02110143 (4) CITY OF CUPERTINO
BUILDING DIVISION PE IT CO,NTRACTOREINFOR ATION
Bu1L Es K NSON AV 1W GIORGI ALAN P AN LEEN PERMITN(02110143
Owd DOMI ALAN P AND EILEEN T APPLICAT11"Ishaaa9Fy 2002
,t, HONE: SANITARY NO.7 7 CONTROL NO.
RCHITECpIENGINEER: BUILDING PERMIT INFO
BLDG EIPCT PLUMB MECH
100 LICENSED CONTRACTOR'S DECLARATION Job Descri IIOn a
c fj I hemby affirm that l em licensed under provisions of Chapter 9(commencing IN-GROUND SPA p
with Salon 7")of Division 3.f Ons Businesl and Professions Code,and my license is
in full
force and effect.
ZOa4 License Class Lic.N PINAL00
oze Dam C9nuaor
< ARCHITECTS DECLARATION
60 u my
JUL o 2 g66
'� C
3 a,r Licensed Professional
k�c0 OWNER-BUILDER DECLARATION
u� 8 1 hereby affirm that I am exempt from the Conuacmt[License Law for the �1�� ' $10000
�
400
following moon.(Suction 7031.5,Busincnand PmU/fcssionsCode:Anycityorcounty LD
X2 which requites a permit In construct,allot,improve.demolish,or repair any structure
FZtre prior to its issuance,also inquires the applicant for such permit to file asigned statement
that he is licensed punusnl mlhe provisions of the Convector's License Law(Chaper9 3vI fflR:(DD'bi3A109 Valuation
$ (commencing with Section7EIDB)nf Division 3 ofthe Business and Pr9feaums;Cak)or
y
that he Is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of i UAPNN Occupancy not mom than five hundred do[]... anC ara($500). 1 O 2 - PIERS p y Type
❑I.u owner of the property,or my employees with wages u their sole compensation.
will do the work,and the structure Is not intended or offered for sale(Sec.7014,Business
and Profession.code:The Committee,License Isdans not apply be an owner or 104 — REBAR Required Inspections
p Open who builds or improsea thereon.and who doessuch work himself orthrough his
own employee.provided that such improssments sm not intended oroffetcd for We.If. 105 — ANCHOR BOLTS
however.the Wilding or improvement is sold within one year ofcompletian,the ower- 1O6 — SEWER & WATER
Wilder will have the burden of proving that he did not Wild or improve for punpose or _
rola.). 202 - UNDERFLOOR PLUMBING
❑L as owner of the property,am exclusively contracting with licensed c.ntracmrsto 203 - UNDERFLOOR MECHANICAL
convect Ne project(Sec.7044,Business and Professions Code:)The Contracmrs Li.
Can.Law deaOut apply I..aowner afpMwnywho Wilds orI.,..dialer,and, 204 - UNDERFLOOR FRAME
who Low,
projects lianmrsue
d punuo the Contractor's
Low.contracts 205 - UNDERFLOOR INSULATION
who
❑ lam ucmIn on at ,B&PC for this reason 301 - ROUGH PLUMBING
\� Owner 302 - TUB & OR SHOWER
O KR'S COMPEN ONDECLARATION
303 - ROUGH MECHANICAL
I hereby alfum under pewtyof 'u ,e of the following decleretiont:' 304 - ROUGH ELECTRICAL
I have and will maintsin a Cenifcate ofConsem to ul6insum for Worker's Compere
tion,as provided for by Section 3700 of the letter Cade,for the performance of the 305 - FRAME
ork for which this permit is issued. 306 - HOLDOWNS
1 have and will maintain Worked Compensation Insurance,as required by Section 3 07 - INSULATION
3700 of Ne LaLather Code.for Ne performanceof the work for which this permit la Issued.
