00080043 (2) CITY OF CUPERTINO - •PERMIT NO. - -
BUILDING DIVISION PERMIT - C,®NTRACTO IINFOg RIMATIOg N:
BUILDINGADDRESS: .
SANITARY NO, APPLICATION SUBMITTAL DATE
OWNER'S NAME: ROYAL POOLS INC OF SANTA CL 1RA00080043
N/C CONTROL#
• PHONL: ' FABR_IZ'IO TRNI 2258 CAMDEN AVE_ 08/07/2000
ARCHITECT YGINTER IffillwTULDINQiPERMf111NF•O
ooa 4083718000
z.~O u=Ni� LICFNSEO CONTRACTOR'S DECLARATION
1 hertby aRem Net I un licensed undo provisions of 9 rommercin
o i—o Drawer ( g - Job Description
F=Cw. with Section]000)ofD' ion3oftheBrsinmsam Profmioas Code,and my limnsei,
44 infullfiou'del w
ffi ' Limn „` tea« 1 NGROUND POOL IND,, PA
convac n ,
ARCHITECTS DE
I Understand my plans shall be used u public recasts
ce
cee Licensed professional
— OWNER-BUILDER DECLARATION s
G 1 hcrtby anion that 1 em exempt from she Contractors License Lew for Ne
❑ following mann.(Saban 7031.5,eusimaa and Prof imu Code:Arry city m county s
ou
6$ which requirts•permit m cmasuun,alter,improve,demolim.or repair any em#.me S FL Floor Area
Prior i its issuanm,alad requires the applicant fmauch permit m fil...igmdel mment q' iluation
that he is licemesi Wnwm 1.the provisms of the Common,.Lkenu law(Cte um 9
(commencing with Section 7000)of Division 3 of the Business and Professions Code)or '
Nal he is exempt therefrom end the basis for the'.Ikeed exemption.Any violation of APN Number Occupan' —
Session 7031.5 by my applicant for a Permit subjects the applicant to a civil penalty of
not mart Nan five hundred dollar(#500).
I,aeowrcrofNeproperty,mmYemploymawith wagmuthcirwkcompewtian, 3561.`'iID�SLuL Inspections
will doth.wmk,ands:Thumum iismt immense La neo s did apply to a0,Business J
• and profeednns Code:The Convacmr'v License Lew does not apply m an owner of
his o ny who build,or opmvm thereon,end who dms such wmk intended
or or red for
his own employe.,Provided r improvement.rove It old w thin nm inteeded m alarm fm 103 — LIFE R
ge.amer- ildever the buil ding redof It sold within omywofmmple fon,the -
pwm.f.k.) was neve theMtMendprtvingN.tlerianobonamimprovefmpm- _ ' 7.04 — REBRR
pose of mums
❑I.as awn«of Ne pnapenY,thn mem,ively contracting with licensed Gmvadtai m 107 — POOL/BONDING
conetrvm the project(So..7U5#,Buli..,and Pmfesdom Code:)The Convectors W- 3P.11 — ROUGH PLUMBING
cents law dom.ml apply to an owner of property who builds or improv.domem,and
who contracts fm such projects with v courn n licensed puoundo he or Comtr.Gmr,
Licen304 — ROUGH ELECTRICAL
. se law.
❑fess exemptrnder Son ,BkPCfmthiemman 502 — FINAL PLUMBING ENERGY
'Owner Dthe 503 — FINAL MECHANICAL ,ENERGY
WORKER'S COMPENSATION DECLARATION 506 — GAS TEST '
1 hereby M.under penal?of perjury ons of the following doe amtima
01have and will emirmun a Certificate ofConsen,to self.m,rm far Waster.Comped-
510 - FINAL PLANNING
svtionlas provided for by Section 37W of the Labor Code,fm the Performance of Ne „
wa for wMchthis
permit iaiasmd. • 514 — FINAL POOL
I have Lod will nommin Worker's Compensation Insurance.as required by Section
7 ofuh Laborcae.forNype amth earNewarkrmwmenNiapmB i.rm. 516 — FINAL BUILDING -
My Wmk 'scum ion 1nArtheG carrier and Policy m
center: Policy No.
C 1 CAIS OF EKEMPDON FRO WOR 4 S.
COMPENSATION INSURANCE
(This section need not be completed lose pemut It for me hundred dollen 15100) -
Or less.)
1 certify that in the performance of ted wmk for which this,eoi t is issued,l"I
I
not employ any person In my mvoner so as to become Nbject to she Wortma'Cotentin-
muchLaws of Califomie.Date
Applicant
NOTICE TO APPLICANT:If,after making Ni,Certificate of Exemption,you should
• become subject to the Workers Compensation provisions of the labor Code,you must
foMwith comply with such provisions or this Permit ludl W droned Media, m
CONSTRUCTION LENDING AGENCY
t Ihereby offtim Nat them is a cunswedun lending agency for the,perfrmunce of
the work for which this permit is issued(Sec,3097:Civ.C.)
Ea h Lenders Name
C4 > Lamer,Address
W — 1 certify thu I have rem Nis application and orateNat Ne above information is '
0+ correct.l More to comply with all city and county oNinances and aim laws retiring m
V O buildingcom ucdon.and hereby thorieem
you ores. uvea o(this city upon the
above-(We)a re progeny for mocify an loss purposes. -
ts E. (We)agree i use,indemnify em keep harmless the City of Cup.nina egevut
V liabilIn, )W n¢emuands.penmswhichmayinany w.Y ammeagainsl mid City ,
�t L in conuqu cof Ne gmmneof ria permit.
V
Lay)
AT LIP T STANbS AND WI.1•Cb PLY WI DI ALLNONPCINf .
-S tl :µEC I11dT1U '
Si natmeafApplic he ate
NA
MATERIALS DISCLOSURE .
Will se vpplimum1futum building occupanrurneorhmdlehiond......did Re-roofs - w
sa drfined by the Cupertino Municipal Code.Chapter 9.12,and the Heald and Safety
Code,Section 25532(a)7 Type of Roof
❑Yes QNo
Will the applicant or future Wilding occupant use equipment or devices which All roofs shall be-inspected prior to any roofing, material being
.mit nemAoba air commnimms a,defined by the Bay Arm Air Quality Management installed. If a roof is Installed without first obtalning'an inspection
District?
0 Yes n Na I a ree to remove all new materials for inspection. Applicant
In. ,<„�e,i,,,,rr„mit.;,,,mqr;m,,,e„ir,,,e,�7,apm,b.,SnrN.G.li- understands and will comply with all non point source regulations.
jd�i"dcam
thk Safetycode,Sroces25305,25533end25530.1underman thatifthe
ecu by vee nam uritis yr.pons' .notifyNemcupant 1 menu cove et 'm m' me of c Rc Inde
rar.rdons •�-fI f/ Signature of Applicant Date
Be am
All roof coverings to be Class"B"•or better .
OFFICE