02030216 (2) CITYDING DIVISION"O
BU[ PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
909 COTTONWOOD DR DRAEGER CONSTRUCTION INC 02030216
•OWNER'S NAME: APPLICATION SUB DATE
SIBLEY ROLAND H 605 COMMERCIAL ST 03/28/2002
FF PHONE: SANITARY NO. CONTROL NO.
f_ (408) 536-0420
Wo O z0 ARCHITEC(ENGINEER: BUILDING PERMIT INFO
&to BLDG ELECT PLUMB MECH
a 6 L= IJ I ""U E-D
y z LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that 1 am licensed undo CSCIIp
provisions of Chapter 9(commencing
w t'.l` with Section 701 of Division 3 or the Business nes Prot....ons Code and my license DRYWALL REPAIR & P INT.
inn to¢j and efrect. �(J
Lipgsoe N{ LicA e G I 710I U l
1 3 u y HIT rECLMtAecords -
"u O a 1 undeestan m Ions sh a a.p�records j
i,00 / �/
1 S o z
Licensed Rofcssiooal ^�
OWNER-BUILD DtECLARAT10N (/
of="r' I hereby aRrm rhos 1 am exempt from the Canuaaor's License law for the
t? following reason(Section 7031.5,Basiness and Professions Code:Any city or county $13000
ga3 sF0 which requires a permit to construct.alter,improve,demolish,or repair any structure
.-Prior toia;...,•.,ce,also re9airestheapplicant forsuch priori fileasignedstammmt.
that hSisJiacrectl parsuahpoahe pmvisiorss of the Conrrumrs Littnu law(Chagcr9 r. a+; + ,.,c10 Valuation
�Cq tea, }O� alp
(commentg with,Srct ]0)0)ofDivision 3 of the Business ind Prgfessions Code) f�)�\xt .[79'1"T[ 4-S "UVl T'r�r.,ie Y;•.
or th t he 1 e empt th f d the bas s for rhe alleged dem'pt on Any vrolari^n '
-^f genion 70J L5 by vny apphcam far a permit suhjccss she applicvm to a evil penalry-
,^fnot more then lie hundred dollars($5010). 10 lAPN AT I ON ;,u-:I "' Type
Occupancye
❑Las^wmrof lhepropcny.ar my employers with wvgesas Ncirsolecompensation. 102 _ PTRRS
-will do she work(and she swemrc'is not intended or oReredfor'sale(Sec.711117Busmesa add Prores.ian.Cade:no Cmu actor's License Law does nos apply m as 103 — UFER Required Inspections
owner of property Who builds or improves thereon,and who does such work himself
or through his own employees.provided that such improvements air not intended lir 104 — REBAR
,offered for sell:If,however,dre building or imVmvemcm is sold-within-ne yeas of- - '- ----'--"-"----ANCHOR
' - -__.. - ..:._--_.__.___- .._
'completion she owner-builder will have the burden of proving that he did not build or 105 - ANCHOR BOLTS °�" -p: > r..improve for 106 - SEWER & WATER
_. -.,._ 202. - UNDERFLOOR PLUMBING __..
ED 1; neroiNe Propcngam Business
contracting NI tae Contractor's iLi:
consumer Law
project(Sec 70ia,Busies and Professional Cod J The Connaaors "' '
-- %i«nulawaoesnot for.suymagjefu of aaPnywho bmensedprovesthinta, 203 - UNDERFLOOR MECHANPCAli"''
-tied who commas forsuch projects.w- contracmr(s'licensed pursumt.m.We. -_._,_,___.
CommuorsuanseLaw. �,. . - . . ,. "204--.-_....UNDERFLOOR'-FRAME-----.-._..___..__...__...._-_..`-..._.._._ . .
