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02110082(EXPIRED)CITY OF CUPERTINO OTF SWIMMING POOL CUPERTINO PERMIT APPLICATION FORM APN # 3 56 Pool Date, & Building Address: Owner's Name: K12�� Phone #: Contractor- Phone: r License #: Contact: Phone: Cupertino Business License #: Building Permit Info: Bldg , k Job Description: Residential Commercial Qty. if Anfflicable Fee ID Fee Description/ Fee Group 141 �07 Sao,- 7X' ls-,��4yw le�eo "Ora. Pool ,,.SwLmfmn Business License 141 �07 Sao,- 7X' ls-,��4yw le�eo "Ora. WOO W. Z WOO �W= Z 4-;: w gggd apyry C4 nW§ 0!-y 0 Z U U LIQ U Z CITY OF CUPERTINO 3 BUILDING DIVISION PERMIT — BuIflD1420@`tE!MT CREST DR CRAM KIT M AND NG SAU L PERMIT No. 110 0 8 _2 ow@KAMAF-KIT M AND NG SAU L APPLICATJD!Js%`1112.TJ 2 0 0 2 PHONE: SANITARY NO. CONTROL NO. ARCHTFECTIFNGINEER: BUILDING PERMIT —INFO BLDG ELECT PLUM =. CONTRACTOR'S CONTRACTOS DECLARATION I hereby affinn that I am licensed under provisions of Chapter 9 (commencing . , SWIMMING POOL Job Description with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. ORIG PERMIT 99070071 EXPIRED. NEW PERMIT License Class — Lin. # Date Contractor AND 1/2 ORIG FEES CHARGED. 832.50/2 = $41 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 Contractors License Law for the following reason. (Section 703 LS, Business and Professions Code: Any city or county 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 that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area $ 2 4 0"00ation (commencing with Section 7000) of Vivision 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 i permit subjects the applicant to a civil penalty of Occupancy Type not more than five hundred dollars ($500). [3 1, 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 and Professions Code: The Contractor's License Law does not apply to an owner of 1: E) B UFE'RE 104 REBAR Required Inspections 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 offered for We. It, 107 POOL/BONDING however, the building or improvement is sold within one year of completion, the owner - 301 ROUGH PLUMBING builder will have the burden of proving that he did not build or improve for purpose of sale.). 304 ROUGH ELECTRICAL [] 1, as owner of the property, am exclusively contracting with licensed contractors to 502 FINAL PLUMBING ENERGY construct the project (See. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and, 503 FINAL MECHANICAL ENERGY who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's 506 GAS TEST License Law. 0 1 am exempt under Sec. R & P r for reason Ow r_ d `K a. 510 FINAL PLANNING 511 FINAL POOL [- WORrEWWOMPENSATION ATION 516 FINAL BUILDING I hereby affirm under penalty of perjury one of e following declarations: 0 I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 0 1 have and will maintain Workers Compensation Insurance, as required by Section 3700 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 am: Carrier: Policy No.: — CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (chis 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 sl J)qe the Workers' Compensation Laws ofC.iir­i. n.