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09040085 CITY OF CUPERTINO G�1F �E� Q I4'�TI�IY: BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 10531 CASTINE AVE CALWES" IDSCAEL— PERMITIT ISSUE DATE 'HNER'S NAME: SA CONTROL NO. PHON BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH BACK F:=LL SWIMMING POOL EO p LICENSED CONTRACTOR'S DECLARATION Job Description U 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is n=y in full Cora an Ct z e,C Z 11 jLicense Class Lie.8 Date Contrsaor 141GG�e'S l ARCHITECTS DECLARATION I understand my plans shall be used as public records to X96 `o y Licensed Professional OWNER-BUILDER DECLARATION `� I hereby affirm that 1 am exempt from the Contractors License Law for the a O following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure u y prior w its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area Valuation Lha he is Iicertsed pursuant to the provisions of the Contractor's License Law(Chapter 9 �] YF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his awn employees,provided that such improvements are not intended or offered for sale.If. however,the building or improvement is sold within one year of completion.the owner- builder will have the burden of proving that he did not build or improve for purpose of sake.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Comacmr's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. B&P C for this reason ❑I am exempt under Sec. `wner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of Perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 37I have and will maintain Worker's Compensation Insurance,as required by Section 700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensatiro-nn lasu� cc carrier and Policy number am: Carrier.S7NT/= � Policy No:00Ola/GL z CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J,Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of (Yy the work for which this permit is issued(Sec.3097,Civ.C.) WA Lenders Name 0 z Lenders Address U 0 l certify that I have read this application and state that the above information is LL H correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorise representatives of this city to enter upon the U above-mentioned property for inspection purposes. E (We)agree to save,indemnify and keep harmless the City of Cupertino against rF-t rA liabilities,judgments,costs and expenses which may in any way accrue against said City /. G V Z in consequence of the granting of this permit. Date ►y APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued Ey: SOU E REGllLA NS. ' Re-roof; - g ore ofApplicant/Con rot are T of Roof HAZAR O S MATERIALS DISCLOSURE Type Will the applicant or fu building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety ode.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes lNe If a root'is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes J�kNu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my res risibility to notify the occupant of the Date reyu' is which m t to' u of a Certificate of Occu Signatu-e of Applicant l All roof coverings to be Class';.` or better O er or authorized agent are CITY OF CUPERTINO SWIMMING POOL/SPA OF CUPERTINO PERMIT APPLICATION FORM _ o�5 APN # Date: Building Address: _ hn 15 Mailing Address (if different from building addr-Iss): Owner's Name: Phone #: Contractor: Phone#:Glvb� Contractor License #: Fax Contact: PY,one#: 375'-760'� Cupertino Business License #: Jo z1v e) Fax #:F24 Residential Commercial Job Description: A f ll O/D 1pv Valuation (cost of project):' l av, Square Footage: Zpp Project Size: Express Standard L,-xge F ajor❑ Green Building: Please complete relevant portio a of the Green Building Checklist & attach it to the application or if applicable, include in plan set&: the sheet index. Quantity Fee ID Fee Description Fee Group Permit Type 1POOLCOMM Commercial Pool B CBSP 1BCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES _ 1BSEISMICO Seismic Commercial B 1POOLVINYL Vinyl-lined (up to B RBSP 800 sf) 1 POOLFIBER Fiberglass B CITY OF CUPERTINO SWIMMINIJ POOL/SPA COf CUPETkiNO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group Permit Type 1POOLGUNITE Gunite (up to 800 sf) B 1 SPAPREFAB Spa or Hot TL.b (Pre- B fabricated) 1 SAUNA Steam Sauna B 1BCBSC Cal Bldg Standards B ALL PERMIT I Commission Fee TYPES r 1BSEISMICR Seismic Residential B 1PLMBLNCK Plumbing Plan Check P 1PPERMITFEE Plumbing Permit P 1 MPERMITFEE Mechanical F ermit M 1 EPERMITFEE Electric Perrr.it E 1TRAVDOC Travel & Documentation 1BUSLIC Business Lic,:nse B Revised 01/07/09 Community Development 10300 Torre Avenue ;} Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF %UPEkTINO Buildi:7,j:ear':I' JOB ADDRESS: RMIT # OWNER'S NAME: ONE # ` S-q GENERAL CONTRACTOR: e `, X # �!Cie . f I am not using any subcontractors: f 1 na a ate Please check a licable subcontractors and complete the followm* information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date