B-2017-1722 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1722
10470 SERRA ST CUPERTINO,CA 95014-6581(342 59 011) LOAYZA'S
LANDSCAPING
POOLS&SPAS INC
SAN JOSE,CA 95160
OWNER'S NAME: DATE ISSUED:04/03/2016
OWNER'S PHONE: PHONE NO:(408)297-5555
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class SWIMMING POOL Lic.#548014
Contractor LOAYZNS LANDSCAPING POOLS&SPAS INC Date 11130/2018 cX BLDG_ELECT 2J PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH$RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
Umnse is in fufi force and effect. JOB DESCRIPTION:
(N)IN GROUND GUNITE POOL WITH COVER(492 SF)&SPA(45
I hereby affirm under penalty of perjury one of the following two declarations: SF);(N)DETACHED BATHROOM(66 SF);(N)ARBOR/TRELLIS(400
r. I have and will maintain a certificate of consent to self-insure for Worker's SF);(N)FIRE PIT/GAS LINE.
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
z. I have and will maintain Worker's Compensation Insurance,as provided for by
APPLICANT CERTIFICATION
1 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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 342 59 011 R-3(Custom)
representatives of this'ety to enter"upon.-the above mentioned property for
inspection purp(ses. a)agree to savelhdemnify and keep harmless the
City of Cupertino ag that liabilities,judgmenth,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against al`d City In consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant dndePStands tjnd III"byn I lth all non-point
source r /e9u1atigfl pertV,6 pe tl rlMdni 11 t9`. ,S ction 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature�
�. Date:04/03/2018
OWNER-B L' I(/ECLAKATI
I hereby affirm that I am cxcmpt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed If a roof is
t. 1,as owner of the property,or my employees with wages as thew sole installed without fast obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,a n exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Cade). Date:4/3/2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of Ore Labor Code,for the
performance of the work for which this pemut is issued. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,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.I will
permit is issued. maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equip!,,�pt oa iletiees-whtch colt hazardop
air contaminants as defined by the Bay jp,€a Air Quality Manag ant District I
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cup 1'llho Municipal Code,Chap er 9612 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,S t'im s.2 505125533 and 258 ,
Labor Code,I must forthwith comply with such provisions or this permit shall /
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATIGN Date: 018
I certify that I have read this application and state that the above Information Is CONSTRU � IN AGE
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction Ie ding-a ency for the pe rmance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for Inspection purposes.(We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may 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. 1 understand my plans shall be used as publlc records.
Signature Date 41312018 Licensed
Professional