05020157+100
O
'AYE
jai
Z;
A.
or
s
00
FZQ
�Fc
00
Z .-
CITY OF CUPERTINO
•' v �- a
BUILDING DIVISION PERMIT
CONTAt.�.CTOtiINk'UxtMATION'':
,OT,:,
BUILDING ADDRESS:
[+��/-� T h1 "T�
So9
ROYAL POOLS INC OF SANTA
PERMIT NO.
LARA 05020157
TtC
OWNER'S NAME:
PERMIT LSBUE DA'IR
E:
SANITARY O OL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 Mrcb of irm that l am limned under previsions of Chapter 9 (commencing
P
with Section 7MAB.fDIvRuU Sof Ne Busfnusand Professions Code, and any license is
in full force {td of lfy�
ucenao I A ue.a 6
Dale lt lof
INGROUND SWIMMING POOL J
G
/
heads
1 crsunJ y 6..h c heads uhlic records
Liven d n essum. /
O /
OWNER IL RDECLARATION
{0
1 hereby A vm Bell see it from the Cmmoctor's Liccnao Law for the
fol wing naso seemon 71131.5, silmss and professions Code: Any city or county
w ich rcyuircs permit In cnnslru alma improve, dcmolisR err ¢pair any suucmre
p onnitsiss enre,also requires the applicant for such permiuo RlcesigneJ nammem
t the is Rcensedpurounalothe none Conmcmr's uecn:c law lChapery
Sq. Ft. Floor Area
Valu 1
pmvixipm
( ummencing with Section 7") of Division 3 of the Business and Professions Code)or
Nat he is exempt Ramiro. and Ne basis for the Alleged cxempdo., Any�viulatlom of
Section 7031.5 by any applicant for a permit subjects the applicant a civilpenally of
not more Nan five hundred dollars ($500),
�,p�r,T�7.,m{sei
e J 3 `F`'Y7FY lYY:�J"a# 0 0
OCCD anC T e
P Y YP
❑ 1, ll owner of the m employees with wages Their tale
xn:
prcpcny,
is r 044. B`aa0en,
will dothewons ands: he ctumCour isnmi tended Licenso offered Law ntapply ]004,Business
4w docs not apply tp an owner of
and Professions Code: The ws trecmrb and
properly who builds orimprtuves@ercon, end whodmssuch workhimulror Nrcugh his0
ha:pi� jt RCQnlre� IDSpeCl10DS
ownemploymuiprovided such Improvementsin neHnmMMoro86wntl fired
pr nen.
builder. the buildingorimprovementissoldwithinoneyear of completion, fire owner.
builder will have the burden of proving that he did not build or improve for puryose of
sale.).
❑ 1, as owner of Be properly, am exclusively contracting with licensed convectors to
'
consumer the project (Sec. 7014. Business and Professions Code:) The Con radar's Li.
.
came law does not apply to an owner of property who builds or improves thereon, and
who commcts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Sec. . B & P C for this reason
wrier Dam
WORKER'S COMPENSATION DECLARATION
I hereby nature under penalty of perjury one of the following declarations:
have and will maintain a CmiRom of Conum m self-mium for Worker's Compcn-
-
an, as provided for by Section 37M of the labor Code, for the performance of the
work for which this permit is issued.
have and will maintain Wurkcr's Compemation Insar.U.. as reyuircd by SCNon
in labor odc,�or Ne performance of the work for which this permit is Usual,
My onkel pen bon Ins u carrier and Policy number am:
Cartier. Policy No.:
CE TIFICATE OF EXEMPTION FROM WOR ERS'
( COMPENSATION INSURANCE
(This section need not kcomplctcd if the permh Is fortune hundred dollars (SIM)
I,, less.)
1 Certify that In the performance of the work for which this permit is issued, I shall not
employ any perxon in any manner u az to Become subjecup the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making Nis Certificate of Exemption, you should
become subject to the Woher'a Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm din them is A construction lending agency for the perform race of
the work for which this permit is issued (Sec. 3097, Civ, C.)
Lender's Name
Lender's Addmas
I certify that 1 half 7. 6 Chia application AM cute that the have information is
ly wM all City and county ordinances and sum TAWS relating m
cortect. 1 agree/dor�Kry
huildingconswMherg6y ad burns MPrc,entaliver of Nis city m enter upon the
almve-memionI nupection proposes.
6ve,ndcmnify dkce NrmlessNe ity ofCupertino against
11abt1111Caadb, Bnd CR"B C6W A In any ay acCNC against said City
in canugocny� of Nc, ran, oft s perC
APPLICANT' U ERSV AND W COM Y WITH ALL NO OIIssued
SOURCE ATIONS.
by: Date
Re -roofs
Type of Roof
Signnu of ApplicanUC reactor'
ctor' Da
H ARDOUS M ALS DISCLOSURE
Wllldreappli oturfutum din cupmt Store or handle Mrardaus mnedal
As fined by be
'
pminniM rcipal C c. Chapmr 9.12, and the Health and Safely
de, Section 255 2(ri)?
❑Ye, 1�1No
All roofs shall be inspected prior to any roofing material being installed.
�C'
Will the applican r fuwre huildin6 occupant tau cyuipmem or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
g P g
crud nus air co mi ants as defined by the Bay Ama Air Quality Managroom
- all new materials for inspection.
P
let?
Disvim? [[[
❑Yes / flNu /n/
Ihavcrc th<hmsNlwlsl\mam77 alt'sky' rev under Chep�.YS of the Califon
nia Hcaldt&SAfetyCi1cZtdons2p551)5.255 25534. I mucnland due ifNe 'ding
does nm current ow a mnam, NALh is my Lea mihilityio nodly Ibc cup of Ne
rcyuiremen chmust W rpnoIII tax. nce r,C KalenfGreat q
O7�
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner fapmnri,edaga Da,