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CONTRACTOR INFORMATION:
DIIVIISIONND
IPERMIT
BUILDING ADDRESS:
PERMIT NO.
11882 PLACER SPRING CT
DRAEGER CONSTRUCTION INC
02010021
OWNER'S NAME:
APPLICATION SUB DATE
SAKAMOTO RONALD K AND SAKAMOTA
605 COMMERCIAL ST
01/04/2002
PHONE:
SANITARY NO. CONTROL NO.
(408)536-0420
ARCHITEC (ENGI,NEER:
BUILDING PERMIT INFO
DG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
Job Descrier' n
I hereby arfirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3o fine Business and Profrasmaa Coca and my license
RE—SIDING
is in full force ;n t.
LicerscCluss Lit.K {p17r l
FOtlPsD
Data -
ARCHITECT'S DECLARATION
I understand my plant shall be used as public secants
MAY 2 8 2002
Licensed Professional
OWNER -BUILDER DECLARAt'ION
I hereby offrn that 1 am exempt from the Contractor's License Law for she
following moon. (Section 7031.5. Business and Profassione Code. Any city or county'
improve, demolish,
p�^
BUILDING $18411
which requires a permit construct, conset, alter, or repair any structure
_.prior m its issur.. also acquires, the applucu t for such permit to file a signed statement
pt's,} -s❑ -L P6g'1 orr9A Area7.� wr:
f.1'r';j3i&b5i.JU
Valuation
that he is licensed pursuant to the pmvraons of the Contractors License Law (Chapter 9
(commencing with Smnon]000) of Division 3 of the Business ad Professions Code)
or that he is exempt rherfrrito and the basis for the alleged exemption. Any viahtion
of Section 7031.5 by any applicant for a permit subjects she applicant to a civic Family
or not team than five nondmd dollars (s500),
�l.�I3TnI7��UND
101 All FOATION
-l ..Occupancy Type
❑I, as owner offire progeny, or my employees with wages as their sole compensation,
- - - - -
103 — UFER Required Inspections •'''<•'
will do the work. and the structure It not intended or offered for sale (Sec. 711
Business end Prafcssions Code: The Contractor's License Law does not apply to an
owner of property Who builds or improves thereon, and who does such work himself
or through his own employees, provided that such improvements am not intended or
10.4.— REBAR _
.- ..__ .._ .__.._.._...__._._.__._.._._._..__...-...._.
offered for sale. If: however, the bu ding ar iniproJcmrnr is s61d'within-Dna Year of
- _ _
105 — ANCHOR BOLTS ' '
I t the owner -builder will have the burden of that he did not build or
i'amp c ion, proving
mprove far No,00, of rarest.
106 — SEWER & WATER
of ownerof theIr taetngnsCociaThcontractors r's
202 — UNDERFLOOR PLUMBING
ectJScenr41s
ewa the project (See. Olo a ownerBusiness and arty wholt Cade I The
Licence
andrnx
t
203 — UNDERFLOOR MECHANICAL
contactsforduch,prnowmtthacoenrwnahalldtnripursuateream.
. Cods who contracts rLawYCh, projects with a contractors) licensed pursuant m.thc
-._ __ _ .._.._.__._._-._._.-
2.0.4 — UNDERFLOOR .F.RAME---
01amexemptunxLaw.
❑ImnexemptunderSec. ',,BffiPCfonM1ismason
205 — UNDERFLOOR INSULATION
ow^ar - NSA
3 01 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302 — TUB & OR SHOWER
Ihcmb rfirm undgr gar rth�rouowin aalamaana: --
hereby penalty perjuryanea g
303 — ROUGH MECHANICAL
❑ 1 have and will maintain a Certificate of Consent td self-insare for worker's
3 04 — ROUGH ELECTRICAL
Compensation, asProvidedI'or by -Section 3700 of the Labor Cade, for the
performance of the wort' for which thisI. permit is issued.
3 0 5 — FRAME
❑ I have andwitl7radmain Walk,Courparlildim tessera^ e required by,Smtlon
306 — HOLDOWNS
3700 of thoLatior care. for h roof .ma ce of the work for which'his permit is
io {a��5rw Work,,', -p�L r In.. dPol r umbo re„ •,
_ _ 307_ — ,INSULATION
rr(rdr^'cFAJPIIarNo..
