02060098 ---a�_ CITY`OF CU
PERTINO " "" ' - -
BUILDING DIVISION PERMIT CONTRACTOR'INFO TION:`'�
BUILDING ADDRESS: PERMIT NO.
10325 VIRGINIA SWAN PL SWAN POOLS 02060098
OWNER'S NAME: APPLICATION SUR DATE
. ARNAND PERRIER 1495 S WINCHESTER BLV 06/17/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 866-6893
{u O O ARCHITECr/ENGINEER: BUILDING PERMIT INFO
2FetoF BLDG ELECT PLUMB MECH
Z w= LICENSED CONTRACTOR'S DECLARATION Job Description
OZ_p Ihon7000fimvhmlumlicensedIress ndProretionsCmr9kommecense NEW SWIMMING POOL INGROUND
P�tu� with genion](IW) f0i ision3ofshe BosinessanO Prolcesions Cola and my license �®
55 Lin full force onJ eRe t. s®����
O T U License Co h F
Dam S GECclo
Su O�' ARCHITECT'S DECLAR ON JAN•D 7 2003
N M} 1 undersand my plans shall be used as public rccoms
y i O O Licenud Professioml
ROWNER-BUILDER DECLARATION ' ^,�`/�
I hereby affirm that[am exempt from the Conooctors Liesnue Law for the B�'dyI�N V V_
�
following miss .(Section 70313,Business and Pssions Code:Any city or county �IP
F❑ which mquimsrofe
a permit to canstrun.ahe.]let. :femolish.or s°Waw
ir any eture.
3� 'r-1-1,101
rions issuance.also rtquims the applicmalor such pcmdtmfile signed smmmeot.
tlprhyis�ittng)nvede
pueuant tq(h pryvRions of the ContractPrs Littnx ldw(Chapter9 �a� �f rC1,Ip� p�,s1 S T] ' Valuation
(comm<nSxsion]OD�I)of Division Sof the Bulifless and rplepeions Code) L�IJl"f') ]- b�9+y:CvtJ(T31��s'A�°AE I�� s
or thai he ii exmp("aref"On and the basis for Ne elljgcd elemla�a.Any violation
-of Secua m703 LS by any applicam for a permit subj«ts the upplicem to°civil penalty Occupancy Type
of nor ..dotFvehundreaaanantssW). 1O3APN�ifpp�er I:��rc,rre-
°1 asowner ofthe property,Lir my employees with wages as sole compemovon. '
will-dothe wo k-and the strucmrt-ns-not intended or offered for sale(Sec 7044.-
Business
043.a a ei and Professions Code The Contractors License Law does not apply to an 107 — POOL/BONID IAW@d Inspections f- ')f mrF
owner of property Who builds or improves thereon and who does such work himself
or through his own employees.provided thnt such improvements are not intended or 301 - ROUGH PLUMBING
-"'afkrcU'fP' I Ifnerhowever,- lhlllhav building-or p - -nt '- Id within notb of'or •""--'
304 — ROUGH ELECTRICF>L".:'�� � ' " '•
Iomplei an the owner builder wiu nage he Women or proving mm he nm not Homo. - "
mprove for parFOseofaala). 502 - FINAL PLUMBING ENERGY
__ .. ._ _. __-_- -_.._.
omot n ,f the property .Business
a rommcuni;o,Com:)
Card ten t° 503 - FINAL`MECHANI CAL' ENERGY ... n <.t
conswn the project(Sec ]OMT Business and Profess ons Code)The Cn Chemo s f. �,
,
License Low does not apply to an owner of property who builds or improve thereon, 506 - GAS TEST "
,.Lind who.cornracu.for.such.projects with.a.commcmr(s).licenud pvrsuenLm Ne ._ _.___. I
—_
`. License Law. u:'.,•.. ,. : ,.:`.;;sass. --- - LANN- N - _ -------_ --...- ---- --
- r_ Contra rap! Sce` ' ' ,B'&PCfor this reason - 0 %!E"iiy;GflU'1
°1°m`xem 'q", , 511 - FINAL POOli
- owner : '.' n:D' 'Date 516 - FINAL BUILDING
WORKER'S COMPENSATION DECLARATION
1p' -I met,affimt ander parm yof perjury one ofthelollowingdedamtima:-
!' : 0 1 have and will'rtiainmin a Comficam of Consem to self-insure for Workers
Compensntiun, as-providcd for by Section 37W of the Labor Cale;forhe
performance of the woh for which this,permit is issued.
