01100115 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR-MORMATIOM'' '
1
-� BUILDING ADDRESS: PERMIT NO.
11561 LAKE SPRING CT DRAEGER, CONSTRUCTION INC qq yy 01100115
OWNER'S NAME
S AND LAISHIM W 605 COMMERCIAL ST A10 -' 2001
PHO (408) 536-0420
NE: SANITARY NO, CONTROL NO.
�q+O O ARCHITECTIENGINEER: BUILDING PERMIT INFO
ELECT PLUMB MECH
�
LICENSED CONTRACTOR'S DECLARATION
z = Job Descripti n
,l2 t 1 hereby affirm that 1 a 3licensed under provisions ofChaptaCode 9(commencing SIDING
mew with fall force and effect. on3nf the Businessend Professions Code.end my license
neas iscefull force and effect.
m a License Class Lir.0
w Date Comment,
3 LL H ARCHITECT'S DECLARATION
O 1 u alcolind my plans shall be used es public records
a
E o O Licensed Professional
OWNER-BUILDER DECLARATION
M m 1 hereby affirm that I am exempt from the Contmcmr's License Law for the
Z< following reason.(Section 7031.5,Business and Professions Code:Any city or county $16000
a which aconites a parant o conssme,,al¢g improve,demolish,or repair any structure
fFF o
Kam »pat t is ]pialrequirestheapplicantforthe suchCon permntofile
ense Law(Chapter
- ------ - - - - _ _.__.. ._ _
toot ns artt licensed]pa.%6u ma pro rsmna none Contractor's License Lew tcnapt«9 n 3�8. �;� rlBrpa 11l Valuation
(c.connaviing with Secs 7000)of Division 3 of the Byypnem go Professors Code? t..� i,i L�i.1'.`
or that he is exempt therefrom and the basis for the alligeg eaemptibn.Any violation
of Section 7031.5 by any applicant for a permit subjects she applicant m a civil penalty-
.of not mom than five hundred dollars ISSUE. 51B%pN tPt�A1L BUILDIN •' Occupancy Type
°1;as owner of the property,or my employees with wages as their sole compensation,
i11'do the work,"and'the'stmewm 4q
is not intended or offered (Sec.70 "
rAusines:ani Professions Code:The Contractor's License Law does not apply so an Required Inspections" '•
owner of property Who builds car improves thereon,and who does such work himself
or through his own employees.provided that such improvements am not intended or
,offercil foo sale.If,howaey the building or improvement is sold within one year of
completion;the owner-builder will have the burden of proving Nos he did not build or NIP,
improve for purpose of sale.).
°I;as owner of the property,am exclusively contracting with licensedThcommnom to , •. .. ,. "a _
construct the does
Project(Sec.Ito a Business and Professions Code:)The improves
themon.
License Lew docs .f apply man owner of a contr who builds or improve tneunn, J fi f,1-O 9 q 0 02
.,and who License La tech-projsm wishs conwnar(e).licenud pursuant,o.the .. .. ._ fi'Y s7 L L __. _ . .s.... .._.._ ._. ... ..
O l ar n xcr License Law, _
� °lent exempt antler Sea •'� •� ,B&PCfor this rtsson
r... .. , .. .-.. ..... .. , ...
_ ow , ,: ..:: nate'. . .,. BUILDING
-.- 't "' WORKER'S COMPENSATION DECLARATION
1 1 hereby M.under penalty of perjury one of th. e following decla n ions:
° 1 have and will mdattan'a Certificate off-Comms m self-insure for Worker's
Compensation, as provided for by Section 37W of the Labor Code, for the
performance of she work for which this permit is issued.
°I have•mid will tinfntnin Woiker's Compensation Insurance,as required by Section
3700'of the Inbar Code:for the performance of the-work'for'which this permii is
� C issued:My Workces'Compensation insurance terrier and Policy number art.....,a,.
CentfIrllv til a.t.s: Ipolcy No:, !T' s J try ♦♦ ,. 1.,yy t E 1's v -1,!.'„ ,, .... ._ .
l.f CERTIFICATION OF.EXEMPTION FROM WORKERS'S' S} '"x -
' COMPENSATIONUxSURANCE';'TT' fr"•' "
`"x'ua(Tho unadn`need nm tie'coritpic'mil ifshe panni,is for one hundred dollars "•P' \ a ,- s_i,i -1 rs i„', f
ISlgy or less)
shall not ertiloy anyas personn any ce of mahneo o asoe worl,for become sub«this�aat is owned,the Workers' Jy;: 'i Int a kvlt'n;-
P Ywsof y . !
Com ' tion Laws of California.Date
panto
NOTICE TO APPLICANT Worker's
If,after Compensationng
is Certificate ofExemption,Lalaada,you oust •,
becomeh compywit such
Cim.aw mhos provisions ofthe Inbar Code,you must
Q 0 foittiwisnbomply wisn oeh provisions or this permit shall W deemed revoked.
CONSTRUCTION LENDING'AGENCY '
`" 'o'ti'n-I herebyaffirm that there is a construction landing'agency fo}the performance
Ne work for which Nis permit is issued(Sic:3097,Civ C.1
`I W E� .-Lend'er's Name'._."_ . ....-_.,,..,, .. v. ........:.:.... a::._..
Fa' red Address,..•. ,. _ ..-• . . - _.
V`0 ,;I certify " have have mad this application and nate that the above information is
+�Ta'(r coartn:'1 egrtt m comply with all city and county ordinances and state laws relating
Q.f) tobtilding commesion,and hereby amtiorim representatives ofthis ci,ysoenterupen
the above-mentioned properly for inspection purposes.,, -, „-
{{..aa ys (Wa)'i to save,indemnify and keep harMexs the City of Cupertino against
4.aV) liabilities.judgments,costs end capcnus xhich.mny in any way accrue against mid
U,:_rZ+ City in consequence of the granting of this permit.”
_ APPLIC
ANTANDERRST AN r'WjiuSu: bN- Issued by: Date
�—
aNm.fAppli .•�,y .: ;Dat '.
Re-roofs
J;HAZARDOUS MATERIALS DISCLOSURE Type Of-ROOF .
the appl fiat or future Wilding occupant itws or hon havidrwend . ... �... .. ..._ . .
as def ed by the Cupertino Municipal Cade,Chapter 9.12,and the Hmhh and Safety y
Code Seco.25532fa) t f i :i.t, t ,'t L, j'•�•t"ter f�„sem¢ e y
t r a f.,+?�
°Yea' P' � r A .: f' All roofs,shall be inspected.prior.to.any,roofing material being.insta_lled. . ._ _
ops ,,WIINeapplicemorfuma Wildingacupanluuequipmcmordeviceswhi<h If a roof is insizlled-without first obtainingan'ins ection;I'a tee'to remove
emishuardous air contnminems as de�pf'ed by the Bay Arid Air Quality Managemcar P g
Dia�N all new materials for inspection. Applicant understands and will,comply with,
°Np t -, •all non-point source iegulanons:. .,
"" 'I'have ieai tM hag«dou meien 1
ranutdoonins Mader Clunjum 6.93 of the '
ci,1', Mie H..)th A S fety Cade'Sccdons 25505 25533 end 25534 1understand shat
_file Wilding does not currently have a mount.shat i,is my responsibility to iotify the - - "-
occup'en,of,he requimments which most be or *,soance'a nifaenc '
_ Signature of Applicant Date
an, Oate
All roof coverings to be Class "B" or"better
f + ' OFFICE -
1