01030068 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10133 TANTAU AVE. SWAN POOLS 01030068
OWN12R'S NAME: APPLICATION SUH DATE
Aft COLOMB 1.495 S WINCHESTER B _.V 03/IZ/2001
MR IIONE: SANITARY NII. CON'I'I(OLNO.
(408) 866—E8
BUILDING PERMIT INFO
O ARCHIT[Cf/r:NO1NIiliR: I.IH'i/ ELECT/- PI_hUMN MFCH
U/
LICENSED CON'I'RACI'ORS DECLARATION kDescrlpt n?✓,J Oherebymann Ihul I nm licensed ender auv,,ionr nl Chapmr 9 o, u,nciny with$c,Tell? X0)or Ulvi,iop 3ol'the Baoncss: cssunnledme, len n,m` '�"j' 3 S SWIM
Y O 6< License Clao Lic.M
w u yN Dalc � S D'p ctnr_ (I
Hirt 'f's DECLAR ^ U
undcrtmnd my plans shall he awd as public m�nrJs /I
T ^
y C O Lic,neJ Professional ,ole
OWNER-BUILDERsn",ho DIiCLARA.'ION
I naso u(Sec the 1_uaa,pl from m,C,molnr's iLicensec Law b,r the
Cam following relook. ,uuaoi ]fl31 S,IL„in,xs and 11 Ill Cod,:epa city nr eamly
eeo whJ y P Intlt , +.' P I fish P Y:Iruu r.I
i3 lir nn t '.' uler y II rilie ,r It Ili rair1file E LaIlcre,l
Ihm rte . ll twat R r ,i nbec t Ira , w Ina IA ) y, o Area Valuation
(ethatbe is ewith Ssaion]IIta100he basis 3ofhe eaIlged ex and pori„duns CIA')
ar that he is 31.5 b troy.,nn and the basis for the alleged exemption.Any violation
of S,nian,drom nye u dred o ll far o p=mtiuubjens thmpplicanno a civil Penalty
arum mor,man nv,hundred aanao fssw). Number Occupancy TWe
0 Lie owner of the prnpuay,or my employ",.,ill wag,.a,meir..ole,ma,marnn,
will do the work,;aid Ibe stractum is all mounded ur offered bar sale(Sec.
Bin and Portes s Code:'Ihe Conln,clori,hlc,n,a Law docs mol opply Required Inspections
n,ibmood prup,ny Who otbuild.,r Inrmv,s mcreo,,and who does such work hitnvelf
mugh bis own nnploy,e,.provided that such inSmwctocm,Ile nol imelmed or 1.03 — UFER
oncmd rot sale.If.bnwomr.Ila handing or hnnrov..rarl i,.cold w'ahia nn,year of
mplelion.theowne,luildcr will have the bld,rof pn,ving that he did nm hold or 1.04 — REBAR
improve lir pm,koe le'del. 107 — POOL/BONDING -
01.a,owm,rafthe Property.ameveltimsely contracting w'llblicensed,ontersintill ,01 — ROUGH PLUMBING
, wn the pmjeal(Sec.70W.Bushmss and Profcs,ians Code:)Thi Contmr,
ctn
Loien,law does len apply to an owner of pmpeny w'ho buildv or improves motion,
;,ad who umnuo,far such pmja,,wish a coteamallsl licensed parsaam to me 304 — ROUGH ELECTRICAL
of".I..our,LIOme[.it:. ncePcrarml,rca,r,rl 502 — FINAL PLUMBING ENERGY
owner Dal, 503 — FINAL MECHANICAL ENERGY
WORKER'S COMPENSATION DECLARATION 506 — GAS LEST
Ilorehy or.under peoully of perjury oneash,fallowing dedumlism: 510 — FINAL PLANNING
0 1 have and will mah,tam a(.,airi,me of Coas=atm self-im,am for Worker: 51. 1 — FINAL POOL
Cooperation, as provided for by section 3700 of the tabor Code, lin the
r„ntm,:mce of he work for which this permit i,ioovd. 516 —. FINAL SUILDING
❑I have and will nminein Woder',Con,pensatlnn Insurance,m tevuiwd by Senior,
3700 0 the Lubar C,slu,for Is, N..I'll a or Ibe wads bur wI,ieh Ili........is
i,asA,MV =Ll; _p minfrin.wtan,vcariicr:unll�lioy at 60,
Carn,r:—//-, 1'nlicY Na: U ll -
CERI'IPICAI ION OF ENEMPOON PROM W ORKE@$
COMPHNSAT10N INslIRd2:CItQ'O TJ
(This sel need not b,<ourpLeted if the permit is lot no,hundred dollars
IS 100)or It,,.)
1 cemIy that In the wrt,anuance of the work ill which this permit i,issued,I
shall not employ any per,on In Imy amoner s,ns Ice become lon"t in Ibe Wnrken,'
C'ongmns:aion Laws of Culifl nin.Dm,
Apphcanl
NONCE TO AI1I11-ICAN"1':IL oflcr,taking Ibis Ccnlncmc of liump,ion,you should
Mcume,abjttt la te hW aloe',Cuawtio
.pema pru,kiran of thYo
e latus Code. u must
Q O fuabwith comply with sakS pmvi,jum or this permit shall he dremd revoked.
F ^ CONSTRUCTION LENDING AGENCY-
CiI hereby aliimt that them is a conwnction lending al for the pedomeole
the work for which,hi,pem it is i,su N(See.3(197.Ci,C.)
LL Q LcndcL,Name
z Lender',Add....
V Q
"co'
Ihot 1 leve Icud ibis uppli,minn nnJ sole Ibat the Ilbovc afanualiun I,
k, F.. n rm 1,I agree Io comply with all city and cony ordiumlce,and,m¢law,mhning
0 fJ rebuildingcamsauaion,and hereby mahoriarermsenlntive-1 this city to curer nplm
the have-mentioned property for inspection purpows.
F sd (We).,me m save,indemnify and keep Karmic,,the City of Coliseum,against
VN liabilities j.d,.,at,,casts and ,spene,whist may in any way acctus against said
•L City in con ju vnce of The granting of mI,permit. 3-/s..{,
1
I. APPLICANT UNDERS'. NILS AND WILL COMPLY WITH ALL INT Issued by: Date 1
SOURCE RF -.A :. �/ /J
J (L�
Sinalllm,o i,la,Ircaalraclm 'I, Re-roofs
IIA%AROOIIS MATERIALS DISCLOSURE
Will m,applictumor mlae building occaenol,tore or handle hm:,m"us avalu-1 Type of Rool'
m defined by the Cartenim.Mamdpld Cole.Cbapl,t QA 2.ami the Heahh and Salty
Cale.ScOmn25532(a)'i ON.
All roofs shall be inspected prior to any roofing material being installed.
Will the applicantrnam,hoadmgrrc,upanto.k=4uirm,ntore,.'i=,,.,nim If a roof is installed without first obtaining an inspection, 1 agree to remove
nil ha,ardom air comaro ams e.defined by the nay Area Air Quality Management
Wrila? s 0 all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I hI've read Ili,1 1 oun macrials u,tun,ee a,under Cbapmr 695 0l the
Cli folia HnJthASully Cn It.Section,25505,25533and 25534.1 undenend thus -
if the building Joos all coacntly has,a mount,Ihm it is my uslo,ibility in notify the
awcopmt of the mnuihI.1lah li he me,prior m issuance or: cru rte of
3
°Cop'"`ry' / Signature of Applicant Date
3� . All roof coverings to be Class"B" or better
a
owm,r ar am .edo, — foe
OFFICE