02060127 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
2221S RAmmnNn WAY PACIFIC POOL & SPA 02060127
OWNER'S NAME: APPLICATION SUB DATE
�
.0 TER 1517 FREDERICK MICHAEL W Y06/20/2002
% s 'PHONC: SANITARY NO. CONTROL NO.
' (925) 447-2242
0,-,- ARCHITECf/ENGINEEW BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
i L_7
S y Z LICENSED CONTRACTOR'S DECLARATION
Di- I hereby affirm that lam licensed under provisions of Chapter (commencing O
F.t with Section 7") fDivi,i.a3ofthcBusm"saadPmfeemalCode.andmylicenu ORIGINAL PERMIT 02050196
y is in full force and effect.
arc a License Class Liss REVISION SUBMITT y NO NEW RMIT ISSUED
Data Commnor
O�+ ARCHITECT'S DECLARATION
Y
of S 1 understand my plans shall be nail as public rtcoras -
55
t�r+0.ap O Lncnud Professional
n n. OWNER-BUR-DER DECLARATION
ttZ 1 hereby affirm on Ions exempt from the Cession is License Low for the
S 3< following reason.(Section 7onsum Business and Professions Code:Any city ar county
d F C which requires npermit to consumer,the ulcer,improve,Such
demolish,or mann any structum,
i3m ..pnono l¢nerve,also requires Neapplicantfar suchperndt micessigned auapter9 --- ._
(commencing 3.d pSecrm to he pfOni,sof she Cmareadue Business
and Pr Law(Chons Code)
/ /♦ S 1, alloI is V i a.. .,,...a.. / nation
Or that a ii rim 3kuon.]Bl andf Division 3 of the 9usiness and Professions Cale) (1 k -N TI ft,Sq S t.,3t l r-:' ea �4�: A 1.;!_N'
Or that he ii exempi,heicfrom'and the M1asia for the allegeU eiemp,iov.Any violation
-of
of moasoonreVthan
ahundred dollars($5 g)mit suhjecuthe epplicannoncivil penolsy- ITCUp anCy Type
01,as Owner of the progeny,or my employees with wages us their sole compensation, sie
will do,he'wmk:and the s.varure isnot intended or'offered'for sate'(See:']Bti', - --- 0 3 - UFE - - _ - --- - --,Beat..,and and Profcssions Code:The Cmaranm's License Law does not apply to an 104 - REBAR Required Inspections -
owner of Profit Who builds or impasses,hereon,and whod such k himself
orththough employees da that such improve re not intended .. 307. -.. POOL/BONDING.____;.._
p, eseA I If h e e�the 6 Id'�g ar imprnvemem s IJ olio one ye r f "'-"- -
01 - ROUGH PLUMBING O1v
im 'pl i n the.pane h IJ rwII have the M1uNen mpruv ng that he did nut build or ` '
imp ve for purynse of sole 1 '
_ _._._ -_..._ __. _ 304_ ROUGH__
❑I,vowner of the progeny,vin exdusively immresing with licensed contractors to --- -- � - ELECTRICAL-
pt ---- --- - - - -- --,_�,----�---
nswm he project(Sat 7tw4,business and Professions Code:)The Cammemr's 502 - FINAL PLUMBING ENERGY ""
License law docs not apply to an owner of pmpmy who builds or improves thereon 503 FINAL MECHANICAL ENERGY
..it he contracts-f such p nlecot w d omractm(s) IiccnuJ pomuam m the . . _.. .. _.._.
en , , r.LamaL 506 GAS TEST
❑1 ps dais ;B&FCforthis reason 1•s� l 'gr`sJ::
510 - FINAL PLANNING
Owner Date
WORKERSCOMPENSATIOYDECLARATION 511 - FINAL POOL
•:, .Ihachy-affimunderp!naitytnfperrvrrnnenfm.rnuow�gaeaaranm,a. 516 - FINAL BUILDING
.-r:e. 0 1 have and
will maintain i Ceriificae of Corsican to"If-brsum for Wmker'a
l: Compensaion. - provided for by Section 3700 of the Labor Cade, far the
pesfomndce of thE work for which this permit is issued.,
01 have and will maimnin Worker's Coin eniasion'Insurance,ai required by Seniori
3700'of the Labor Code,for she performance of the work for which this permit is
issued.My Worker's Compenmsion insurance canieranJ Policy number are:
d..r M...f�-.....i-....» ,._......._..