� Applies" NOTICE TO APPLIUART. If, afro making this Certificate of Exemption, you should become subject to the Worker's CAipensatioh provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lenders Name Lender's Address 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 liabilities, judgments, costs and expenses which may in any way accrue against said City inconsequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE ;TU)r�� Re -roofs Type of Roof f` Signature of Dal. HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino M;tmii at Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? []Yes 0 All roofs shall be inspected prior to any roofing material being installed. k If a roof 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? Dyes Ei�/o 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 responsibility to notify the occupant of the requirerne is which must be met prior to issuance of a Certificate I Occupancy. Signature of Applicant Date 7 7- 70 All roof coverings to be Class "B" or better 1 Owner I or authoridd-tigent Dat 0 qTY CDS' CUPERTINO BUILDING DIVISION PERMIT g BUILDING ADDRESS: PERMIT NO. OWNER'S NAME: .• ••� w. ,•-,ti.. ,...mak. APPLICATION UB 3A ` �. PHONE: SANITARY � ' ° ` •Cb ''a. `ARCHITECT/ENGBVEER: PHONE # BUILDING PERMIT INFO BLDG ELECT PLUMB MEC JNSPECFiONS IAI I I �kS FC TO ARRANGE INSPECTION JOB DES PTI CALL ?i7- 3228 MONDAY -FRIDAY 24 HOURSE L FOUNDATIONIPIERSJH.D.S, 0�7 BEFORE REQUIRED INSPECTION. JOB ADDRESS SFDWL ❑ KITCHEN REMODEL AND PERMIT #ARE NEEDED WHEN PHONB3G, p DDITION ❑ PLUMBING RE -PIPE UFER GROUND] ` ❑ MULTI -UNIT ❑ STRUCTURAL PAD/SET BACK -CERT —C%p RESIDENTIAL COMMERCIAL OTHER MODIFICATION GARAGE SLABS/PREGUNITE Q HAZAII—DOUS FIRE AREA ❑ INTERIOR ❑ CHIMNEY REPAIR POti!RNOCONCR�I'EUNi'I`;A$OUEEi,�S.BEEIifSIGNED' IMPROVEMENT ❑SWIMMING POOLS UNDERGROUND/SLAB ❑ YES If yes - I understand that a Class A roof assembly is required, ❑ BATH REMODELIREPAIR ❑ DEMOLITION ❑ OTHER PLUMBING ❑ NO Initial I,C.B.O. # ELECTRICAL DO-N01"t1UR TLOOR U wF AI3pVC HAS T3EE SkGNED; ` ' EXISTING ROOF COVERING COMMI RCIAL: .',• ❑ NEW BLDG/ADDITION ❑ DEMOLITION PLUMBING Number of existing coverings ❑ TENANT ❑ FOOD SERVICE MECHANICAL r IMPROVEMENT ELECTRICTo he removed To be retained ❑ GTR FRAMLNQ VENTStArRQ INSULATION--' :PLACE NO SUBFLOOR,C#NTit.ABO'VE HAS BEEN SIG �K TYPE OF ROOF COVERING ROOF SHEATHIDIAPHRAM SE EXISTING: PROPOD: PLUMBING ❑ Built -Up Roof ❑ Built -Up Roof TUBS & SHOWER PAN 0 % •-0 ❑ Asphalt Shingles ❑ Asphalt Shingles MECHANICAL t 'ZJ f �1 Wood Shakes ❑ Wood Shakes ELECTRICAL/POOL BOND J O �-01 CI Wood Shingles ❑ Wood Shingles FRAMING/STAIRS/E. EGRESS �"Ad= -- /� ) ❑ Other (Specify) INSULATIONIV ENTILATION Provide I.C.B.O. Report No. COVER NO WokK. UNTIL ABOVE HAS BEEt IGNED Provide Mfgr. Installation Specs. E ' TERIAL SHEARMOLD DOWN INTERIOR SHEAR/HOLD DOWN PECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSP SHEETROCK/SHEETROCK SHEAR . $ EXTERIOR LATHIW-SCREED 0 SHOWER LATH 44 NO TAPE OR PLASTERIfNT I_ ABOVE 1,1AS HEP. SIGH , ' �7s r' •"',.... 10" S GT TCH ..,,-" .jam` '+..-7'r"S ' '^' / APPROVALS mow,, f 6 OCCUPANCY i+�O CJS h -'ST r ( FINALS ' _ PLANNING 777.3348 �% G`Q /� 4e� 7 - �j< GAS TEST ++,e�,9•• p. ��� ,,,,, ),/ i` GRADE (P.W. 777-3354) j C✓ J 7, , fLl� r HANDICAP •S ELECTRICAL i PLUMBING . . MECHANICAL ENERGY. VISUAL FINAL ONLY BUMDING_ _ OCCtiPANCY Ofi OILDING'IS NOT PE:RIvtITTED `UN fll, BUILDING FI:*kAl_ IS sIGNED 13Y BI: tI_t)(;'4G I\' PHC7CiR. CERTIFICATE OF OCCUPANCY El PRE -INSPECTION: PLYWOOD: IN -PROGRESS INSP. DATE _-_._ _ INSP. DATE INSP DAPB TEAR OFF INSPECTION: BATTENS: FINAL: INSP, DATE INSP. DATE INSP. DATE NOTE: VED ACCESS TF SHALL BE PROVIDED FOR INSPECTION HYY'LIt+HtVI �a'3 r'Vai 1 ttV67 e..Vr T