08070133 CITY OF CUPERTINO .�' +• as777'777
BUILDING DrVISION PERMIT C�NfRAGT(:TR`INF,URMATIEJN
BUI , PSS: PERMITNO.
STEVENS CREEK BLVD DRAEGER CONSTRUCTION INC 08070133
OWNER'S NAME: PERMIT L4TIE DATE
MATTIESON REALTY SERVICES INC 605 COMMERCIAL ST 07/18/2008
NE: (408) 536-0420 SANITARY NO. CONTROL NO.
ARCHTTECT/FENGINEER: BUILDING PERMIT INFO
00 0 0
u0o LICENSED CONTRACTOR'S DECLARATION JpbDe$Cn eon
F 1 bortby a01rm Nat 1 am Iicentcd under provisient of Ghipter 9(commencing P
WNSmtion7")dDivision3aftBusmme,ardPrafesdmuCode.andmylicemcu 6000SQ RMV MANSR RF SDNG &RPLC W/NEW JAMES
^OH in full fore andalm bl�� l�
5�z Licensearm. La.a HARDIE SDNG SSAME' DESGN 8" O.C. GROVES
�, Dam o Contractor
aye ARCHTECI-S DECU'Al l
W U I understand my plans shall be coed as public records
6
goln Licensed Professional
5 OWNER-BUILDER DECLARATION
I hreby aflim Nat I am exempt from the Contractors License Law for the
❑O following won.(Section 7031.5,Business and Profession&Code:My city or county
which requires a permit W cmtswn,almr,improve,demull h,W repot,any sim sure
_i y prior W its issuance.also mquires Ne applicant for such permit to file a upmd summa,
�< thmhe ati;ansed purrumtWNe pWKsiont of the[ontracWr'a liarrsc law lCuprm9 Sq.Ft. Floor Area Valuation
(commencing while 00)
Section70o(Division3oftheBusinevtand ProfessionsCade)or $55000
Nat M is exempt thme(rom and the bssat for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a petmil wbjecu the applicant to a civil penalty ofNumber Occu ane Type
ter Wort dean fin hundred dollars ISM 36232053 � P Y YP
❑1,u owner of 0e prvperry.m my wplaym with wage u Ihebmk mmpcnaWon,
will do the wort and the swcture k not intended oroffered for sale(Sec.70th,Budws
and PWfesdmu Cade The ommacWrs License law does mI apply to an owner of Required Inspections
Property wW builds I.,.Oracort and who does,uchwork hineadfmthWugh his
ownemployrrs,provided loss such improvements ere no,intended oroffeed fmr a ff,
however.the Wilding or improvement at sold within one year of completion.the owner-
W;Ider will haw The pada of preving Nat he did rent build or improve for purpose of
nale5.
❑1.as owner of Nte pmpeny.am exclusively contracting with licensed contfannrs to
coeswct she project(Sec.7064.Business and Plefesslont Code:)The ConescmrS U.
centre law does nor apply W an owner of property who Wilds or bmyreves thereon,and.
who conmcta for such proems with a cormamr(s)licensed puraumt W the Conuanoh
Licence law.
❑Iomeaerep,unect See ,B&PCfor Nismuon
Owner Date-
WORKERS
amWORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of Oe following dmlarWant: t
I bare and will maintain a Cenifiestea Content W self-insuw for Workers Cmnprn
sation,as provided for by Section 37M of she Labor Code,for the performance of the
were for which this permit is broad. C
O 1 haw and will maintain Worker's Compensation Insmana,u rtgdred by Section
3700 of Ne labor Code,for the Performance ofthe woh forwhich that permit or send.
My Wo e.Compensation Ind.carer and Policy munber are: �1
Carver: o"It"rV A) Policy No.: :7 l tJG 12
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(That secdan wend Write completed ifft permit Is fora..humdmd dollars(SI00)
ce Iona)
1 certify Nat in the performance of Ne work for which this Permit is based.l shall not
employ any persan;n any man.,so as m become mbjecl to the Workrs'Cmnpensallon
Laws of Calirom;a.Date
Applicant
N'OnCE TO APPLICANT:If,after making this Certificate of Exemption,you slwld
become subjcn an on,Wohers Compensation provisions of the IabWr Code,you mus
.,O forthwith comply with such provisions or Nu permit shall he d ro
decreeoked.
'Zr y CONSTRUCTION LENDING AGENCY
[—� I hereby affirm Nat Vert u a censwetion lending agency for Ne performance of
ai r7 Ne work for which this,permit Is issued(Sec.3097,Civ.C.)
QLemicrs Name
ZD z Landers Addw
V Q 1 unify that 1 have read Nis application and We thm the above bolonatiun ie
ILr correct.I agme W comply with W city and coaly enNinamva and sum laws restrict to
C) Wilding cmuur,ion,and hcmbyauNorire mpnaenu0wsof Nu city W aces.N.tic
W above-hom i and Fgxny for inspection proposes
LL (Wc) rtt W vac,i emnify and trap harmless the City of Cupertino again
h thbilides,ju g en cru expm,u whichmaylnanywayaccrmagalmsoud C,y
V z in conwq f gran a ofthopermit. _
APPLICA N R N S AND WILL COMPLY WITH ALL NO -POINT Issued by: Date
SOUR
ignurt
(5 ° Re-roofs
ppl, H=S MATERIADISCLOSURE Dam
LSType of Roof
Will the applicant or furore Wilding mcupantstom or handle heo rdW3 material
as dalmd by the Cupenim Municipal Cods.Chapter 9.12 and Ne Health and Safety
emle.Section sss3z(.)T All roofs shall be inspected prior to any roofing material being installed.
Y. No
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicmr or tort W;Iding accupam um equipment car device,,Mich P g
t b=11r:air conumi fired by Ute Bay Area Air Quality Management
Districts all new materials for inspection.
❑Yes No
1 haw read the hasstdmu materials mquimmcros mdcrChaplefti.95of de Califer-
rsHWN&Safety odc, •Wmta25505.25533and75536.1undcrsund Nmifthe building
doesmor cu dy ve ret.that it u my responsibility W may the recupmt of the
rcquiremco hi, m lite ctpriertaissuanccwfaCetiftaca " ncy.� Signature of Applicant Date
Date��t DAll roof coverings to be Class';W'or better
Owncr w mNoris.d ager '