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02050196Q MY GIF CCUP ER7I, N OF SWff V/ING POOL ���� IN® I II 9TY IICCA TII DN ]FORM APN # 3 Date: Building Ad „22 2 5' fffmln ©A w Owner's Name: 111--6 Phone #: Contractor: A- r,. Jade Po sh S PX License #: Contact: Phone #: Applicant/Contractor: Buil n Permit Info: Bld Elect Plumb Mech escription: Residential: Commercial: Sq.Ft. Floor Area: $ /Sq.Ft.. goo Architect/Engineer: Valuation: — Type of Construction: Occupancy Gro cJBUI OF I G>urExONNO PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 22218 HAMMOND WAY PACIFIC POOL & SPA 02050196 OWNER'S NAME: APPLICATION SUB DATE POSTER 1517 FREDERICK MICHAEL W Y05/31/2002 • PHONE: SANITARY NO. CONTROL NO. (925)447 -2242 ARCHITECT /ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm shat 1 em licensed under provisions of Chapter 9 (commencing with Secsion7000)of Division JOfthe Busi and Pmfaxmm Cdlaandmyficm,a L.ic^ nrPye mite <� «_ qa, 65I CRR�� RESIDENTIAL SWIMMING POOL to a or ARCHITECT DEC ION 1 understand my plans shall be used as public records hall W use Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm That 1 am exempt form the Conwcmr's License Law for the following came. (Section 7031.5, Business end Professions Cade: Any city or tummy' which require a permit to connmct, alter, improve, demolish, or repair any structure $55000 _prior m its issuance, also requires the appliam for rah Permit m file a signnl smrertrwit - �Q.Y,,}�}�• [ p6+�oOr �,k? A`eaI- t 'l Valuation Nat, hgialiamaidparamosaQ,! kperisuionsof the Contractors License Law fChapter9 (commencing With SCnjon.7 ) fDlvininnJ Of the Busine {s end Professions COdel or that he is exempt thekmma and me basis for the all'egul calculation. Any violation of Section 7031',5 by any applicitI for a permit sabjects the applicant to a civil Penalty Iof not mom Than eve hundred dollars (35110). APN � her 103 - c T:; ,1 i ,: t Occupancy Type property, employees with wages 0 1, a owner ork: U�R 4:0 4 etheirsolecompensation. '-will tlhi she Work' entl the swcsure is' not 'int<nded'or offered for isle (Sec. 76W' nd the Bus nets end Profess o s Code: The C reran . L' Law does not apply to an -" "" "' i - 107 - POOL / BON�FAIUfSd Inspections - - owner of property Who builds or Improves thereon, and who does such work himself or through h' wit employees provided that such improvements t or ":d li2d for le'IChowever the bmldn Pr mic yaaa g mprn of proving Id " tit n ode year or - completion, the owner-builder wlllhavelheM1uNeno fprovingthmheddnotbuldor -- " -' " "-1 . „ 304 - ROUGH ELECTRICAL''` improve for purpose of sale.). 502 - FINAL PLUMBING ENERGY Q I; ieowner of the p P.rY Iu.xvel coatmctn ITT I' E _ Ontloclars to and .. ..... .. ....__. _......_ ...____ _ _ ..._ .. 503 FINAL MECHANICAL ENERGY: construct the pm3at(Sm 7044 Business Pmfexson coxi Th Cmarmarrs License Law does not apply to an owner of porpeny who wads or improves thereon 506 - GAS TEST ._.and,who.conrocm f su h purimm. with. a. cormacmr(x). licensed pursuant to.the....._. �Cynt t s L tense L XI I am exempt nde s B S P C f his reamn .._ ,. -._ _.._.. -- "PLANNING­-­­- _ . 510 - FINAli " 511 - FINAL POOR° ')T.- -_ I " ` S ^_L. ° `3F 'S WORKER S COMPENSATION DECLARATION 516 - FINAL BUILDING "' I hereby aRrm under penalty of perlm:y ore of the fallowing deelamin id: ❑ 1 6Ve'and wiii unilmaln a L'enlfcale of Concern t0 self -insure for Workers Compensation, as provided lot by Section -3700 of the Labor Code, for the performance of the work for which this permit is issued._ •, �® ❑ 1 ha and II t Worker s Compe sal hi I ra a as tsq Ired by Secl n 37W f the L C d f the f - f �Il �� u ue pufom a c the rk which this Permit is Weed. MyWorkers Co pereat n 1 situ c and Policy numw are.' C t. 4.1i.t got 'iCOMPENSATION f Y CERTIFICATION INSURANCE ORKE Ir, tl 1 (Th'i xm nn need not w cnmple cJ'f the t Is for one hi ndred Jnllars r perm fS100)or less.), a,:: pd iii I mf,I thepK m eof sit okf l ht it pe tit is edl sit II t Toy any pe an s:�y1e, t t the Workers in 3 r O -. .,. .: ; a 'I.. Y laws oaCal rr ate/ /v�^� Rtsh�2 T p ocs bunply tit W rkers Chim thin itsll the Lmed Coda you iliumiN rams, comply W nit such provisions or this permn shall be decree] revoked. ' f - s'� CONSTRUCTION LENDINQ AGENCY I" ` 1 hefcby'vIII tit 1 the is a contuse eo i leading agency f r ibe peaummrice of the work for hich this peril issued (Sec 300, C v. C ) - Lenders Name....:;. .. x_6.1....,. " -` -.,.. ,. ...... -. _.... .r ........ ... .. _.,..._...... ...... .. .. .. .. ... ..__.1 __.._. ... certify that 1 have read this application and state that Ihe above information is cod<dtr 1 agree to comply,with -all city and county. ordinances and state laws relating so wilding cma ruction: and hereby amhoAae'iepresuratives of this city so eater upon re1 the awve- mentioned p.kny for inspection purposes. s liab'I segainst said Cry nrAPPLIC, - ti URCE 3 ATIOy$LQO.I .:.: 31oY J{Sv n 777"'wy� Issued by: Re -roofs n t ` '. vi i H \ZARDOUS MATERIALS DISCLOSURE ' w u N pplicant or fm re w MI g dccupans store' handle haLVdous mwe 1 asd -1Cod Type of Roof -- ' -_.... .. — _.... : .............e.. -. ford by Ne CUpcnn M p Ch pt 9y12 nd lit He IN dSafety . Code, ❑YS YSj3(lI I'INhi lrl gC ti r ;' E' a �.7 i'y a Ei �.l� }ps A ri 4y31k... �, I IJ III All be roofing,matenal.being installed roofs shall Inspected prior_to.any _ '; wnm palemo Iremlagoccupantuzeeq ?m!hide'am. itch,' 'a If a roof Isihstalled without first obtaining an mspectlon;'•Pagree •to'remove emthar tl ommmmanb as defned by tit <Bay ArnArQ 1ryMe.which District f _ 's "k ' all new materials for inspection Applicant understands and will comply with -point all non source regulations ' I have rta1'Ihe haeaNO s materials, ater alt requirements °ulWe Chapmr 6.931 of Nr r Cahfoms Health & Safety Code, Sections 25505. 25533 and 115534. d understand that if the Mtdd'n does not cu currently have tannin; rim I I my responsibility to notify the - __. ... -. ... ._,_..,. .. _. _. __.. I t occup t ! Itie equvemenis sit muv be met prior4o its n e of a Cenifmt' f ' Occupant - ' - S 3{oy , _Signature of Applicant _ Date _. All roof coverings to be Class "B" or better hi ie<q nr' Dam r_ . .— OFFICE—._. ....._.. .... ._.... _ _. .- - -.- _....... -- -��--- . _. . .— OFFICE—._. ....._.. .... ._.... _ _. .- - -.- _....... -- -��--- . _. r� CRTY a>IF CU?ERTffN© CUPEUNO tITY OF ?E IR\ ME .11 APMICATID IFORM APN # Date: Building Address: A dl / Owner's Name: Phone #: Contractor: License #: BCONSTAX Contact: Phone #: Applicant/Contractor: Fax #: "BuilM Permit Info: Bldg i Plumb Mech Job D scription: jgpsidential: P66 z Y Commercial: Sq.Ft. Floor Ar $ /Sq.Ft.: Architect/Engineer: Valuation: Type of Construction: Occupancy Group: 1 of 3 Fee END Fee Description Fee Grow -quantity BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ uasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC 1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENEIt GY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi- Family Res MECHANICAL BNEWMULTI New Multi - family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 1 of 3 �itOZ_ [C[-- � U C Fzc yjv j vZi F_ r rseg' n30a Y E c X cu [—Z> 04 ® Z � L G - CRTY OF CUIPIEIIYTHg0 CONTRACTOR MO ®N_ BUILDING DMSION PE PERMIT NO. BUILDING ADDRESS: 2221R TJAMMOND WAY PACIFIC POOL & SPA 02060127 OWNER'S NAME: APPLICATION SUB DATE FOSTER 1517 FREDERICK MICHAEL W Y06/20/2002 PHONE: SANITARY NO. CONTROL NO. (925)447 -2242 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 1_7 u u (_J LICENSED CONTRACTOR'S DECLARATION Job Description I 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 ORIGINAL PERMIT # 0 2 0 5 019 6 is in full force and effect. License Class Lit.# REVISION SUBMITTED, NO NEW PERMIT ISSUED Date Contractor - ARCHITECT'S DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm 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 i which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement - - Sq. Ft. • r-t1001; -I,e3 ' �'t � nation that hq is�licens4d pufsuant to the provisions of the Connector's License Law (Chapter 9 ( commencng with Section.70QD) of Division 3 of the Business and Professions Code) or 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 ton civil penalty of not more than five hundred dollars ($500). XPR Occupancy Type [11, 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. 