03010099 (2) CI'rY OF CUPERTINO a " � " ..,
BUILDING DIVISION PERMIT RCONTRACTO,R�INFORMATION: ..
BU HAA NG A DDR ISS: SWAN POOLS PERMITNO.
10506 MANZANITA CT, 03010099
WNCR'S NAME: 1495'5 S WINCHESTER BLV APPLICATION SUB DATE
MIKE DANESE O 01/16/2003
PHONE: 408 866-6893 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
00 LICENSED CONTRACTOR'S DECLARATION
y V I hereby infirm Nm 1 oro lowed under provisions of Chapter 9(commencing Job Description
with Section 7k)(oof Division 3of Ne Businessand Prom.Wons Gyle,andnry licenac is pp
m I'II1dncand 11'cc
' Eqz Liu � >.� �yg $ NEW POOL & SPA lFAeYQAL•
ED
ZOg„ Dmcnsc Claus. _ Cann
F_tt,El oam_J CCommctur INGROUND 525 SQ. FT. GUNITE
AR'hall he ne DECLARA ON APR 2 1 2003
A��t Iundcr&tanJ my plans shall he used as public rccnNs
dOyU
t�+FLL0 Licensed Professional ,
OWNER-BUILDER DECLARATION BUILDING
<2 1 hereby affirm that I am exempt from Ne Contractors License law for the
ad 00 following reason.(Section 7031.5.Business and Professions Code:Any city or county
a�$� which requires a Permit m conatrva,duet,improve,demolish,(ir repair any structure
'^
now to its issuance.also$quires lheapplicam forsuch pera lm file asign,dnalemcnt
that he is licensed pursuance the provisions of the Character's License law(Chaper 9 Sq. Ft. Floor Area Valuation
�$ (commencing with Section 9000)of Division 3 of the Business and Professions Code)or $35000
y R§ that he is cations therefrom and Ne basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit aubjeca the applicant to a civil Occupancy Penally of
not more than nee hundred deltars cutin). 34261028 . 00
ApN Number 0 l'Pe
p1,as owner of Ne property,or my employees with wages az their sole compensation,
Will do the work,and the structure is not intended or offered for sale(Sec.7140,Business
and Professions Code:The Contractor's License law does not apply to an owner of 103 - UFER Required Inspections
property who builds or improves thereon,and who does such work himsel for through his
own employers,provided that such improvements arc not intended or offered for spin.If. 104 — REBAR
however,Nc building or improvement is sold within one year of completion,the owner. 107 — POOL/BONDING
builder will have the burden of proving Nat he did not build m improve for purpose of
dale.). 301 - ROUGH PLUMBING
❑1,as owner of the property,am exclusively contracting with licensed contractors In 304 - ROUGH ELECTRICAL
construct the project(Sec.7144.Business and Professions Code:)The Contractor's Li-
cenveLawdoesnotapplymanownerofpropenywhobeRdaorimprovesthcreen.and. 502 — FINAL PLUMBING ENERGY
Licensee Laws for such projccuwith acontanor(s)licensed pursuant the Contractor's 503 - FINAL MECHANICAL ENERGY
❑ 1 am exempt under Sec. ,B&PC for this Mason 506 - GAS TEST
)caner Data 510 - FINAL PLANNING
WORKER'S COMPENSATION DECLARATION 511 - FINAL POOL
1 hereby aRnn under Penalty of perjury,one of the following declinations:
516 — FINAL BUILDING
❑I have and will maintain a Certificate of Conscntto self-insure for Worker',Compere
waited,as provided for by Section 3700 of the labor Code,for the performance of the
work for which this Permit is issued.
44 I have and will maintain Worker's Compensation Insurance,us reignited by Section
3700 of Ne Labor Cale,lir the performance of the work for which this consult is issued.
My Wor�kkwf's Compensation
nllasonow;Yrtier anJ Policy number
CartictL? YWtY Policy No,:/�Ie'Y,/-1_
CERTIFICATE OF EXEMPTION FROM ORKF.RS'
COMPENSATION INSURANCE
This section need net M completed ifthe Permit is Intone hundred dollars(S Hg0
or Ins,.)
I certify that in the performance of the work for which this Permit is issued.I shall net
employ any Know in any manner sat az to bceeme subject o the Wmkers'Compomsalion
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
became subject to the Workers Compensation provisions of the LaMn Code,you must
z forthwith comply with such previsions or this Permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this Permit is ismcd(See.3097,Civ.C.)
W Lender's Name
z Lenders Address
U 0 1 certify Out 1 have read this application and sin¢that the have information is
W (~ coned.1 agree w comply with all city and county ordinances and state laws relating to
�V hiildingconstrunien,and hereby autherire rcpresenativesof this city manor anon the
W above.mentioned property for inspection purposes.
gig We)agree m save,indemnify and keep harmless the City of Cupertino ugpinst
r�-t rat Ifaint ides,judgments.costs and expenses which may in any way acture against said City
U z in consequence of the granting of Ibis Permit.
'—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signature nr APPliaa " nate
I1A2ARDODOUS MATE RIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant score or handle harardous material
az defined by the Cupertinn Municipal Code.Chapter 9.12,and the llcallh and Safely
We.
Section 25532ad?azssixa)P
Myra Met. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future budding occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hiaaNnus air emoundiran4 as Jclincd by the Bay Arca Air Quality Mu agcro nt all new materials for inspection.
District?
❑Yes mod
I have road the hazwd^us�m+aterials requirements under Chapser6 95 of the Cali lot.
all IRalth&Safe(,Caue,Smtinns 25505,25533 and 25534.1 understmtd Nut If We building
Jnes dol currently have u Icnam, mitis my responsihility at nattily the occupom of the
requirements Inch must ansefaCtrtiIII eamofOccupancy Signature of Applicant Date
/ •14 3'0
w ,,,itiuthmimila nt Date All roof coverings to be Class "B" or better