02080052 TINO
CI BUILLDM G DIV SRioryPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10390 STOKES AV SWAN POOLS 02080052
OWNER'S NAME: APPLICATION SUB DATE
LORENZ DANIEL A AND ANNETTE P 1495 S WINCHESTER BLV 08/09/2002
'HONE: SANITARY NO. CONTROL NO.
1. (408) 866-6893
pppO BUILDING PERMIT INFO O ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
<�LLI IJ
Z y 2 LICENSED CONTRACTOR'S DECLARATION Job Description
O Z_0 1 hereby affi,m that 1 am licensed under provisions of Chapter 9(commencing
FNFto with Section 70)(0) a.
)ofDi%ixtm3m1heBusiremilProfcssim,Code,mdmylicense VISION--IN HOUSE USE ONLY
F<:
se 2C4 is In full fumcmd effect, NO NEW—PERMIT ISSUED
as c< Liccnm Class Lic.g
c w Date Contractor
ARCHITECT'S DECLARATION
F E:O g 1 underrated my plans shall be used as public records
25< Licensed Professional
i.eaff OWNER-BUILDER DECLARATION S
1 hereby affirm that 1 am exempt from the Contractor's License Law rot the
F Z a following reason.(Section 70 31.5.Business and Professions Code:Any city or county
Y F o which overdoes a permit to mnswn,alar,improve,demolish,or repair any structure
toCam -prior to m:issuance.also requires the applicants for such Permit to file a signed statement
that rte is a«n:<d praarm5�e mepro•i.m..of me Centmams's License Low(Chapter 9� S Ft. FI or-Area anation
(commciving with Secdon7060)of Division 3 ofthe Businafs,aad Professions Code)', e;�(-)y F h3:vq'J 1,';�i:�r�J: ef. y.fi'•i'
or that he is exempt Iherefmm"'anll the basis for the alleged ascurption Any violation
of Section 70315 by any vpplicant fruit pemtit subjects the applicant m a civil penally
of.not more than live hundred dollars(E54)). AP Number 'rr .r: :a. Occupancy Type
D I,as owner of rhe property..,on employees with wages az their sole compensation. 1 03 - r
-will dmtne wo,k,-.nd'shestmcmre is'nos intended or oReud'for soo-Sec:70 til:
Business and Professions Code:The Contractor's License Law coca nor apply m an 104 - REBAR Required Inspections-"
owner of Property Who Wilds or impmves thereonc and who does such work himself 10 7 - POOL/BONDING
or through his own employees Provided Oat. nimprovements tintended
--offered(dr sale Ifhowe er the bidding -p mend is-Id within.nc year of -"_ _. ._.,.. _. _ .__.. _ ._.._ _-._ _ ------
-. _ ._ - -
completiontheownerbuIderwillhaveduebuNenofproving that he did not Wild or 301 - ROUGH PLUMBING `')
mpm.efor pmp mimic.). 304 - ROUGH ELECTRICAL
_._...___-__..-_..-_wiN li<mseE comncion�o __.___.__ .._.
❑Laaw.mer.(,heproperty. meanrsivaycomm<ting 502 —FINAL PliUMBING'ENERGY 5{ _ 'i•r"aif!:.I,,
.ustru<t the project(Sec.71YW.Business and Professions Codas The Contractors 503 - FINAL MECHANICAL "ENERGY
License law does not apply man owner of property who Wilds or improves thereon.
and who-contracts for'
-such pmjects with a ennuact«(s)limeaced,posturt.m.the .. _. _...-.--•'506'--- GAS- TEST-'------ -"-' - —-----
Contractor's License law. .
D 1 am exempt under Sm. :B&P C for maxim 510 - FINAL PLANN I'NG"i-''%�
-_ owner'" oam 511 - FINAL POOL
WORKER'S COMPENSATION DECLARATION
516 - FINAL BUILDING
I hereby af0roe under pewlty of perjury,one of the following declarations:
y. D 1 have and will maintain a Corti icau of Coraent to self insure for Worker's
Compensation. a provided-for by-Section-3700 of the Lab« Code, for the
(performance of the work for which this rmut is issued.
;- D 1 ha4e and will'miinatiit Worker's�Coginsi scion Insuhnce.as rcquiad by Section
3700'6f the Labii Code,for she pMmmancc of the work for which this permit is
i r n nil P.II y tW arc v u
d.My Worker's C to Ins. sons.:.. ... _._ ..-._ ._._ _._.__.._ _._....... »..._.-......-..............-...,......w.........,..,.W-..