7041, Business and professions Code: The Contractor's License Law does not apply to an - — - - - 104 - REBAR Required Inspections owner of property Who builds or improves thereon, and who does such work himself or through his own employees. provided that such improvements are not intended or 10 7 - POOL/BONDING 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 301 — ROUGH PLUMBING improve for purpose of sale.). 304 — ROUGH ELECTRICAL O I, as owner of the property, am exclusively contracting with licensed contractors to 502 FINAL PLUMBING ENERGY construct the project (Sec. 7044. Business and Professions Code) The Contractor's — License Law does not apply to an owner of property who builds or improves thereon, 5 0 3 — FINAL MECHANICAL ENERGY and who contracts for such projects with a contractor(s) licensed pursuam to the -- contractors License Law. 506 — GAS TEST O I am.exempt under Sm.. , B & P C for this reason 510 — FINAL PLANNING Owner WORKER'S COMPENSATION DECLARATION 511 — FINAL POOL 516 — FINAL BUILDING I hereby affirm under penalty of perjury one of the following declarations: D 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 oll' the Labor Code, for the performance of the work for which this permit is issued. O I have and will maintain Worker's Compensation Insurance, m required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: Carder: Policy No.: CERTIFICATION OF EXEMPTION FROM WQRKERS' • COMPENSATION INSURANCE ' (Phis 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 pemtit is issued, I shall not employ any person in any manner so as to become subject to the Workers ' Compensation Laws of Califomia. 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 f forthwith comply with such provisions or this permit shall be deemed revoked CONSTRUCTION LENDING AGENCY I hereby affirm that there is a conswction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name - - Lender's Address yy I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above - mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against S liabilities, judgments, costs and expenses which may in any way accrue against said r City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT �. Issued b SOURCE REGULATIONS. y: Date Bqu Signature of Applicant/Conuador Date ,i Re -roofs HAZARDOUS MATERIALS DISCLOSURE Will the applicant or fume building occupant store or handle hazardous material Type. of Roof as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code. Section ' 25532(x)? - OYes ❑No All roofs shall be inspected.prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? all new materials for inspection. Applicant understands and will comply with ❑Yes ❑Ne all non -point source regulations. I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the -. occupant of the requirements which must be met prior to issuance of a Certificate of Occupancy. - Signature of Applicant Date All roof coverings to be Class "B" or better Owner or authorized agent Date OFFICE W 0 C �QE y 2 O z - C � 10, X p: U3U,� F Lr 0 < E u� =a CFL a3° I b Q: fTY Q-UF CU4'M;RTIINO CONTRACTOR INFORMATION: BUILDING DIVISION FERMIT BUILDING ADDRESS: ZAL PERMIT NO. 22218 HAMMOND WAY PACIFIC POOL & S 02050196 OWNER'S NAME: APPLICATION SUB DATE FOSTER 1517 FREDERICK MICHAEL W Y05/31/2002 PHONE: SANITARY NO. CONTROL NO. (925)447 -2242 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 1.-7 L_J L. ] I_ -1 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Bus' s. and Professions Code, and my license RESIDENTIAL SWIMMING POOL is in full.�r)/e and effec Li ense �S �> Li . N 'S 3 e65f a5 to 5 _ 31 —O C Con or _ ARCHITECT'S DEC ON I understand my plans shall be used as public records Licensed Professional OWNER - BUILDER DECLARATION I hereby affirm 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" which requires a permit to construct, alter, improve, demolish, or repair any structure $ 5 5 O O O i prior to its issuance, also requires the applicant for such permit to file a signed statement -L - - - - •.r t QOr S � , [ • • (, o ' ' Valuation that tie 3 hcensed.pursu`antao IFte' provispons of the Contractors License Law (Chapter 9 r (cdmrnencing with Section 7000) of Division 3 of the Business and Professions Code) that he is basis for Any • It) , 7 .4 OF�11 11 or exempf theref om and the the all'egad c} craption. violation -of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred doliars ($500). 