00110114 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO
1.1009 SYCAMORE DRIVE SWAN POOLS 01011.0114
OWNER'S NAME: APPLICAI'[ON SUB DATH
CHERIS MIGDAL 1495 S WINCHES("ER BI_ 1. 1/21/2000
`IIONIi: SANITARY No. COMR011.NO.
(408) 866-6893
pBUILDING PERMIT'INFO
WOO AltCfll'fGC'1'/LiN(i1NH1?I<: BLDG HLECIMAJOR MECII
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N�� fel 1=] I_1 I_1
6
yi LIC(thatIDCOSBd underSDECLA of Chapter
1 nemby attires that I am Bemused under rm,i.ians orcnamer)son menang Job Description
mtw whh Smtion]Illgll of Division3nf the liu.incss and Pn,fc..run,Codeand my litems
--� -infnnfnmenl,derecl. -1 p NEW INGROUND SPR & EDUIF'MENT ONLY
SCC
,,are
3 w V
1iuIC
AkCHI'fr;C'rS UIiCL1RA1'IO L///� l
e.3 1 nndemtand my plans hall be nnad ns mhLo ream s
a i p O I.ka"ud Professional
a. o'P.i OWNER-BUILDER DECLARATION
^ 1 nemny almm nem I am esemrt fon,the Conitaclor'x I-metwe Law fur the .
F Z" In lowing reason.(Section 71131.5.Business and Professions Cole:Any city or county
E Z D which requimx It Ie,,air to cnmwcl,alter in;pmwe.demolish,ar mpmr any mr-whim
z
linor to itkaII hpl': IIorsuchpcrnin to t1,!"i"a'dwateamat
a m 111111 1alaulell falmotail1 111c110111111.1101 nhe c 11 -I Ullow L (u'mer`) Sq. Ft. Floor Area Va u'f 5
prom cn ngwthSecl,17(NH))olD'v's,.3ollhmBuCus:ldlr:fsaoalCode) p $ %660
nr Leet heti.cacntpt It...from and the basis tin the alleged exanption.Any vii,lalion
of Section 703 1.5by any applicant fora nnil subjects the applicant m a civil penalty
of not mom than live bu;,dred dollars filing)). APN Number Occupancy Type
❑L as Owner ofthe ma n,or to loyees with woe.as their sole toes tion. 34256025. 00
1 per rem. > g Iec.7
will do me work,and the ode Ibe is not imendal rase Low Ion sale(Sec.]IN4,
Bnannxx amt arm
Coderfn,emnn,cmrx License law d,a:s not rklr to an Required Inspections
ofra,ptoy wan bo ve""novickci lhrnc imw wim daea wen wmk hi'r l or 103 — UFER
w . l
of mmugh his awn employes. Wildcdelbul such i;ngval I,slid
um not law un,or
clichedasur sae.11;eow.wd, he willhave
prole.old wide,not Wild of 1.04 — REBAR
%n'rooeon,the owner,ale.).will have the burden of proving mal he did ant Wild or
npmoe tier gorla,ee of sale.). 1.07 — POOL/BONDING
❑I.as Owner of the pmgcmy,amexcm.ivclyeonmmrngwith licensed contractors.It, 301 — ROUGH PLUMBING
,names the project(See.7(P4.Hm%mms.and Professions Cavdc:)The Contractors
License Law one,not apply to an nwncr of property whm
ISO builds or onpnwes uses. X04 — ROUGH ELECTRICAL
nn whh cootm 1,for such nrj,,T wim a vmnrauogsl Ilcaascd ....uanl m the
c,mtmcmr.Lieen.eLa,e. 502 — FINAL PLUMBING ENERGY
❑Iall]exempt mmaer See. .Bra tic in This teas°ln 501�3 — FINAL MECHANICAL_ ENERGY
(]caner WORKI;R'S COMPENSATION DECLARAt'ION 506 — GAS TEST
Ihereby affirm under penallyofleyorytine othe followngdeclarations: 510 — FINAL PLANNING
I I nave and will omo,000 it Ceni icme at Consent l,,-.eu:io.om for workers 511*
I NAL POOL
'mnpcnsabnn, as provided tin by Stenon 3700 of the Labor Code. for he
,erfonnanceofthe vook orwhhl,mix nail is awed, 516 — FINAL BUILDING
Phave and will ma rimin Worker's Compenamion Insurance,as myuimd by Section
4703 of the LLam Code.for the peffammnae of the work for which this permit is
issued.My Worker's
ConiKn%at in1nwmnce currier and Policy numMr are:
CaOuri, /?ty�_- W94A_Policy No.:
C1;lt11PICATION OP EKEh119'ION FROM WORKED S'
COMPBNSAI'ION INSURANCE
('This section n ed Bol be o ndoed it the permit is far ane hundred calla..
