04040009 (2) CITY OF CUPEWrINO
BUILDING DIVISION PERMITCONTRACTnR INFORMATION `
£ ,,.ik'txZvq-. ...534}R )FY' $c6hs
Bu1LDINGADDRESS: DRAEGER CONSTRUCTION INC PERMIT N004040009
NF.R'S NAME: PERMIT ISSUE DATE
IRVINE APARTMENT COMMUNITI ;S605 COMMERCIAL ST 04 /14/9004
ONE: SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
c0o LICENSED CONTRACTOR'S DECLARATION
vd 1 hereby affirm that 1 am licensed under pmdxiona of Charter m
r 9(commencing Job Description
- wiNSection7IXNB of Division 3 of the Business end Profession.Code,and my license is
jagin rune Class rrep. STAIR REPAIR
? License Class Lira
o^ DataContractor
e 1q- ARCHITECTS DECLARATION
g N I understand my plain shall he used as public mmrds
,
It
Liccnud Pndcssinnal
OWNER-BUILDCR DECLARATION /
COO
g 1 greeny,(Orin on 11. exempt from Cssions o License Law for the
pO r011owwhich iremoon.Permit
] ostr Business and ere.demolish,
Code:Any city or county
5$ which rcyusca a permit re sires the
allot rat ray
demolish,m repair any semen
poor at be is
itrence,also dp.. .nato the lhcapplianl rue Cmunch rmiuucca.signed statement
F5o
that with
pumumuo the Of Divinn.of the Commas Uccoselaw(Chapter9 Sq. F[. Floor Area Valuation
y $ thammcncingwit tSenior 7")Of Division tor he he alleged
Business An,nnsCede)of
s, .. Net he Is exempt therefrom and the buil for the alleged gumption.Any violation of
Section 7031.5 by any applicant for a permit subjccu the applicant o a civil penalty of 3 M`56gIi978ar00 OCCD Type
not more Nan five hundred detars($500). Occupancy YP
❑1,as owner afire property,in my employees with wages as their sole compensation,
will do Ne work,and the s nic ure isnot intended or offered for ole(Sec.7044,Busineu
and Professions Code:The ConmcNr's License Law dues not apply to an owner of Required Inspections
property who builds of improves thcmon,and who does such work himself or through his
awn employees,provided that such improvements arc not intended or offered for sale.If.
however,the building or improvement is writ within one year or completion,the owner.
builder will have the burden of praying that he did not build or improve for puryose of
sal ).
I,as owner of the Firemany,am elusively contracting with licensed convectors m
on Cl the project(Sec.7044.Business and Professions Cade:)The Contractor's Li.
cense Law does not apply to an owner of property who holds or improves themon,and
who contracts for such pmjecs with a contractor(s)licensed pursuant to the Contactors
Liccnx law.
❑lame I tle c. ,Bk PC for file action
er Da¢
OR R'S MPENSATION DECLARATION
1 he a im ty of perjury one of the fallowing declarations:
1 haveand will maintain a Certificate of Conxm m self-insum fur WorkersCompen-
aation,as provided for by Section 3700 of the Labor Code.for the Performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 or On labor Cade,for she performance of the work for which this remit is Issued.
My Workers Compensation Insurance carrier and Policy number art:
Carrier. Policy No.: _
CERTIFICATE OF EXEM"ION FROM WORKERS'
COMPENSATION INSURANCE
Obleacetion need not be completed If tbo permit Is format hundred dollar(SIDE
ar lean.)
1 emify that in the performance of the work for which this permit is issued,l Mall net
employ any person in any mmncr an as N become subject to the Worker'ComTensavon
Laws of Celiforuls.Data
Applicant
NOTICE TO APPLICANT:II.after making this Ceniftca¢of Exemption,you should
become subject to the Wohcr's Compensation prevision.of the Labor Code,you most
.JO forthwith comply with such provision.or this permit a hall be deemed revoked.
Z'51 CONSTRUCTION LENDING AGENCY
[-rte I hereby aPom that there its construction lending agency l'nr the performance of
Ne work fur which this permit is issued(Sec.3097,Civ.C.)
W Q Lenders Name
M z Lcntler's Addrcu -
U Q I ramify that I haus read this application and rete this the above information is
IL,F correct 1 agree to comply with all city and county aNinanas and sum laws misting to
DU building construction,and hereby authorize representatives of this city to enter upon the
W ahuve-mentloned properly for inspection purposes.
gy (wc)agree m an.indemnify and keep harmless the City of Cupertino against
rag liebili*ApicanU
sts and expenses which may in any way accrue against said City
U 7 in eonorriming of this permit
F7 APPLI
AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /
SOUR
Re-roofs do
SignamSMATERIALSDISCLOSURE, Type of Roof
Will the appliWilding occupant store or baMlchoardoermuct d
as imlood by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety
ode,Sogdian 25532007 All roofs shall be inspected prior to any roofing material being installed.
Ycs 01�g
�\ If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant or.uis building occupant sax equipment or devices which P g
h havardnus oil consminants dcfincJ by the Bay Area Air Quality Management all new materials for inspection.
iasicR
❑Ycs u
1 have mad the hazeMnusmeteriais requirements;under Chapter6.95 of the Cali.or.
nie Health{k safely Codit,Sc my 25515.25533 and 25534,1 undcrsmnd that iliac building
docs n n c ly as�e term Not it is my respamihi)ity w nobly Ng occupant of Ne
nigh it fu-b an pdpexiuumaol7Certlfiateof g r. Signature of Applicant Date
I(
owner r Na se a and All roof coverings to be Class "B" or better