06030070 CITY OF CUPERTINO �
BUILDING DIVISION PERMIT CONTRACTOR�INEORMAT .
BUILDING ADDRESS: PERMIT NO.06030070
11631 UPLAND ROAD
OWNER'S NAME: PERMIT ISSUE DATE
06/15/2006
,WE SANITARY NO. CONTROL NO.
ARCHITECnENGINEER: BUILDING PERMIT INFO
BL ELECT PLUMB MEC"
u00 LICENSED CONTRACTOR'S DECLARATION
C F I Wreby affirm Nu I am licensed under proriaiou of Chap...9(commencing Job Descriptio
`ZtV wiNS c6on70f10)of Division3ofN Bwtinessand Protmiuu Code.andmylicenwu
"'Co, mfmilforteandefr I NEW SWIMMING POOL AND SPA
DN? Licen Class Lic.P
-Fp Da Camrw.nurg '
W HTIECTS DECLA ATI N
�< I understand my plans shall be '< cm
JyU
t
'0,S Licensed Professional v
OWNER-BUILDER DECLARATION
I hereby slam
that 1 am exempt from NC Contractor's License law for the
p O following ream..(Satian 7031.5,Business and Professions Ccdc:Any city of county
m f+ which requires a Permit to construct,alter.improve.demolish,or repair any sweture $60000
-2Y prior to its iWUMCC.2JS0 RgUI1e5 the appllCNl for Such Permit to lie a signed smanern
< Nat heis licensed pursuant toNepmvisimuofthe conuxmr'sLicense Law(Chapter 9 Sq.Ft. Floor Area Valuation
x�$ (commencing widt Section 7000)of Division Sof NC Business and Prefessinna Coale)no
`<
that be is exempt therefrom and the,hub for the alleged exemption.Any violation of
Section 703"by any applicant for a permit sabj¢s the applicant to a Chit penalty of Occupancy Type
not more than five hundred dollars($500).
❑I.uowner of the propcny,ar my employees with wages uduv w4 cmmpeuadon.
will do Inc work.and time structure is not intended or ORerrai innards,(See.'/ .Business
and Professume Code:The Commences License Law does nut apply to on owner of Required Inspections
property who builds or improves thereon and who does such wort himself or through his
awn employees.provided Insomuch improwmats are not intended ororfered forsale.If.
however,Ne building or improvement is sold within one year of completion,the owner-
rudder will have Ne burden of proving that k did Out Wild or improv far purpose of
comma
I LE
❑1.as owner of Ne property.am esdesivdy can ing with tissued common b -
couw'Urt PrvZ (Sec.](N4,B massa 'ons Ca4:)The Cooaracmes Li-
Co.Law docs not apply w an ow Wilda or improves Inamon.and
who contracts for such projees wi a)kamsed pursuun w the Conaraencr'a
License Law.
❑I am uMap%under See .B9 PP fro this nu an O.V rs_"� ! [toot
Owner Date mAi� ///fes q pp ppp �C1� qp
OM SATION DECLARATION10 1(JJ W la Id IT a y
1 hereby a0iw under penalty of Perjury one of tire fallowing declaratiou: }3��J M1711GiWx$lf�iJp LUC9 3f�dl_Yp��[tply
I hsw and will maintaina Cenr3emof Caesentwself-insumror Wor &Compcn-
NG
ration,as provided for by Section 3700 of the Vhor Cade,for the performance of the
work for which this permit is inued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor GOO,for the performance of Na work for which this perno,Is issued. '
My Worker' C 1 carnia and Policy number are:
Cartier. /l.l gl�y No.:
CE0. Fl ATECIF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
That xctionncednotbe completed if lh nit anehundredca lan($IM)
or less)
1 certify Nm in the perform c mf ch Nis permit u fssned.l,hall not
employ any person in any c 'e I I.lW worked compnsatian
Laws of Califomi
ADPlican
NGXICETOAPPUCANT: L afwr making Nu CcniRaw of Ewmption,you should
m
becoe subjects Compewoien pwvisimu of one,Lahnr Code,you mum
.J O forthwith Comply with such provisions or this Permit shall he doemed mwkcd.
Z7) s CONSTRUCTION LENDING AGENCY
[-� IWreby affm that them is a construction lending agency for the perfurmunce of
athe work for which do,permit u issued(Sec.3097,Civ.C.)
W�Q
lander:Name
Z:)z Lender's Address
U 0 1 Certify that 1 bass:read Nis applicado.and state Nat Inc show information u
ly, COMM.H )agree to comply with all city and county Ordinances and rote laws relating to
O[, building conswnion,and hereby amhmim represcnmlws Of this city to enwr upon the
H ashove-mentioned pmperty for inspection purpotes
(hoc)agree to taw,indemnify and kap harmless Inc City of Cupertino s admit
lZl liabilities,Judgments,costs and expenses which may in any way access against said City
V z in couequencc Of the gnntin6 of this pcmit. r
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 6— Tti 6
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signature of AppliesDate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willthree VOICart Of yteC.,mgp_Murt Wilding acuhaptswreaand Health and
u defined by Ik Cupeni Mu ' al Code.Chapter 9.11.and the HCaIN and Sa(cty
Code.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
Yes o
If a roof is installed without first obtainingn inspection,I
Will Na applicam or future building aaupam esu cquipmcot m Jevicu which aagree to remove P
cmh lt-a ra air comaminane as dc0ned by Inc Bay Asa Air Quality Management all new materials for inspection.
Disarm''!
❑Yes
I hawre ds, ANousm "aisrequimmcOsu.drChapwr6.95ortheCalifor-
niaHcalNASarc Cmde,Sccti 5,25533v 25534.lunWc dNaifth Wilding
does not[urmndy ow a w 't is my ruporuiMlity w Iwtify the accupaot of Inc
requirere swhie issuance of a Cerdf a
Signature of Applicant Date-
owner or 0 rot D,w All roof coverings to be Class "B"or better