01040155 (2) NO
CI BUI DINGVUISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
23655 OAK VALLEY RD. LIFETIME POOLS INC 01040155
OWNER'S NAME: APPLICATION SUB DATE
PHIL & DIANE OLSEN 910 SAN ANTONIO RD 04/30/2001
/ PHONE: SANITARY NO, CONTROL NO.
(408) 738-1576
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ILER: BUILDING PERMIT INFO
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6y= Job Description
i LICENSED CO`]'rRACTOR'S DECLARATION
I hereby affirm that I am licensed under previsions of Chapter 9(commencing
p m r w with Section]000)of Division 3 of the Business and Professions Codc,and my license
a w IS in fYII fort and CBttI
EK sc Li,ea,ecm., �r3 Lie.a Z20,SFzes� NEW POOL & SPA.
E.
O O Da¢ L -Sr-n Coact
3 0ti,G ARCHRECuse a,public
1or /
h u'O 1 undentund my plans xM1ull he used as publi<rccoNs
.E o O Licensed Pmfcssimml
OWNER-BUILDER DECLARATION
y y I hereby offirm that I am exempt from the Contractor's License Law for the
following reason.(Section 7031.5.Business and Professions Code:Any city or county v t--
f F❑ which requires a permit to construct. Ito improve,demolish.h p y suracture
w o poor to itsl0 requires the pplic tfo suchpermit no fl signed spinumend - .____. .... ... .. .....
—' " @m he is licensedp -pat_t th provisions.1 the C t ct License I (Chapter 9 .- .SLI. FL FIool Alcan ff $3869Auauon
(cu ,with Scat ]000rf Divi u3 of the lite-nes ndlmuct,i s Cudc) i��ls . r.�r4\. 1 {„ n - n 41 G,J s,.1�.e.a tl. :
or that he 11 e,empt th befrocan add the basis for the alleged exemption.Any violation
of Sermon 7031 S by any applicant for a permit subjects Ne applicant to a civil penalty
of not mare Nan five hundred dollar,($300). 3 4 21 �69rl 1 Occupancy Type
❑1,as owner ohne propcny.or my employees with wages as their sole compensation.
will do the work,and the mmcmreis-not intended or offered for.sale(Sec.7044. Required Inspections
Business end Professions Calc The contractor's License Law does not apply to an 103 - UFER 9 -
owns,of property Who Wilds or improves Neuron,and who dues such work himself ,
or soma h his pin employee,.provided that.pcn impro canon,are not intended or _ .._. . 104 .r- REBAR _ __.. ..
.offered or sale.IC however,the building or ire en of pmrnt n sold within one year of
completion,,me owner-We,
ildw;uburden of proving the bevmg that he ma not Wild o, 107 - POOL/BONDING ;
improve for purpose of adv.).
_e ._ .. . ._ . . . rac _301 --ROUGH. PLUMBING .i
a,owner Dene -. ..... ..- -..- . . -
O 1.' P(Secrty.am Business and rowing n,Cocc:)The contractors to
- own the project tsa.'nous Baume,.,dna Prore„nrna ewa:)The connaemr, 304 - ROUGH ELECTRICAL
en
License Law docs not apply to an owner of propeny.who Wilds or improves Hereon, '
and who contract,fer.sam project,with a commotorts)licensed pursuant to the _ _ ___502 - PLUMBING -ENERGY
Contractors l.ic,n,e uw 503 — FINAL MECHANICAL ''ENERGY
❑1 am exempt under Site ,B&P C far this reason
Onvnet Date" - 506 — GAS TEST
WORKER'S COMPENSATION DECLARATION 510 - FINAL PLANNING
1 hereby affirm under pemslty of perjury one of thefollowing declamtiens 511 — FINAL POOL
" " ° I have and will maintain a Certificate of Consent to self nsum for worker, 516 — FINAL BUILDING
_ Curn,awma: as provided for by Section 37W of the LaWf Codc, for the
performance of the work for which this permit is issued.
❑1 have end willtmaimein Worker's Compensation Insurance,as required by Section
3700 of the Labor Cade,for the performance of the work for which this permit is
issued:My Workers Compensation Insurance carder and Policy number arc'.
Cviicc�Ra iCosvl pl °. .Poi icy No.: I S 6S �r� 1 s ••r{ C.• .•' s 3. I )>
1 ,CERTIPICATONOP EXEMPTION FROM WORKERS' .. s :A•- s ' rIi ':.i ri�l�:.i -1 , . I.. .:
COMPENSATION INSURANCE :_
(This section need not be cmnpleted if the permit is for one hvndrcd dollors
(S1001orless') -
1 cenity ihai in the portDmsonce of the wink for which lNs. perm.1 is issued.1 - - - -r, I1',Vt"'.'
shall bot employ any ycrton in any manse to become subject to the Workers' -
Compcn.ninnLawsofCaliforni Da¢ �—Or
Applicant
NtJ1'IC a ung this Cisions of
Untie,Exemption.youshould r s
u)ec w taker's Compensation provisionssll the LNor Codc.you must
C Q fonhwilh amply with such piovisinns ar Nis p<nnit shall he Jmined revoked.
CONSTRUCTION LENDING AGENCY
F' .1 hereby ullinri that there is o construction lending agency for the p;,urmnance '
> of the work for which this permit is issued ISec:309].Civ.C.1
a.Q ,Lenders Name-
5-
ame_ .. -._7-Z I<Wer's Address' ., t ,,. ..
V ti 1 verify that I have read this application and state that the above information is
con-rect.I agree to comply with all city and county ordinances and stat,laws relafmg
V to Gilding constmction.and hereby omnarize representatives of this city to enter upon
} f� the ahovcmeramo d property for inspcenom purposes, _
F.y (We)agree to nee,indemnify and keep hmm,,s the City of Cape rum,ugai est
'rq liabilities,judgments,costs and«penes which may in any%ay acme against said
4.7:Z City in consequence of the grants ng of this permit,', -
t"t APPLICANTUND- NDW OMPLY WITH ALL NON-POINT
- so I , ATION Issued by: Date
Appfieaavc .' .Date Re-roofs
KAIARDOUSMATERIALS DISCLOSURE
aPPlk m .ror mi to p tat rh nlle harallousm i `l Type of Roof - -- - - -- - - - -
f d by Ne CupeN 'Me pal Ch pt 9 12.and the Heahh and S f tyf -
CoJaSet 25532( 1 -,f s` U'• •� •_..-s y. r
_ : .. .. .-.All roofs shall.be inspected prior to any_rooftng material being installed—___
Will the appllcam nr futureW g occupant use equipment or do,de,,which If a roof is installed Without first obtaining an inspection, 1 agree to remove
emit hazardous air rnmaminnnu a tined by the day Area Air QYaI'IIY M11anagcmem
Disarm' all new materials for,inspection. Applicant.understands antl will comply with
oY., - oleo - - all non-point source regulations. ._, __
Y have read the hurt(n mit;material(requirements under Chapter 6.95 of the
California Health&Safety Code.Sections 25505,25533 and 25534.1 understand that
ifshe building does not cttrcndy have terand,that it is my responsibility to notify the p -
occupant of the requirements which must be met prim w issuance of a Certificate of �—
`"fanny' PP !cant °` `` tA� Date
"_- to =�"-U o
,rt unmanned agent Data All roof coverings to be Class "B" or better-aci '
"' --
r .. _ OFFICE