Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
01110122 CJBUOF CON
UPERTNO
BUILDING
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11731 SOUTHSHORE CT DRAEGER CONSTRUCTION INC qq 01110122
COLLINS 605 COMMERCIAL ST A11C/29/2001
PNO,N'E: SANITARY NO. CONTROL NO.
(408) 536-0420
wO O ARCHITEC-PENGINGER: BUILDING PERMIT INFO
Fro_ BLDG ELECT PLUMB MECH
I,5 u i LICENSED CONTRACTOR'S DECLARATION Job Description
z_ 1 IRrens arfim,,w,I am bansea anger provisions ar chapter 9 mammen[mg RE-SIDING.
with Sation]V001 fDi11 ppppppn,l of the Businea anJ mkssio sCafe.a dmylicense
eyp� 'rs in full.li,aca
rCp6 Licens mss Lic.p F
INALE®
5°:C 1 ,am
�_ cammemr
;HITECT'S DF.CLAR ON
u a 4 1 um unand my plain shall be meJ as puM1lk fecal,
n' FEB 0 8 2002
licensed Profes,innal
EEC,
c OWNER-BUILDER DECLARATION
Her
m I hereby affirm for 1 ant exempt from the C°mramar',License Law for the
t,?a following reawn.ISectiun 9031.5.Business:md P,of x,icns Code:Any city or county $16500
YF0 whichrtquiresapernJtmmnnruct.alcor.improve.dcmoliah.orrepaironyswaurc BUILDING
3e' prior toitsiuuattcc.alum mquireamc applicant for suchpermiuofilcasigmd$comment �(�.r;.s��g,va, -- - - -- — -- -- - -
- mat he is licensed promo totheaxwi,mr,of me C.at..r',License Law cluiptn 9 ,3 W9,?J;flr&' .1513a i I q'a s a Valuation
(commencing withSection 70l of Division 3 of the Busine,s and Professions Comm _ ,. y is..
ar that he ii exempt timrefrmn end the basis for me allegfd exemption.Any violation
of Section 7031.5 by any applicant for o permit subjins the applicant to a civil penalty
of not mom than five hundred dollars($500). 10 1AP.N P I DAT ION Occupancy Type
_ol.asowneronhepropm,manyemployeeswith%agesastheirsoleconnKmahom 102 - PIERS
will do the work.gad the structure is our intended ar offered for sale Ise[.IOsa, 103 - UFER ,
Business and Professions Cafe:The Connor',License Law dues not apply to an Required Inspections ,.
owner of pmrcmy Who build,or improves therean.and who does such walk himself 104 - REBAR
m through his own cmpinyeas.provided that such impmcni am not intended or __
'aTtiod far sale.If.however,the building or improvement is sold within one year of 105 - ANCHOR BOLTS —
'completion,the owncrbuilmer will have the burden of proving that he did not build or
improve fic"arpo>e ofsala.). 106 - SEWER & WATER
01.ssm,mconheprop�rty.come,[loo, lycon�ra[tingwith licensed ormametomm 202 - UNDERFLOOR' PLUMBING
consumer the projeet(see.]Bu.Basin.,and Pm3a,fons CwdeD The Cammmora 203 - UNDERFLOOR MECHANICAL
License Law docs not apply to an owner of property who builds or improves thereon,
bad who contracts for.such projects with a.contm[mgs)licensed pursuant to the 2 04 - UNDERFLOOR-FRAME -- - -...._ ... . .. . . _.. ..
oiaw.
mexemve��rsc. B&P C for thistisnn 205 - UNDERFLOOR INSULATION
O.o<r Date 301 - ROUGH PLUMBING .
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
1 hereby affirm under penalty of imrjury one of following dealaraeons: 303 - ROUGH MECHANICAL
tt ❑ I have and will mailmotp a Certm=me of Consent m see-insula for workers 3 04 _ ROUGH ELECTRICAL
F..1' Compensation. as provided far by Section non of the Labor code. for he 305 FRAME
performance of the work for which this permit is issued.