Carne 4. (sl - P :1"icy No .
f, - CERTIFICATION OF EXEMPTION FROM WORKERS';" :~s i. !.�1,!• 1 ri, t. L.Y a i rr�..�, _I t,'•!; f
COMPENSATION INSURANCE,"...' 1
I f Cion sedion`nced not M complctal J the permit's for ane hundred Aollua I
(81 W I or less.]
cnt that in thePerformance
1 I
.•„ Y pe in any manner
s work for which this Permit corker I
alai]tins employ any person in any manner so ss so become subject m the Workers' ` a f "
Compensation Lows of California Wm
ApplicanNOTt..' after
bec6 CE'10'AP.the We"""aRurri'm ng this nsism nte'or Ex.1hmC q you should •, .
becdme au oma m the Workers Compensation pmvisions of the Labor Cale,you must
ZQ forthwith comply with such pr�viIi.a,.,IIsis permitshall be dee med msaked. _ - -- - - -
� . .__ ....._ - _. - ___. .T_-_.... DA ._ .. - _ _-
t,',' •`s CONSTRUCTION LENDING AGENCY ` 1.s'
I hereby which that share is,issue sec. lending agency C.) for perfam,once ---
�"� Lethe kf which tM1.p a issued(Sea]09].Cis.C.) - `
Leede Name . .: . . .c._. :�. ._ _.. .._ ....... ...... .. . __.._. _. _. ._ _. .. .__ _.
_ Q"z Lend Addrc:. •• I ,u. ,}
_ .1 certify Thio 1 have read alis ity'anati o anal stainanc she above laws
man is
gss"�. coriect.1.gree to comply with all,cisy and county ordinances and stem Iowa rtlodng
"0-f, to builJing conswction,and hereby:outhmixe rcprcsemmives alibis city to enter epos
she above-mensiuned,"opicny for irsspecown pu,po.cs.
I (We)agree so save,aiulem'mty and kkp harmless the City of Cuperinm against
Vi liabilities,judgments,cost and expenses which may in any way accme against said
V.Z. City in camequence of the grommet alibis permit' n APPLICAN'TUNDERSTANDS AND WILLCOMPLY WITH ALL N6N:POLNT
SIssued by: Date
SOURCE REOULATIONSI a";',
&gnumre or ApplacHAZARDOU ; A ;'Uma , Re-roofs
HAZARDOUS MATERIALS DISCLOSURE '
' Nall the pphcansor future buaWing Oce pant storemhand.c harWaus material . .'gyp&Of ROOF _
' ns deft ed by she CLpcn nn M ,pal Cale Chaps 9 12 and,he Hcahh soil Safny -- 1
Cale.0Yeg255]2la) Otho: .v.•sI - ...�i� to s'o4•t rs'i 1. is [^ f %11 h5
All roofs shall-be inspected prior to.any roofing material being installed.
,Will tne.appLcaptormwrtn�Ecingoaeupa�t-uscequlpntentnraeviceswhice If a roof is installed without first obtaining an,inspeetion;I'agree to`remove
emit hazardous aircomamiwms.as defined by she Bay Area irQmlity bfanogenem
Disbar? all new materials for inspection. Applicant understands and will comply with
uY. poo- " - all non-point source regulations: _
1:base read the haziNoua materials rcquiremems under Chapter 6.95 of the -1
California Health&Safety Code,Sections 25505,25533 and 25534,1 understand tion
'if the building does net currently have a ferant.shut it is my responattlty to mail,the
occupant of the mquincritems which muse be a es prior so issuance of a Certificate of '
�, Occupancy. ..
-trSignature_ of Applicant Date
owas,or nuthonzeAagent Date, All roof coverings to be Class `B" or better '