❑lomesempsundcrSce. ";B&PC for1hgxamon 205 - UNDERFLOOR!'' INSULATION
°wNi
Data 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR .SHOWER
�-^ Ihereby upon under Penalty^fP,forydne,ofthefollowing eceldrabons:� ' 303 — ROUGH MECHANICAL
:�on+-� ❑ I have e'will maintain Certificate, of Cause.,to self-mann far workers 3 04 - ROUGH ELECTRICAL
Compcnsm;on, is provided for by Section 3700 of she Labor Cocke. for the
arram,an«'nrwewarkrarwhmgtmspermiu:isaure. 305 — FRAME
❑Ih a'willmalma Warker7s Comnerionto berargance.as mintairedby,Section 306 - HOLDOWNS
il 37W of the Labor Cod f thepit form a of the ork'f which thispemui is
sued Myw kers Comps i In BandPolrynu x 307 — INSULATION
r�uERTITI�[ iLL .Pdfy 3 1)O S^F> �p 308 ...._='rSHEETROCK,
" r EXEM FROM.WORKERS f a R ( n '� M f ' R s y s•r I, 1 RI 1 - c.t
CERTIFICATION OF 3'09 `- EX-TERIOR LATH
COMPENSATIONINSURANCE'
_. 310,r INTERTOR—L'RTH
(Thr tact on need not Ce complemE d she perms rs for one huMrtd dollar
(s100)or less;) 311 — SCRATCH COAT '
r: - - :. -- 3--1-3:..-_-°-ROOF:=NAIL
I ttn fy th Ong the performance any f thework fwhich his ct 's s s ued I - -' -
Comntp ply nyp o y lir to becomesublectrtheW.kers 501 - FINAL ELECTRICAL 'ENERGY
Compensation la of Calf Data - '.'
APP' -- - -- 502--=__ .FINAL__PLUMBING ENERGY-- _.. ..
INOTICETOAPPLICANT I(alY m k ng th C ri(cat f E empuo you should A'---- --
z swam ub3ent m w ker c 503 - FINAL MECHANICAL ENERGY
pc p s o sof N<Lebo Cade sr '
O O fano m ply thxptnp oto x t n nbea emukw _ _. 504... e_.FINAL BUILDING_ ENERG$ _. _
-
CONSTRUCTION LENDING 505 - FINAL ELECTRICAL
a'' ' ' 1 lie by affnm Nat Ut -rs a mnstm u n lend g agency f she perfortni tt' 1
Wattn okfq, hchth Pemrt s msec 3897 Cie C.) a.y _ 506 — GAS TEST
-hendersNme ._. ._ .. ___FI
._ _ .. '.__ .. _ .-. ......._.
5'a z olio Aaa 507 - FINAL PLUMBING
tX0 r' 508 - FINAL MECHANICAL
I acidify that 1 have read this application and grant that dm^have Information is
to t U c6imn.I agrca to comply w;N all city and counry,ordinamen and state laws adding 509 - FINAL GRADE
0.:(, m hooding construction,and hereby mahorire reprcunutivee of this city m enter upon
W4 meanava-memlanedpropertfor mapcctianparpoas. 510 - FINAL PLANNING
-o. (We)agree tdaava maemniryand keep harmless:the Eitybfe$p6No6 against
10 liabilities,judgments,costs and exp<nsas which.may many way accrues against said 514 - FINAL PUB I C WORKS
C;ty in can- lice of Nr gran"go . - "
A LIG' D11= A' 'stt NPLY�'WITH 'NON'-POINT''e I
S URCP E LATIG ,. `y- y Issued by: Date
Isis^tui _ AppheausC t star c'. ,^.
,
D¢- '. Re-roofs
HAZARDO MATERIALS DISC105URE L; ^
win the apiqllicand or Image wldingoarpantshareorhandl hioiidwsmairnal _. Type.ofRoof_.__ ..
ny def ed b in Cu n MuSea,, - -- _
Y P p 1 Code Ch Chapter 912 d the Hea1N end �,, .. _._..
Code Season 25512fU RY l l s f 1s 1 -r t r
OYes iN I
_All roofs shall be inspected prior to any roofing material being Installed. _
r w n to ppl t f r
miffing nompaint t ea; t devicesgpn h If a roof Is installed without fust obtaining an inspection I agree tdremove
inn hassrdo ma u m defines by N Bay A n Quality Mawhich
t
°;RC1° all new materials for inspection Applicant understands and w 1 cpm I with
oY " a 1 all non- oin source re ulatlons P'y`
I ha read thelhaaardo s mat rials egmrementi under Chapmr 6.95 Of the P g -
Califovua Hea1N&Safety Cada Sactions 25505.25533 and 8531:I understand shat
-;if the building does not currently have a mnant.that it is my responsibility mnotify the-
Occup s r quircm a w h mu r lie m r p r oe issuance of Cenifdam of '
- Signature of Applicant Date _
-_-.-. ....
light °m swagent , D to All roof coverings to be Class `B" or better
0 ICE
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