm 3 2 O O O
u-'^ prior m its issuance,also nopires the applicant for such permit to Glc a signed statement
-�i
that he is bottomed purmenuo the previsions of to Contractor's loco¢Law(Cupen 9 Sq. Ft.Floor Area Valuation
«� (commanring with Section 7000)or Division 3 of tW Business and Professions Code)or
Nat be,is eserept sbmefrom and U.basis for the Wleged ettmi tion.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of 3 Agrikl4er' Occupancy Type
not more ftm Gve hundred dollen($500).
❑l.uo mrof Nepmpmy.mmyemploycowiNwaguuthehmlecompensadon,
will ao the work.and ft Me.is notivended orortered forsalc(See.]ON.Business Required Inspections
and ertywhau Cade:The Canhacbrs and
Law dors Out apply CO rt owner is q p
own emwWo,prods orimpmvuchimrove who doesamM1work M1imse3redor forage his
awn a however.
the u,provided chat such improvements ase cot ine,Md oraRercd for ala,.
builder thabuilding Orden of pmmtg cold n didone yw of mprove for
becameo
builder will have to burden of Peeving Nat M did Out mild or Improve far puryue of
.k.).
❑I,as ower of the prrperty,am cxeluvvely contracting with licmued can ommors m
construct the pmjen(Sec.7064.Business and Professions Code:)The Contractors Li-
who Low does won apply ban owerofproperty slice sedporimproves Jounce,and. l
who se Lace,for such projects wird a contractor(s)licenced pursuant u tk Contractors E
License Law.
❑lam exempt under See .08 PCfor Nia moon
cr Dam
WORKERS COMPENSATION DECLARATION
1 hereby affirm under pc a ty of perjury,mm of lite following declantions:
❑[ham and will maintain aCeniGe4o of Covent to self--insum far Workers Compen-
adon.as provided for by Sueuon 3700 of the labor Cade.for use Performance of Ne
work for which Nis pmmi.is Lssued.
Plat have and will maintain Weakeee Compensafan imwrmce,as required by Section
3-(110 of fm Labor Code,for Nc performmm of the work for which Nu permit u menu d.
My Worker Compevadon Insunme area and Policy number am:
Cartier, L.L Policy No.:t T'IG
CER77FlCATE OF PITON FROM WORKERS'
COMPENSATION INSURANCE
(This CO.seneed cot be completed if las permit Is fororc bun schion lars($100) a
or less.)
1 certify Nut in the performance of me work for which this Permit u issued.I dnll not
employ any pawn in any mmrcrw as in became subject in Out Warke s Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject b Out Workers Compensstian previsions of Ne Mbar Cada you muss
.J 2
forthwith Comply wird such provisions or this permit suit W deemed rooked.
'Z'O CONSTRUCTION LENDING AGENCY
I bereb affirm Wt fauacaravuctinn lendio a
(-+ Y { gcay for the performanm of
C' LC work for which this permit u issued(Sec.3097,Civ.C.I
1 Q Lenders
�z l<ndcrs AM Address
U 0 1 certify that I have had Nis application and state Nal Out above information is
Ig, P COMM 1 agree in comply with all city and county ordinances and sure,laws relating to
0 U Wilding Construction,and hereby auNori>e mpresentatim of this city to Corer upon the
r W above-mentioned property for inspection purposes
w04 (W)agree b ave,indemnify and keep harmless in,City of Cupertino against
h liabilities.judgments.toll and expenses which may in any way accrue agaiasa Said City
O vZ in constrain a of Ne grunting of this permit.
^" APPLI NDERSTANL COMPLY WITH ALL NON-POINT Issued by: 61 Date
30 CE RE CATIONS
'170j Re-roofs ���--
Sign o(Applicm antncmrD
AZARDOUS ATER3. L$AISCLOSURE Type of Roof
Willtuap icmturfmua ilding Pon or handle hxvardou material
as defined by be Cupertino Municipal Code,Chapter 9,12,and ft Health and Safety
.pert..zss3z(a)+ N All roofs shall be inspected prior to any roofing material being installed.
Will tne,ppliamt or?
to.W ng attvpant taw egripmmt ar dcrias wM1ien If a roof is installed without firs[obtaining an inspection,I agree to remove
emit lo.ol.ns air Conmminanta as defhrcd by tM Bay Area Air Quality Management all new materials for inspection.
Donna?
❑Ycs
I have road the hxrardausmatem
rials mq.occnu umCrCupmr6.95 offt Cali(ar- -
rde AlNkSa(ctyCodc.Sc 25505,25533aa125534.Iun&=dNatiftM Wilding
dace not currently have a moa�,Nat u or my res asihid m notify the asupmt or Ne
ottpn wh mutt be poor tis' of a CcNfhcate of OCcuPan .
Signature of Applicant Date
owner aumonzcd m I DO6 All roof coverings to be Class "B"or better