B-2018-0471 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS; CONTRACTOR: PERMIT NO;B-2Di8-0471
10880 N*OlMP14"Y SQ CUPERTINO,CA 95014-0537(316 40 052) GENIE POOL&SPA
SERVICE INC
SAN JOSE,CA 95136
OWNER'S NAME:•DE&BELLD B DATE ISSUED:03!20@018
OWNER'S PHONE/ PHONE NO;(408)978-1948
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class 0-63 Lic.ft437842
Contractor GENIE POOL&SPAC RVI•-IN-Date 10/31/2018 X BLDG X ELECT_PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing --MECH X RESIDENTIAL_COMMERCIAL
with Section 1000)of'Dlvislan 3 of the Ruslness&Professions Code and that my
Rconse is imhrll force mrd effect JOB DESCRIPTION;
REPLACE SWIMMING POOL HEATER
�
rm under penalty of perjury one of the fallowing two declarations;
ave mid will maintain a certificate of consent to self-fnsme for Worker's
ompensation,as provided for by Section 3700 of the Labor Cade,for the
rformance of the work for which this permit Is issued.
ave and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the,Labor Code,for the performance of the work for which this
permit is Issued. Sq.Fl Floor Arca; Valuetton;$4500,00
APPLICANT CERTIFICATION
I certify that I have read tits appllcatlon and stale that the above Occu 052
APN Number:
ane
Information Is correct.I agree to comply with all city and county ordinances 3(640 umum p y TYpe�
and state laws relating to huddling 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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City In consequa�aqrde of the granting of this permit WITHIN 180 DAYS OF PERMIT ISSUANCE OR
s ui arellulati a ler Cuersi no IsnnlclwalI C,,de!8elch al1918;polnt
regulate p 180 DAYS FROM LAST CALLED INSPECTION.
(EIgnaturey/ �� "' Date 3 2� Issued by:Abby A3mnde
Date:QaZ2DD lg
OWNER•BUILDRR DECLARATION.
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS,
fallowing We reasmmss All roofs shall be inspected prior to any roofing material being Installed.If a roof Is
L 1,es owner of the proper A or my employees with wages as their aole installed without twat obtabdmg an inspection,I agree to remove all now materials for
compensation,will do die work,and the structure is hat Intended or offered for hmspeotlon.
eats(9600441 Business&Professions Cade)
z. I,me owner oftheproperly,am exclusively contracting with licensed Signal—ofAppli,mit:
contractors to..onot the projeG(Sec.7044,Business&Pmressb ms Code), Data:3/20/2018
I hereby olfirm ander penalty of perjury one of the followhng three declaradons: ALL ROOF COVERINGS TO BE CLASS"A"OR SETTER
r. I have mid will maintain a Cerificate 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, HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation husmance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California/Health&Safety Code,Sections 25505,25533,and 25534.IwRI
permit Is issued, maintain compliance with the Cupertino Munietpal Code,Chapter 9.12 and the
s. I certify that in the performance of One work for which this permit is issued,I Health&Safety Cade,Section 25532(a)should I store or handle hazardous
shall not employ any person has any manner so as to become subject to the materia.Additlona0y,should I use equipment or devices which emit hazardous
Worker's Compensation laws of California.If,after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District 1
will malntnln enmplsanae with the Cnpartino Mnnf ipni dc,.Cllapter 9.12 and
exemption,I became subject to the Worker's Compensation provisions of the the Health&Safety Cnde, 6edmh 25505,25 ,and 25 4.
Labor Code,I must forthwith comply wi0m such provisions or this permit shall
be diseased revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:3/201201 8
certify that I have read this application and state that the above Informuilon Is COMST.RUC`PLON LENDINGAGENCY
correct.I agree to comply with all city and countyordinancesand state laws I hereby affirm that there Is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit Is Issued(Soo.3097,Civ C.)
to enter upon the above mentioned property for Inspection purposes.(We)agree Londor's Name
to save Indemnify and keep harmless the City of Cupertino against IlablllOes,
Judgments,costs,and expenseswhichmay accrue against said City In Lender's Address
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I.understand my plans shall be used as public records,
Llcensid
Signature pate$120!2048 professional