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01040149 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDIIESS: PERMIT NO. 1103 ELMSFORD DR SWAN POOLS 01040149 OWNFR'S NAMI?: APPLICATION SUB DAM SILVERMAN, RICK 8 MARY t495 S" ' WINCHESTER E V ' 04✓26/2001 �I PHONF. SANITARY NO. CONT BUT.NO. (408) 866-6893 O O ARLIII'I'[CUFNGINEER: ' BUILDING PERMIT INFO �E+ BLDG ELECT PLUMB MECH/ F i ¢n LICENSED CONTRACTOR'S DECLARATION Job Description m� I heron IHnn,ha I am licensed MnJer i on>of Chat 9(rnmmcncin p�=' Ya pow si per g — F'3Cm with Smaion7lXXp,fDlvid nJof,he HMsmcan:uaA Profcxsions Code.undm licemm fix» in haliduarce 3 SWIMMLNG POOL. E:.�'a Licen¢Class Lic.p I IC 3 h Uam 8_�_( Sommctor� 0 ARC]II'l lI d,dl)ECLAI ION �r E LL O S 1 understand my plans shall be uxJ as public mcordx E�N e. p 5p Licanwd Prnline. .nionW Jut 20 I here.affirm that 1 1. exempt from the Contractor's License law for me 1 9 C a following mason(Section)NLS,Rosiness and os.dhaaal C,or Any city naeur ne, G O Which mtsissune.also re amanhealter. for such permit Bre a signed ig on,tuement W that hor n sfiv issuance.ab ant to rhe that applicantnofor Coop aien License gne(Chaps ant mane criarnnNpunh." 'hofhe Emissionsofthe it,Busier%Licensee Lse awn,, ode) S Ft. Floor Area Valuation or that he I,exempt with Section i..I and a baton.of the Bmloess:md Pndan,vi Aide) q' , drat he a b .,I,apon and me Examit thm,dlaged mxetmptiatt.any violation - $254417) of section 7031.5 by any drol d nt for a pemnit sMnjmctn the.applicam v,a civil penalty ornm mare man fine nnndara sonars(asro). APN Number Occupancy Type ' ❑L as owner if me pct,pony.or my cmployccn with wages as their sole comfismatlon. 36206006. 00 Will do the work,and the structure is not intended or offered for sale(Sec.70TU Business and Professions Code:The Contractors License Law dues not apply u,an Required Inspections alov,of properly who builds or Inrpmves them I.and who does tach work himself or through his own employees,provided that such improvarems are not intended or 103 — UFER offered for sale.If,however,the building or improvement is sold within one year of ,rnpinaon,d,e owner-builder will have the burden el proving he,he did Bol bnild or - 104 — REBA R impmm Ito pmp„mofnnlc.). 107 — POOL/BONDING ❑I,as owner of the progeny,am exclusively contracting with licensed contrmunvu, 301 — ROUGH F'LLItdBIPIG Lmanrc't,he projce,N,a.7M4,Bmincsx and R'oleseiona Corel'Ilie Cu imctnr's icense Law does not apply to an owner of property who builds or improve.,human. 304 — ROUGH ELECTRICAL and who contracts for such projects with a c.ntmaort,)licensed pursuant to the Co"`'1`'11`1 ucen`e Law 502 — FINAL PLUMBING ENERGY ❑1:no exernm under Soc. .it&P C for this mown Owner Date 503 — FINAL MECHANICAL ENERGY WOR KI;RS COM 11I7NS A]ION DSCLA RATION 506 — GAS TEST 0 Ithereby affirm under penallyolpeinryonenfherolmwin,dumamerec: 51.0 — FINAL PLANNING _ ❑ I have ami will ri dmam a Cenificam of Consent n sell-i-me tar Worker. 5].1 FINAL FOOL Contpmasaion, as.provided for by Section 37H) of the labor Code. or ,her perarromeeofthe work tarwhich this permit is inxned. _ 516 — FINAL BUILDING . ❑1 have and will maintain Worker v Compensation Insurance,as required by Section D7W al the Ln Cu,ll:,for,nc mt perfaance of the Work for which,his permit is issued.My r, rr�mnsaion ln.wmnce carrier s/d Pct'y nuns O are ... t Carrie( Policy Nn: 3( 0 cBRriricATION OF EXEMPTION FROM WORKERS' COMPHNSAI'ION INSURANCE (This section need not M completed if the permit is for one hundred dollars (sl W)err less.) 1 emify that in the perfomunee el the work for which this panni,is issued,1 shall no,employ any person in any manner m as to broom subject,o the Workc d Compumauon Lnws of California.Dote - Applicant NOT ICF TO AITLICAN'C If,almr making this Cmificmm of 17 cmpti.......hould becoe subject o)he Workers Compennat inn provision,of the lamast .1 bor Code,you O Qm bod' h Comply wlh nal,pnrvixien,or mit in permshall he J,enood r'cvoked. - z R fA CONSTRUCTION I.17NDING AGENCY > 1 hereby affirm that then:is a construction lending abency for We perhmmamce , Gs7 of the work for which thio'perml,r,,,,e,d(Set.3097.Ci,C.) 6. f] Lender's Name = z Lender's Address fs, O correct. candy that I have read his application and nue Ina the above rommutlon is rrect. F., I blare to comply with all dry and county ordinances and state laws mlming to building nnaater,and hereby bahorlzc repmsemes of this city to enter upon m . W eahove-neematie mionc,l IF oy far Innlx'Crm,pummel. 1.., L (We)agree to save.indemnity and keep hamnleo the City ofcupernno against (A liabilities,judgments,coos and expenses which may in any way accede against said U z City in cor,o nence of the graoin,of this permit. APYI fANT UNIJERS'1'ANDS AND WILL COMPLY\YITH BLL NON-POINT ., so'R r R Gu ill(v Issued by: Date Signarum of npplic HA7A DOU Dam Re-roots HA]�Rnum MATERIALS DISCLOSURE w,n me a Cupp t or rMnre Municipal Cl occupant a„m 2,and the ba amaan material Type of Roof as def Bed by the Cupertino Municipal Gxlc,Chapter 9.12,anA the Ilcxhh and SMlny Cale,section 255121a); • D Yen 0 N All roofs shall be inspected prior to any roofing material being installed. Will the applicant or rams hdddiagtecupam„w cgn4,ttrem or devloes which If a roof is installed without first obtaining an inspection, 1 agree to remove Boit hazardous air contaminants as defined by the Hay Area Air Quality Management P g D,alkl?vel ❑No all new materials for inspection. Applicant understands and will comply with all non-point source regulations. 1 have mad the hazardous maedals resItion nus under Chapter 6.95 blithe California HCz11h&Safely Core.Sections 25505,25533 and 25534,l understand that Ifthm heildinl Anus not currently bum a tenant.mel it is my respansmila,to notify the occupant in the re,rvircmems which must M met prior to issuance,of a Certificate of . (kc tory. I�oS CKz 'l-u-01 Signature of Applicant Date Taxer or,aumorind,Lenr Date All roof coverings to be Class`B” or better OFFICE