($hul)or less.)
I a,dd,tem in me varwar nanen of the work fur which this permit is issud,I
.hall not employ any person in any manner so as b,become,subject to the Worker,'
Compclnation laws of Uncomic.ic.Dae
Applwarn
N(C CE'ff)APPLICAN'D 11:a0ar making mix L'enidcmc of pxemptiun,you should
b,..... hjsl It Eno Wooer.Co;ll'a"it it n pmvlsion.of tea Label Gale. an must
CO 4mnwhh a ;ply all ouch is.ovisiorotor this permit shall be ccnmal rcwkcd.
FVi CONSI'RUMIONLIiNDINGAGENCY
a ? I hereby allinn that there is a amummian lending agency for the fcrfonnance
of the work far which this pe.it is issued(tics.YN7,Cr,C.)
L Q L.eader'x Name
z Lenlet,Add—
V Iunlly thin) ooc uA this a...llnnlnn uluI rune lbatlhcubove lnt'annatlon is
Lm (•�• err tcl.1 agree m....nply with all it,:u I county nodmanees conA ,am low's.elming .
V to building consumctinnnnd hcmhv auhunic mprewnmtivcs of this city at curer upon
} the obtuse mentioned progeny for nw,,,tion purposes.
0. DVe)agmetowvc,indemnify and keep harmless the City of Cartoon againu
lr y liabilities.Judgments,casts and expenses which may in any way accede against mid �^-+,
U z City in amsey,mncc of the grant, of leis I,crmit.
AVPLICANy�INUIiHST N D N COMPLY WITf1AL1.NON-YOIN'r Issued b Date '
SOUR ffGU1 ,. Y
J:l—c'J GO
•Sign - (it Appliannt/C rumor Dal, Re-roofs
IIAL,RDOUS MATERIALS DISCLOSURE
Wel the.,ficammintim lmddiag,ccurana comm Wane haaaN"".material Type of Roof
as defined by the Capitation Municipal Cole.Chapter 9.12.and the Health and Sally
Cala Sectio 25532m)?
O Yca 0N" All roots shall be inspected prior to any roofing material being installed.
win me;,rphea;lt ar mlam ofildillg,acaganl use egnlpincit,or ties it es u1iia11 11'a roof is installed without first obtaining an inspection, 1 agree to remove
nil h;vnrduus Bir conennlanmu x.x Aclinad by line Bay Arca Air Chain,Management
dada• all new materials for inspection. Applicant understands and will comply with
ove. ❑No all non-point source regulations.
1 have mad I m harardnus materials myuiremcros order Chapter 6.95"f the
California Health At Safety Cale,S ns 25505.25533 and 25534.l understand(hot
ifthe building dlesum cumeady uvnL mail is my resrym..old,to notify he
ecupam of Ih regtlimmems w <he lou Mo n¢t rrinr m;..mute of a Ccnihrnm of
Occupancy.
If L( � Signu[ureofApplicant Date
'Ow— mleadxedag I Dale All roof coverings to be Class `B" or better
OFFICE