Y a
C3 eS�(°a ( f 'IFS v: POICN " .-• - .- ' f� a d3. i' 't a)v eiffs.. , .
1 CERTIFICATION OF EXEMPTION FROM'WORKERS- \,!s'a (,� ."1"( . :. Y t.�ku✓11 A 3,��
COMPENSATION INSURANCE.h II r s - .. n ._ _....-.,,,.�.... ..-.-..
.....,t« rv.-...,-._+- _ T:.-___._-__-___"_.r._.-.__-_.soon.-�__••__
(Tnnunion need not W completed if the permit is for one hundred dollar. �+ \
IS Fill)or I ciao)
% Ic m(Y Uat In I,cpefrtn cc fthe kfrwh hth permt si..eJ'1 Fs dti .'.., i r,I,_l: Ul :,s, ••I :
sh II not employ any per.vn r a Y ma sat a6 Wcome ti)n so Oc worker'
"CmripctossersIs of California.Date
-.INO�TICE TOAPPLICANT
-- making this Ceifiic Exemption,.• .•you sh.o•uld
ticco . blcctt theWok esCompm t op e.'tinsofth Ubtr ;dc, . t
Q Q forth"ith complywith suchprovisions o this perms sM1all bed tod ked.
......... ......__......__.__..._.___..--..__`."._I
._ .. ...__. ....._ _ _ .._ ___...
� - - - -. ---------
3
-_-_-_r CONSTRUCTION LENDING AGENCY." I` - St lr R.:"
1 h by affirso that then is a ton tmct on lending agency for the per(oima' e. "'I`' I• t- r `
.W s••t sof the vvmk fm which hispermit 1,issued Sec.30ry7 Civ.C)
Q - Londe,s Nome- a.::
y Lender's Address
V I certify that 1 have read this application and slate Nat Jrc above information is
'fzr Est cams I.,me.ic.mply with all city and c.umy ordinances and ,am laws relating
,to building mn.aructinn:and herctYi.a Wriac'repre4emia,vend his city m enter upon
the nboFemcinkmed property l.r inspection purposes,-the
urposes,_ .._.
(we)4ne'to save,indemnify and keep harmless the City of Cupertino against
Z) liabilities,judgments,costs and expenses which may in any way acime against.said ts _102
V i City in consequence of thdgmming of this permit.
APPLICANTUNDERSTANDSAND WILL COMVLYWIIUALL NON-POINT''' ISSDellby: ! , Date
SOURCE REGULA'fl0ft"s„' 'hl':'"•,
- ;SignarimufAppOeult/C,ntma.r-., .",-.,:,.;,:� ." .., Da�r;y'i'; Re-roofs
.HAZARDOUS MATERIALS DISCLOSURE
ill theapplicantorfumrebi Ids g«suparrusbomorlareadhibloudeasmaterial Type of Roof— --- ._. ..,t. _._ .-_.,�_.._ _..�.. .- -•
as J i d by the Cupem M if'p 1 Cod Ch Pt >1 d the Health and Safety +: s \ n
,C� zovon 255311) nOr,ayl ,`,313+�'.t a ,. - . .;•k 16 �:... tP} ; . I I•ti �% •f IC`,
All roofs shallbe inspected-prior.to any roofing material-being installed.,_,_--_
_Wilidbe...lca i' fuwmhuila g« ,simmecq p' �tonaevr« wmab If a roof is installed'without first obtaining an inspection;IPagfee to
em t h Y Y Quality 8 mcut
Dsiict rdousairconatmtnantzmde0ncdb me ea Areaplana e,,,, all new materials for Inspection Applicant understands and will comply,with
DYs....- -D No .allnOn- OinI50LLCCereLLl3h0n$ i
gr., r .p. _ . - ..-...-.
i t i} p
F,. I,, r
1 have read the hazardori's'midi I q immenu udder Oupief 6.95,or Oc
,California Health'&Safety Code,Sections 25505,25533 and 25534,f understand that
ifthe bulldin oases not cutrtml .have a tenant.tchat itis
responsibility
Canniocat the
B Y Y P Ynotify,
"�'`"- must W' cif
«cupant of rhF rcquircmrnu which prior r Date
Signature Signature of Applicant_ _
q. 0 authonallr •.Date,
All roof coverings to be Class "B" or better.
acd a .
-d
. . .. OFFICE-. . ._. .. ...._ ..