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C4NTRA.C"fOR°'INF'ORMA"�IQN '
BUILDING DIVISION PERMIT
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L,:,"'C"NNGADDRESS:
PERMITNO.O 5 0 6 019 9
0.'SNAME:
PERMIT L$UB DATA
MENLO EQUITIES
6
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SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
LICENSED CONTRACTOR'S DECLARATION
Job Descri tion
1 hereby artim that I am licensed under prevision of Chapter 9 (commencing
P
with Section 70(k)of Dlviaion 3 ofthc Business and Professionsdmy Eccesc is
mmumreean ertett�p eI!
r 3
License Clas Lie. N
Dae r' contrata
NEW COMMERCIAL POOL.
CONTRACTOR: CAREFREE TOLAND POOLS
ARCHITECTS DECLARATION f3'
I umicrmad my plaw.hall be used as public recurds
Licensed Professional
OWNER -BUILDER DECLARATION
'
I hcrehy affUm that 1 am exempt from the Conu.ctoes License law for the
following mason. (Section 7031.5, Business and Profcainas Cmtet Any city or county
which re4vire3 a Permit In construct, alter. improve, demolish. or repair any mature
prior in its inuance, also requires the applicant for such permit to Ole a signed statement
that Ito is licensed pursuant to the provisions ofthe Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valu4ft 000
(commencing with Settled 7000) of Division J of the Businessand Professions Calc) or
the he 0 aumpt Therefrom and the basis for the alleged exemption. Any violation of
ApN Number
Occupancy Type
Section 7071.3 by any applicant for. permit subjects the applicant to a civil penalty of
not more than Bw hundred dollars ($300).
31620084.00
01. a owner of the property, or my employees with wages se their sore compensation,
Required Inspections
er's
will d9 the work and the suucture is not intended or offered for sale(Sec. 701( Business
and Profession, Code: The Commences License Law does sot apply m an owner of
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property who Wildstar improves thereon, end who doessuch work himself m through his
own employee,. provided thnsnch improvements art notin,Med "offered fee seta If.
however, the building or impromnent u sold within one )ear of completion, the owner.
builder will have the burden of proving that Ise did not build or Improve for purpose of
ale.).
0 1. as owner of use property, am exclusively contracting with Ilmu sed convaaon to
concoct the project (Sec. 7044, Business and Prefesslom Code:) The Contractor's W-
mame law does not apply an an owner of propeny.who builds or improves thereon, and
who contracts for ouch projects with a cm ncw*) licensed pursuant m the Convector's
Lt.,. Law.
❑ 1 oro exempt under Sec. . B & P C fa Ni. mann
Data
WORKER'S COMPENSATION DECLARATION
1 hereby .Rimm under pcaaity of perjury oro of the following declarations:
!ave
1 and will maintain aCeNBcam of Consent m self -Insure for Worker's Compen.
"tion, as provided for by Section 7700 of the Labor Cede. for the performance of Ne
work for which this permit is issued.
'It 1 have and will maintain Water's Compewdon Iesu m. as required by Section
7700 of the lsbar Code. fa the pcofarmmca of the were for which Nu permit is beemd.
'
My Worker's CpnmpnueOon lnsunn-a/ cosier andel PoolivcypnumW are:
tinier. fr07-r— FU /V t, PabgNp.: 0�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section dead not Wcumplced If the permit Is for onchun lmd dollars ($100)
or lca )
I certify that In the Performance of the work for which this Permit Is laced, I ,hall not
employ any person in any manner an as m become subject to the Workers'Compensation
Laws orC lifomla. Date
Applicant
NOTICE TO APPLICANT: If. after making this Ce tificate of Exemption, you should
We= subject m the Woftes Compensation provisions of the labor Cade, you most
forthwith comply with such provisions or this permit Mall be deemed meted.
CONSTRUCTION LENDING AGENCY
I hereby affim that Vert tea construction lending agency for de performance of
the work for which the permit u mored (Sec. 3097, Civ. C.)
'
Lender's Name
,
lander'. Add.
1 certify that I have mad this application and mm that the above Infomation is
cortett 1 gree m comply with JI city and county ordinances nd sure laws mining to
bulIding cpnswcuon. and hereby authsria representatives of Nis city to enter upon the
above-mendoned property for Inspection purpoYF
(We) at is ave, indemnify and keep bermlea the City of Cupertino lt
Oebilide.,Judgmenu.cosu d expewes which may In my way ettroe sgtlnn�dCy
to conseq of Ne gran n f tPLIC NOER D L COMPLY WITH ALL N
Issued by: Date
SOU UL S. / iIO�
Y
Re -roofs
Type of Roof
Signaure of Applman omne r M
H RDOUSMATERIALatno.orSURE
rMuni building ocaupantvoreor hand h owmateriai
Willsheft
a defined by de CupeNno Muniripd Code, Chapter 9. 12. and the Health and Safely
Cupertino
Scene. 25572(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yes ❑No
If a roof is installed without first obtaining an inspection, I agree to remove
Wilt the applicant of future building occupant use equipment or devices which
emh hasmdnw air conuminans as defined by the Bey Ama Air Quality Management
all new materials for inspection.
District?
❑Yw ONu
I a case>eMims materials requirements under Chapter 6.95oftheCelifor-
nlaHeal ryCsdc d ,23373 am125514.1 dthis We Iding
as din
duo, o y ha use is my mspoasihlliry m notify the uP of the
mqu on ieh me miauancesf cerafiesmarOc ane
Signature of Applicant Date
/
All roof coverings to be Class "B" or better
e ar,atnn : dog Date