308. . SHEETROCK,
' 5
'EXTERIOR
"CERfIF� EXEMPTION�M WORKERS
t
3'09 '— LATH 'I'
COMPENSATION INSl1RANCE -
'INTERIOR LATH
' -
(This u<tion need not be completed if the perm is for one hundred dollars
al0ojo�lettl3
311 — SCRATCH COAT ;
' 1 n fythat to the p,ro, Nance of the work for wh ch this per1l , rssuN 1
•shall
- 31`3" -- ROOF NAIL I.
not employ any person in any manner sat as to become subject to the Workers
501 — FINAL ELECTRICAL ENERGY
'Compe^:arinn Laws of Callfmnia. Date '
'Appheant. '' ' -' -' ` - - -
----- 502- "-- FINAL PLUMBING ENERGY-'_.__ _ ....... _.___. .
- NOTICE TO'APPLICANI: lf, arta innkimg this Cenllicatc of Exemption. you should
'become subject o the Workers Compensation provisions ofmc Labor Code you must
'
503 — FINAL MECHANICAL ENERGY
forthwith comply withsuch provisions m this permn shall be dc<meJ revnkeJ.
_ .._ .
504 --- FINAL -BUILDING ENERGY—,;,r
` '..
'CONSTRUCTION LENDING AGENCY "''
505 — FINAL ELECTRICAL
I hereby aRrn that thele is a convolution lending agency for the perfmm3nce
'on
h heworkfarwhichis pe. it i.issued(Seew97:co,CA .' .,
•_.._.
— GAS TEST. _ .... _.__ _. _._ .__.. _.._ .. ........_ .. _
Lender's Name•.. .... _ ,. ... ._..__ . ... -.. ..:.
Leneen Ackl i,:
_ _ ..._506-
507 — FINAL PLUMBING;a•r r.
l certify that l have mad this appliea6on and state that she above information is
508 — FINAL MECHANICAL
omien. l agree .q comply with ail citgapd county ordinances and State laws relating
509 — FINAL GRADE
to building c.susinion, and hereby authorim representatives of this city to enter upon
In, 'Pr carehinnedprogenyforin.peri IT.W..+es. . ,..
510 — FINAL PLANNI
(W) gree m sea a demnify and k p harmlcu th ry Cof C patina against
I liabilities. j dgment. is add open m hindi may in any wayeernme against . and
,
514 —r F I NAL U 0 S
Cry M sequence thegranting of th pr it.
APPLICA\I'U\ULRSTANDS AND set ILL COMPLY WITHAL 1NON-POINT'
Issued by: D
SOURCE' REGULATIONS.
Re -roofs /
Slgnamrc of ApplicanbCnmmtor -Date
HAZARDOUS MATERIALS DISCLOSURE
Wil I me appl icant or future'building occupt nm c, h dle hicoulorn, rantand
-opal
Type of Roof.- ... ._-
its defiand byph Cupcn M Chapter 9.12 d the Health and Safety
'Cod S❑Y 255321a1
s, p
.. 's ! k
i
,� ., _
t
,-..
< .. .,
roofs shall be.inspected prior.to,any roofing material betng.Installed__
_ _- _
Will the applicant or fitione building nec,apantune equipment andevices which•
-All
If a roof is ihr tolled without first obtaining an inspectl6n<I'agree 65.cemove
cmrito? us airt u lsodcf bS the Day Arc AvQ lay Management
all new materials for inspection. Applicant understands and will comply with
DYet
all non -point source regulations..,,, .
I have mad the �hazardous materialt requirement. under Chapter 6.95 of the
California Health & Safety Code. Seaians 25505.25533 and 25534, 1 undermmod than
.... - _. ------ --—� --
if the buildin8 doesndt eumcntly haveamnam; thin it is mY responaibilirymnotify the
- - '-'" -_
e requirem" cnu whim mint be tet prior m isauantt otf a Cenifc5te of
tozec
u eot'f..t•h
Signature of Applicant Date
_ .. -„,
- lots
All roof coverings to be Class "B” or better
,.'rte - - •Dam -
r.aumoH: age^ .
OFFICE-