❑1 have and will maintain Worker's Compensatim
on ln,unce.m required by Section 306 - HOEDOWNS
3]00 of the tabor Code,far he parfornuance of the work far which thi"permit is 307 - INSULATION
issued.My Workers Compensation Insomnia carrier and Policy number ere: _ „_ _._ _ - _.. .__. ._ ...
_ 308 - SHEETROCK
I ' 'CERTIFICATION OF EXEMPTION FROM.WORKERS', 3O`9 EXTERIOR LATH'.
COMPENSATION INSURANCE —
310--,- INTERIOR-LATH---
•.'. mus'sactiaoneednofe[onf
binedineper
nmitisfor one hundred dollars 311 '- SCRATCH COAT .. . . .
Islw)orless.), 313 - ROOF NAIL
I Mm y that in the performance M the work for,Mich this permit is issued,I
shall not employ any perwo in any manner so as to become subject to the Wmkern' 501 - F I NAL EliECTR'I CAL'`ENERGY
Compensabn Lawsof California:Date. 502 - FINAL PLUMBING..ENERGY
..Applicant. - -- -
NOTICE TOAPPLICANT if,after makingthis CenifictimofExemption,you should 503 - FINAL MECHANICAL ENERGY
Z become&object m the Workers Compe...firm provisions of the Labor Carle,you mux,
rm
O Cfawith[amplywithsarnprovisionsorthispermitspanlxdeemedrevoked. 504 - FINAL BUILDING ENERGY
V1 CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
x ticrchy ulfinn thauhcie is a c°nmmginn lending agency for the perfo mance
506 - GAS TEST
or the wad for which this permit is i>sucd Iscc.309]:civ.C.)
y `p LhdersName' 507 - FINAL PLUMBING
;D Z Lender's Address
1 mf, otlhavereadmisepliillmoenda,am thm, x.1howeinformationis SOS -
FINAL MECHANICAL
corrin,.1 agree,o comply with all city and county mdinancm and mate laws relating 509 - FINAL GRADE
O U tabuilding conswction,and hdabyauthoriurcpamemauvesofthiscity toenter upon 510 - FINAL PLANNING
ythe abnve-mcntloncd propmy for inspection purposes.
(We)agree a.are indemnify a ad keep hmmle,sthechyofC.,mroagainst 514 - FINAL PUBWC WORKS
.�., In liabilities pdgmcma costs and expenses which may in any way accme against said
V-Z city APPLI in CANT UNDER.TAuence of rise NDS1AND WIL ng of this OMPLY WITH ALCNON-POINT'' I
s eaatu r.Ter I, Rous MA Issued fs Date
� amn-- TwrtM Re-roofs
TERIALS DISCLOSURE ©
Will thl apph[am or future buildingowe....I sauc or modlo ha.,adaus mamdal. Type of.Roof �— b ,. - ./_� .. �..�'• -- ..� . .
as defined by the Collection Mudeipa�Chapmr 9.12.end the Health and Safety
Cade.Section 255321U9 I g ! 1• .,!•.: \ .
oY=> "°t I, c,-'�,'' ' All roofs shall be inspected prior to any roofing material being.installed. -..,
1 Will the aypLeamorfrom building occupant use equipmem or devices which If a roof is installed without first obtaining an inspectlori;'llagree lO remove
emit hazvdous air contaminants as defined by the Bay Am.Air Quality Mamgemem
Diablo?. all new materials for inspection. Applicant understands and will comply with
y ores N° all non-point source regulations:
4.1t
I base lead the hala,dmw mauriak requimmerm under Chapter 6.95 of the
California Health&Safety Cash.Sections 25505,25533 and 25531:I mtdcrtumd that -
if,he bullding Jin,not currently have a tenant,that it is my responsibility to notify,he
ticdupem the ragdir en,s which mus,be met prior to issuance of a Certificate of
ney.. _ Signature of Applicant Date
1 SOI All roof coverings to be Class "B" or better
0 cr or aumoria n Dam
- - OFFICE -