103 APN 61I Wer t'� - - Occupancy Type ❑ 1, as owner of the property, or my employees with wages as their sole compensation, 1-94 B R ' will do the work, and-the structure is not intended or offered for sale (See. 70t14,' Business and Professions Code: The Contractor's License Law does not apply to an - -� E - - '" "' d inspections 107 — POOL /BON 1 p owner of property Who builds or improves thereon, and who does such work himself or through his own employees. provided that such improvements are not intended or 3.0.1 — ROUGH.. PLUMBING - - - offered for sale. If, howeder,-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 of - - - 304 — ROUGH ELECTRICAL improve for purpose of sal`,)' 502 — PLUMBING ENERGY ❑ I, as owner of the property, am exclusively contracting with licensed contractors [0 _FINAL 503 — FINAL MECHANICAL ENERGY ' - ' construct the project (Sec. 7043, Business and Professions Code:) The Contractor's , License Law does not apply to an owner of property who builds or improves thereon, 506 — GAS TEST ' andwho. contracts for such-projects with a.contractor(s) licensed pursuant to the �_c traetoraLieenseLaw. ....... ... ... .. ... . .__ -_5.10 = ...FINAL; PLA.NNIN.G..... -. - )ZI I am exempt under Se. ' , B & P C for this reason !� ' -' 511 — FINAL POOL o""er, ate 516 — FINAL BUILDING 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 Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑) have and will maintain Worker's Compensation Insurance, as required by Section 7700 of the Labor Code; for the performance.of the 'work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier: ''':' :: ° ' Policy No.: • . ' CERTIFICATION OF EXEMPTION FROM WOR$ERS'i. t • COMPENSATION INSURANCE' (This section need not be completed if the permit is for one hundred dollars ^ "' ($100) or less.) I certify that in the perform ce'of the work for which this permit is issued, 1 shall not employ any person initekkra nner so 0 o e sS1 ct ro the Workers' t Compensation laws of Cali rn . Dap V ' plicant y OT.ICE TO APPLIC term ng this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you roust IJS forthwith comply with such provisions or this permit shall be deemed revoked. i CONSTRUCTION LENDING AGENCY I hereby affirm that there is a consliuction leading agency for the performance of the'work for which this permit is issued (Sec. 3097, Civ. C,) Lender's Name - Lender's Address ' I certify that I have read this application and state that the above information is i correct. I agree to comply with all city and county ordinances and state laws relating 1 to building construction. and hereby authorize representatives of this city to enter upon ' l the above - mentioned property for inspection purposes. i (We) agree to save, indemnify and keep harmless the City of Cupertino against 1 liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of [he'graming of this permit. t APPLICANT UNDERSTANDS ND WILL CO \iPLY R'ITH AL NON r' -POISr s URCE ATIO s. `� Issued by: Da e � - 53/0 �( � I - i nzt6 cant1C tmetor Date' Re -roofs HAZARDOUS MATERIALS DISCLOSURE Will the applicant or kture 'building occupant store or handle hazardous material .Type.of.Roof .. .. . • -. _ as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? „•'• ' ED Yes - No All, roofs shall be inspected -prior tp any roofing material being installed.. W'll.the applicant or• ture building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ° Yes b b all new materials for inspection. Applicant understands and will comply with '° all non -point source regulations. I have read the hazardous materials requirements under Chapter 6,95 of the California Health & Safety Code, Sections 25505, 25533 and 75534. I understand that ' if the building does not currently have a tenant, that it is my responsibility to notify the - occupant of the requirements ich must be met prior to issuance of a Certificate of Occupant Signature of Applicant Date All roof coverings to be Class "B" or better wncr o [oozedent Dale OFFICE