My worker's Compensation Insurance carrier sold Policy number are: 308 — SHEETROCK
Carrier: Policy No.: 309 - EXTERIOR LATH
CERTIFICATE
COMPENSATION iIN5 INSUON MOM RANCE
310 — INTERIOR LATH
rTMemction need not be completed ifde permit s fmow hundred dollars($10(y) 311 - SCRATCH COAT
uric".) 313 - ROOF NAIL
I certify that in the performance of the work for which his permit is issued,I Nail not 501 - FINAL ELECTRICAL ENERGY
emplayanyperomin anymanne na�wbecomes bct so the Workca'Compemadon
Laws of Cali fomia.Date 502 - FINAL PLUMBING ENERGY
Applicant g e
NOTICE TO APPLICAunr1f,after making this Ce ffD w of Exemption.you should 503 - FINAL MECHANICAL ENERGY
Wcomesubjccttothc Wolkr,ComN..0onprovi ons fdw IAWr Codwyoumust 504 - FINAL BUILDING ENERGY
OO forthwith comply wit such provisions or this pennies l le deemed revoked.
z 505 - FINAL ELECTRICAL
.V) CONSTRUCTION construction
gagenAGENCY
F kforwhichtmthestherciilocd( ec.30Y7,di,C.) forthcperformanceof 506 - GAS TEST
IX > thewurkfnrwMmthiapennBisima.d(sa.3097.civ.c.)en Nam.
Lea507 - FINAL PLUMBING
d] O d
a
Lee denAddrem 508 - FINAL MECHANICAL
U p I certify that 1 have read thirty and Application and arae that and
salve information is 509 - FINAL GRADE
U F
correct.1 agree m comply With all city end county ordinances and rote laws relating on /v
O V buildingconswction,andbotchyauthnrimmprcsentaeivesofthiscitytoenterupondo, 5
move-mentioned property for inspection purports. 14 FINAL PLANNING
FIN I W RKS
(We) S.to save,indemnify and kap harmless the City of Cupertino against
Co)0. Ilabi Edo,pollutants.core and expenses which may in any way memo against mid City �
U in consequence of the printing of this NMit.
APPLICANT UNDERSTA AND WILL PLY WITH ALL N N-PO Issued by: Date / J
SOURCEREGULATI N
Re-roofs
Signature ofApplic HAZARDOUS MATERIA D CLOSURE Da Type of Roof
Will the applicanwr(umrc building accup stores hand",hamdous material
u defined by the Cupeninn Municipal Code,Chapter 9.12,and the Health and Safety
Om
Code,S.ceien 25532a)?)a
0yes oNa
All roofs shall be inspected prior to any roofing material being installed.
Will de applicant or future Wilding occupant ore equipment a dcvias which If a roof is installed without first obtaining an inspection,I agree to remove
mit hourel air contaminants u d.Bncd by the Bay Ama Air Quality Management all new materials for inspection.
RHm7 P
❑Yes 'Cl No
I have mad the ham lou maerials mquitem.nts under Cheper 6.95 ofthe Califor-
L
&Safe�ten.o
Secdro5505,25533andz5534.1umicnendNmiflhe building
curt,ndnt.N MY respouibility m notify IW acupent of Nc
n muenccofec.rtineamofo, aeY. Signature of Applicant Date
Owner or eudwn'cd age
dt �e All roof coverings to be Class "B" or better
CITY OF CUPERTINO �<
SWIMMING POOL
CUPERTINO PERMIT APPLICATION FORM
r APN# i
��6 — 1 S_. o,73 Date: �l 25 OZ ,
Building Address:
070 91A1 AJ v4
Owner's Name: ` Phone#:
Contractor: Phone: License#:
Contact:.; Phone: Cupertino Business License #:
Building_Permit Info:
Bld
Job Description: /A/ 612e)VA10 71
0A U&V
Residential Commercial ❑
Qty. if
Applicable, Fee ID i 1, Fee Description Fee Group
BSWMI Swimirming Pool BUILDING
BUSLIC = Business License BUILDING
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PA 289.¢
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TF .306.7
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avv� - _ . CUF�TiNO
COUES
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"m L n�°I MUST be
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a anb�ncru an ar+r
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Pearmom Nom 11r buldit�
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