03050126 CITY OF CUPERTINO
auu.olNc DIVISION PERMIT CONTRACTUIt INFORMATION ;
BUILDING DING;
PERMIT ND.
DRAEGER CONSTRUCTION INC 03050126
AM PERMIT ISSUE DATE
605 COMMERCIAL ST 05/27/2003
(408) 536-0420 SANITARY NO. CONTROL NO.
ARCHITECTUNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
loo LICENSEDCONTRACTOR'S DECLARATION Job Description
i 1 bomb,affirm Net 1 am licensed under roviaioOeSCrI
ns of Chapter 9(commencing p
< with Session]OIIOBusi Ind Pmfcuinru Cadednd myliccnx is
< n full fora d (fen � ` / O w� p
'gz p;`" �" µoC C' re c .r REPAIR DECK FINALE®
ARCHITECTS DEC TION
I understand my plans alsdi W used u lid lie rtenrda
> t OCT 2 2 2003
o Massed Pmfusionn
5 OWNER-BUILDER DECLARATION
Ce O hereby.(firm on 1 1. exempt from the Contractor's Co License taw for the BUILDING
a O following mason.(Section 7031.3.Buster,and improve.
demolish,nuns Cole:Any city or emus, n
5$ which requims a permit m umm the cher,improv:, ermttm sepsis any tat a ant
NQ prior m its l ceps d pursuant
to ms pro inion of for Such Conmuclon s Eense Lo (Chaps cot
ggg�o that the(comma cing wit pSectio 70the00)provisions nl the The
License law(Chapter Sq.F[. Floor Area $8�]�tba[ion
$
(commencing in Attempt Section and
or Sea,
r the
al B ed assumptss and Prormon,An vi Codd or
Nath 4 essmpt themfrom and dm bWs(w Je alleged essmpaon.Any viohGon of
Residue 7031.5 by any applicant for a permit ubjects the applicant o a civil penalty ofp y Type
m
net om than five hundred dollars(55110). 3 5��1l8�e6 0 CCn araC
❑L o the ,of Ne properly,m my emplayma or
wag.ar ale'. c.compensetion,
will dolhwod.andthThe Comes not l License, ffmad Law
forsale70aa.wniwu 101 - FOUNDA'UdWed Inspections
and ProfunoCode:The Cont ancon,License Law dose or apply lf an owner of
man employ build,,provided that
Jmrcogand who Are
himsslfor red for lelin M. 102 PIERS
awn employ=, Nat such improvementsid wad are notes,orintended or Offered for Owner.
however,Ne Wilding or improvemantis soldr within orc Sear ofcompletion,Ne owwn 103 - UFER
builder will have tim buWen of proving that he did mi Wild or Improve for purpose of 104 - REBAR
Sale.).
❑1.AS maws of the property,am exclusively contracting with licensed contractors to 105 - ANCHOR BOLTS
construct Ne pmkct(Sce.7W.Busmen arta Prolaskns Code:)The Contractor's U. 106 — SEWER & WATER
cense law drum not apply an an owner of property who Wilds or imps.[[[themon,and
who contracts for such projecta with a contractor(&)licensed pursuant 7o IN,Conmclors 202 - UNDERFLOOR PLUMBING
Lkenre Law. 203 - UNDERFLOOR MECHANICAL
❑1 un aempt under Sec. .E 6 P C fns Nia renin
wr Data 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
I hereby affirm under penalty of perjury one of Ne following declarations: 301 - ROUGH PLUMBING
❑I haat and will maintain a Cerdfiaa of Consent N a elf-insum fa Wwker'a Compcn- 302 - TUB & OR SHOWER
talion,as provided for by Section 37011 of the labor Code,for the performance of the 303 - ROUGH MECHANICAL
wad for which this permit is dsecd.
❑1 have and will maintain Workers Compensation Insurance,AS required by Section 304 - ROUGH ELECTRICAL
3700.r 0.Labor Code,for She Korn mann of ewoh for which this permit is Issued. 305 - FRAME
My Worker's Compensation lnsumna ca a Policy number w:
C 'r h . rolieyNa•: �V p/( rvo'o7 306 — HOLDOWNS
X CERTIFICATE OF EXEMPTION MOMW RKER� 307 - INSULATION
COMPENSATION INSURANCE r y t(.O j 308 - SHEETROCK
or luc)(Thksection wed not h eompletad IIIb permit is forow hundred dollars($100) 309' - EXTERIOR LATH
I certify Nat in Nc performance of IN,work for which this permit is issued.I shall not 310 - INTERIOR LATH
employ any person in any manneran AS Sec become subject to de Workeri Compensallon 311 - SCRATCH COAT
Laws of California.Data
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:If.after making this Cmdricata of Exemption,you shoulJ 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisiom of ted Labor Crede,you muse
Z forthwith comply with Such provisions wShia Permit Shelf hdomedrevokcd. 502 - FINAL PLUMBING ENERGY
?0 CONsrxurnONLENDING AGENCY 503 - FINAL MECHANICAL ENERGY
(-. 1 hereby affirm that them is a constroctino lending agency for the Krformance of 504 - FINAL BUILDING ENERGY
QS> he work for which this permit IS issued(Sec.3097.Civ.C.)
W'q tameeraNarne 505 - FINAL ELECTRICAL
az emaer&Aaamn 506 - GAS TEST
[„)Q I certify that I have mad this application and state that the above Information is
LL corms I.gree N comply with all city and county ardinsnces and ataan laws misting in 507 - - FINAL PLUMBING
0 building construction,And hereby Authodre mpruentaNcs of this city to enter upon the �j FINAA MECHAN CAL
above-mentioned property for Inspection purposes
a (We)Agree to save,indmi nify and keep harmless the city or Cupertino egaiwt. 5 9 FIN
y in CoNesSSAM ethacnsnand capewawhtch may in any way serve against said City 51 G
V Z in consegwna u Ne granting of phis es whiAPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by5 Date
SO EREGULATIONS.
( ,e4V^,f-- 1, nSamT Re-roofs
StgnJt AppbcanUCon—tor Data
C
HAZARDOUS MATERIAtSDISCLOSURE
Type of Roof
MI]the applicant or future Wilding occupml nom or handle hassrdous material
AS defined by She Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
aM.Smile.25533(.)7 e All roofs shall be inspected prior to any roofing material being installed.
[3 Yet
WIII @c applicant or future building Occupant tau equipment or dcvicu which If a roof is installed without first obtaining an inspection,I agree to remove
emit haardnns air cwtaminsou AS de0wd by the Bay Ams Air Quality Management all new materials for inspection.
District]
❑Yet �To
1 have mW the hvaNnusm.tariak mquimmmitn under Chaptar a.95af Jut Califor-
nielkalN&WctyCW.Secd=25505,25533. 25534.lundcmand Nalifde Wilding
data rot currently ham a anent.that it is my responsibility in notify the resonant of She
uimmcnta which must be met prior N issuance of a Cmdriaa Occupancy. _ Signature of Applicant Date
-o .Nomad agent Dow
p4L ° All roof coverings to be Class"B"or better