04110153CITY OF CUPERTINO
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BUILDING Drvlslon PERMIT'
L0 ]2AC�l'f)I24N t RMATI01� V
SWAN POOLS
BUILDINGADDRESS:
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PERMIT N°04T10153
OWNER'S NAME:
PERMITISUEDATE
JOE WILSON
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SANITARY NO, CONTROL NO.
408)866-6893
ARCHITECDENGINEER: /
BUILDING PERMIT INFO
BIDO ELECT PLUMB MECH
••. -" LICENSEDCONTRACTOR'SDECURATION
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-.. - - Job Description
.1 hereby aiRnn that 1 am licensed ands. prodalom of MoraCr 9 mammcudne
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infullto=a0(D)mf Diviaion3ofMe 0usinm and Professlore Code.and mYlicaseR
in full Torres and cffefl'C
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Loren CILic. A`
INGRID= POOL & SPA .
414010- ConuuYr
ARCHITECTS DECLA Obl
I understand my ptam elWlheuicd Y publ mcnrdt
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LiccnsedRafesaianal
^ Oat I am attempt fr DECLARATION
I thereby affirm that 1 attempt form Ne Contractor's License Law for the
(Se tins Cade:Mycity
following maaan.erNan](DI3,Buslmsand Co
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�•+ f),/�}i}{(rt\ X„�
tcounty
which requires a permit In cnnewn, a@a improv, demmltsh, her repair any structure
ve. de
prior in its issuance. sive require; Me applicenl for such permit to file a signed moment
IWlhculimmcdpumanllolhcpmvisimnoflhe Conm wr,UanwUw(Cluper9
Sq. Ft. floor Area
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V Valuation
(commencing with Section 7000) of Division l ofthe Business and Professor, Cede)orthat
he is exampt therefrom anal the btu far the alleged exemption. My vtold. of
e170 0
Occupancy Type ..
Section 7071.5 by try applicant for a permit subject the applicant to a civil penally of
tort ream Morn nae hundred doib s (65om
❑ I,ummof Mepsopeny.mmyempioymwlNmg uftkmiccompemdm,
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,' - - Required Inspections
70". Business,
the °anm Code:
d the comonso's u� La a� rmaiepply
add
eProfter The M an
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property who builds co mProw thereon.andwhodmauc6wahhimWfar Uvough his
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own employes. provided that such ireprovemmatme nmintanded araaemd forsals. It.
however. the building or Improvement is Yid weths me you of ampictiot. the owner -
builder will Neve the burden of proving that he did =I build or improve far purpose of
❑ 1. ea owes of the property are exclusively contracting; with licensed anuamnn Y
construct the proles (Sec. 7W, Business and Prefessiam Cade:) The Cm maacmri U.
ecrum Law does not apply m an owner of property who builds orimproves thereon,and ,
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whoammes, for such ptjoct with a cormseem(O licensed promuant Y do Como mea
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Licenm Lew.
❑ I am tempt under See, ,B&PC for this maron
Owner Dat
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penaRy of perjury am of the following deelandom:
havemd will maintain aCulifscamaf ConsentmselGlmumferWorker's Campen-
_. „_-_.. _.....
Y1mn, u providW meby Section 7700 of the Tabor Code. for the periosmY¢ or Ne
work for which this pcnnit is used. _
d by Section
I have and will maintain Worker's Compensation Compeatinn Insurance, requirea
I of the Labor Code. for Ne performance of the work for which this permit is issud.
my,
y Wallace,,5Compensation Inmmsee carrier and Paltry number me: --/
Carrier.N•ryPoliq No.: ����� "r
CEERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Mh=cmn need not Ito eomplemd lfflan, permit u form hundraddoUars(SIM)or
leas.)
1 certify Nal in the permrmana of the work for which this pconit Is hound. I shell not
employ any person in my manner Y u he become subject in Me Worked Compcnudon
Laws of California. Dam
_
Applicant
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NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you mourn
become subject in the Worker's Compensate. provisions or the labor Cede, you mm1
forthwith comply with such provision or this permit shall W darned mated.
CONSTRUCTION LENDING AGENCY
1 herchy affism then Mem Is a councette lending agency for Me performancetar
the work for which this permit Is issued (Sue, 7097• Civ. C.)
Launder', Name
Lender's Mdmaa
1 canify that 1 have read this application and sold Met the above Information Is
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comea'L I a&= to comply with all city Yd county onrlMmaa and atm law misting m
building construction, and hereby authadm mpresenudvva of Nis city re ,mer upon the
move-mendoned property for inspection purposes.
(We) agme to save, indemnify and trap harmless the City of Cupertino against
liabilidu, judgments, costs and expenses which may in any way acme agaiml aid City
in consequence of the graining of this permit.
ppp
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DS AND ILL COMPLY WITH A INT
Issued by: Date /
ATION .Re
-roofs
Type of Roof
FIJI mumer Dam
AZARDOATE ALSDISCLOSURE
Dlicmtorfut ildingaceupmtsmmmhandlchaveommamrWNe
rERST
Cupertino icipal Code, Chapter 9.13, and the Health and Safety
2557Z(e)7
*a
All roofs shall be inspected prior to any roofing material being installed.
a roof is installed without first obtaining an inspection, I agree to remove
e appllcYt errfumes building occupant tatecyuipmenterrskwim whichIf
, air contaminants u defined by the Bay Area Air Quality Management
all new materials for inspection.
OYcs �o
1 hoc mad the huaNrusmaterials requirements underChapter6.95of Me Califon
nia Health& SarctyCodn Sc ca 25505.)5577 and 25 X 1 understand that if the building
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docs not comedy have a Irn It'
mq&p
=f-liMliry
aoncenifkSignature
of Applicant Date
All roof coverin s to be Class "B" or better0
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rm th t