. . fl
c and will m.irmin Work rs Comp romlo Insutlr �'ai required by Section
700 of be Labor'Cade,for the perfomance'of thc'work for which this permit is
Mist d My W tiers C pe t Insurance rand Policy be e
�. t y: .... .: -s. ..- t� TT sass .. _ ., ...._-. ....__.-_.-....-.....
C rlrPOhcy Na s �' i3 � f. A° ts: y\y-I 9' y .t ..w :':I dll:
I11CLkTIFlCATION EXEMPTIONATWORKF.ItS j+ ' 4,1,J" t q_eI\y.j b t.fa' t`s y..�o )
L.44- .. - COMPENSATION INSURANCE• x L -I - 1 •`
"iThis se t'Jn need not he completed if the permit is far one hundred dollars '
Ig l W)or leas)
sh1 c mfyvNnt nth pert ee of te ark for worth this perm t 1'is ed 1. i
shall am empl y any Pe y n r u to be orae suh)e t t theWork n' rqu ' •x. ,.tl:-
ma S ///
C mPa erten Iowa of to.
.Da'e/
APPhcant AAAA ���� _ -
NOTICETOAPPLIUCNT'If efxr//::ssddkm6 thisCertificate f Exemption,y should �- �- -� ��_ � -_ -- '- -, -- Cl Fe,..I- -- ---
Q Qtieeo s b)ai m th Wo kers C' n s Wpm sons of the Labof Cod y m s ( `
fdnhwnth comply with' h pro i.tons nr N s pe 1 shall b<dee ed re ked
r _ . _ - __ ___ _- __ - __-.... ._ _. .._. .
a;; affix CONSTRUCTIONLENDING AGENCY < �— - - - t
I ask
which that there rs a tori Ira non le d ng agency(or the performance'
W Q Of
mk far which thinmotca Issued(S 9119],CN.C.) -
Lender s Name-.._ ._::. sur.. _._.-__. .. _......_. _ __ _
Lender's Address
V � 1 certify fy that I have mi
ad this application and stme that the inane information id
correct.1-gree to comply with all city and county mi inancas and stem laws relating
to building construction,add hereby nnthmi°e mpmseotatives U this city toemer upon
r;W th h e veil property!r inspcct purpose"
.
...y.yl (Wel gree to mdorihifypnl step h Icss'1hc CFof Cupertitohirtiry
V]
liabilities,j dg its costs and expense which ha y in any y ccrue gains said
City eco . q ntt oP th granin of th
pe nt ^
APPLICA UsyUERSTAt S I, )WI COMPLY WITH ALLNOsl Ppoi Y� I !
SOURCE cui:AnDNsfrl/ Issued by: Dat
Scm'App]icon vc r nate Re roofs
` HA VC ,
he
DISCLOSURE •"
WjllN -plm or, Wild Or hadleha>yde'-mmmnal -•—Type of ..
udefad by th Cpm M s 1Code Chapter 912 Mth Health Rod -- --._._,,._-.__- «_+,�� ...«._.'._,
code oY, is; x(ad?t ") 6 '.f+ ', a - Sf' :Q)AAf.i`t s';?1'1.?J-A 1.1Cq:'d: %:,:t!
_ _',�',Y l ,• t"t t All roofsshall be inspected prior to_any-roofing,material being Installed
Will the applicant or future building Occupant use equipment r devices which a^ _-- -
If aroof is installed without first obtainin .aurins ection, I a ree to'rerrove
em t h aoln,o r co t m -its as dented by the'B y Area Air Quid ty Management g P g
Dismet?,
- ❑Yea ,:renes- �� all new materials for inspection. Applicant understands and will complyrwith
all non-point source'regulatlons,
1 heve mad',the haZnfdIR,mat...1,req rtmcnts under Chapter fi,95 of the
QaLfomm Heanti&Safety Cade,Sections 25505;25533 end 25534.1 undcasand that
if the building does not currently have tenant,that Itis my responsibility to notify the .-�._. ._. -. - _..- ...... .....__-- .. .-..._.
ILI
occupant nt tti qusements�,whic t un b met prior to is voce of u Certifies.of `f
G" p Si nature of Applicant Date
�'I�(f� g__ _. . PP. . ... .... . . ...-- -- -_ .
a,age All roof coverings to be Class B or better
L � ..-_ .._... __. -. . : ...: '--t . - _..OFFICE-.. -----
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