02100155 CITY OF CUPERTINO "% �"` % ` "QTY •_
BUILDING DIVISION PERMITCQNT� GTO( RgINFORMATION••
uul9ToT5AygRpS2OUNTRY SPRING CT DRAEGER CONSTRUCTION INC PERMrrN02100155
OWMRSrrAbg:HAO 605 COMMERCIAL ST APPLICATptSpB2DF 2002
Ah
IIONE: (408) 536-0420 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG [CECT PLUMB MECH
0 0 0 0
w0Z, LICENSED CONTRACTOR'S DECLARATION
ne(w!F 1 hereby alfirm toot 1 am lecimsed under provisions of Chapter 9l commencing Job Description
SIDING
<ZO with Section 7lkanofDivision 3ofthe Business and Professions Code,and my licenm is
n full Race an! ITL,I.
z on
M=OZ FO Dam /J�(Z /J�, GtECTS mmcnn pf(w +/
ARCHITDECLARATION
rc I undcrsmnd my plans shall he tats]as Public rccoNs /
3aO
H=as LiccnuJ l'ml'cssional
OWNER exempt frDECLARATION
O a p 1 hereby affirm IM1m I am exempt from the Conractnr's License Law Gr the Y $12000
Or_p O following rcavon(Section 7031 S.Business and Professions Code:Any city or county
u m m E which mgtum,a Permit to construct,alter,improve,demolish,or repair any Slmetum
I—zi prior to its issuance.also acquires the applicant for such permit to file a signed statement
sm`e that he is licensed psomanuomeprovromnsof heContactor'sLaccase Law Chapter 9 3$g6bt1I1daAa0 Valuation
e� (commencing With Section 7000)of Division of the Business and Professions Codc)or
a 3$ Our he is exempt therefrom and Ne basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom than five hundred dollars n5oB). PN N Occupancy Type
La sownerof the fire struc, miss employees with wages asracy sole compenutlon,
102 — PIERS
will dothe wons and theewnurcixnot s tended License
row do for
not pplyt an Business
T(53 bF-L and Professions Code:The Cunrereon.License taw docs or apply to an owner as 104 — REBAR Required Inspections
property who Wilds or improves thereon.and who does such work himself or through M1ix
Own employees,provided tesixuch improvements are not intended or offered for sale.If. 105 — ANCHOR BOLTS
however,are building or improvement is said within one year of completion,the coo
builder will haw firm burden of mving thed he did not Wild or improve for purpose of 106 — SEWER & WATER
5a1C.). 202 — UNDERFLOOR PLUMBING
[D 1,as Owner of the propeny.am exclusively contracting with licensed commcmrs to 203 — UNDERFLOOR MECHANICAL
construct the protect(Sec.7044.Business and Professions Code:)The Conractor's Li-
censeLawdoesnotapplYtoanownerofproper who Wilds or improves beacon,and 204 — UNDERFLOOR FRAME
who
iccense Low, ho srdn projects with aconuamor(a)licensed pursuant to the Conracmrs 205 — UNDERFLOOR INSULATION
❑ l am exempt under Scc. ,B&P C for Intimation 301 — ROUGH PLUMBING
owner Dam 302 — TUB & OR SHOWER
WORKER'S COMPENSATION DECLARATION
Ihereby affirm under PmrhyOfpOnuryone nthe following declonations: 303 — ROUGH MECHANICAL
r Ihave and will maintain aCedificamofConsent toself-insure for Worker'sCompcn- 304 — ROUGH ELECTRICAL
sadion,a.promded for by Section 3700 of he labor code,fear the pan000ame of the 3 05 — FRAME
work for which thislarmitisissued. 306 — HOLDOWNS
Cl
1 have and will maintain Worker's Compensation Insurance,as required by Section 307 — INSULATION
37W ofthe Labor Code,for the prefnrmantt of his,work for which this permit is issued.
My Workers compensation Insurance comer and Policy number are: 308 — SHEETROCK
camer$�a , e /, . ,li r.l_RoucyNo.: �ps�(o65 309 — EXTERIOR LATH
CGRTIPICATEOFE EMPIION FROM WORKERS'
COMPENSATION INSURANCE 310 — INTERIOR LATH
rini...eedon need not Wcompleted acne proof is for one hundred dollars(SBao 311 — SCRATCH COAT
Irt lea`) 313 — ROOF NAIL
Iifify inthe nerlaiymaneeorastoWoork mwnirnthis theWorlieraComssued.I anallnot 501 — FINAL ELECTRICAL ENERGY
employ any person in any manwr so as m Maomc subject to the Workcri Compensarinn
LawicanCalifornia.°"`
Applicant 502 — FINAL PLUMBING ENERGY
NOTICE TO APPLICA NT:IL after making this Cenificxm of Eamo mfixa uld 503 — FINAL MECHANICAL ENERGY
hccom,subject the Worker compcosatim provisions sal endomed yoked.ou must 504 — FINAL BUILDING ENERGY
�,Z forthwith comply t with suchprovisionsCorensonhis pprmilions Mhe Labor
Cesicd.
Z O CONSTRUCTION LENDING AGENCY 505 — FINAL ELECTRICAL
F
I hereby affirm Oat there is a conestritiction lending agency lot the Isrharmancefir 506 — GAS TEST
e4 >
the work for which this Permit isissued(Scc.31y97,Cos.C.) 507 — FINAL PLUMBING
41
In Lemb,'s Name
z Lender's Address 508 — FINAL MECHANICAL
U0 l wary that 1 have read this application and sure that the above information is 509 — F I NAL GRADE
U. coned.I agree m comply with all city and county ordinances and stat,laws relating to
OU auildingconswction,and hereby authnfimmPfeunahwxOfthis city tocrime upon the 5 FINAL PLANNING
r D.1 above mentioned property for inspection purposes, O
(We)agree judgmero ave,indemnifyandhick aafMcss the yacerm Cupcnst said City 5 4 FINRKS
U N Iiaconsequencmengathe rauiand capenuswhichmay inany wayaccmcagainrsaidCily C.aC 1
U Z to PLICANT NDERSTAN S m..Pcrmlt. Issued by. Date U
APPLICANT UNDERSTANDS AND WILL COMPLY WITII ALL NONPOINT
SOURCE R� I.ATIONS.
7 ac(aa Re-roofs
igna I AppimantaConracmr Uatc
HAZARDOUS MATERIALS DISCLOSURE, Type of Roof
Will the applicant or future building(occupant store or handle hafaNnus material
as defined by the Cufamino Municipal Calc,Chapter 9.12,and the Imalth and Safety
WO.Section 25532fid?
❑yea r(N. All roofs shall be inspected prior to any roofing material being installed.
Will the appheam or future budding Occupant use,equipment If a roof is installed without first obtaining an inspection, I agree to remove
ran qui Iredevice,em,h g P g
mit heaDistrict? us air aontaminanu az defined by the Bay Arca Air Quality Management all new materials for inspection.
DisvicR P
❑Y,x 2No
I anvc road the M1umNuu.mamriuls myuiremenr under Chopmrfi,95 of tha Cnlihrz-
niaHcalth&Safcty Calc.SCNum25Y)5.25533eod25534.1undcr,a dthmiftM building
does not cufmntly haw a tenant,coal it is my resp fichility lir nml lyrhe(occupant of the
requirement lehmust bemet pt; fmiazu ofacemficateofOccupancy. Signature of Applicant Date
- G2l�L
wner aul orim ag nt Date All roof coverings to be Class "13 or better