02090128CI BUSANG
CONTRACTOR INFORMATION:
BUILDING DIIVC'ISIONNO
BUILDING ADDRESS
PERMIT NO.
11872 PLACER SPRING CT
DRAEGER CONSTRUCTION INC
020901428
Fgni`%'E DICKINSON
605 COMMERCIAL ST
SUB
APpuc09/19/ 2002
PHONE:
(408)536-0420
SANITARY NO. CONTROL NO.
ARCHTTEC lENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
Its rtby aRrm (hit am licensed under p t:ion: or CTavta 9 kommettdng
with$<c:i�n )i110)of Divismn Jofthe Bueine BProfessinm Code, and my license
5 in full ! end BCCI. N/ _ V
License IF a Lic.
- SIDING
Dale Camrarmr
TION
DELL is
1 lbe
understand my plan shall til record,
DEC 2002
Licensed Plate .... di l
OWNER -exempt R
m the Commentfar
I hereby affirm that 1 am exempt from the Comment's res LiAny a , a co me
following Casson. (Section Business and Ptofdemolli Craft: Any city or county
$12000
carr.5.
which n:quisu a permit construct, improve. demolish, or repair any swnu¢
naaee It
aaltia,pplicant
_ pt, t s issuance. of 4 theappl' antf such Permit rile a signedsu¢mem
re
tb the sl cued puwant i0 the pyo into fm Cntmeto/L fns
5 3' 6 j§�'`t0(y.I➢oUbrea," 1K.
Valuation
Coe)
(c tpene gwith5 t 7") fDiv! J of the Busine.UndP Professions Code)
(�t; V 1. _ .. ... 1.•s 1s .:. tFlY,aA
:
or Jrathe is eiemVf therefrom'and the basis for the alleged emmpiion. Any violation
- of Scotian 7O3 F.5 by any avplicaat for a permit Subject, tnc applicant to is civil penalty ,
of at more than It,. hundred drug ars(350C).
101 ApN96Lf*MTI ON
Occupancy Type
C3 1. as owner ofthe property. or:n'yemployees with wages as their Sale compensation,
102 - PIERS
- - - 10 3 - UFER Required Inspections ,k"'' •'
q p '
-will co the workrana'the Stmalore :t not intended or offered-far'sale (Sm. 7044:.
f -and J«5
Bds Professions Code The Contractor's License Law not apply to an
owner ofpropeny Who Wilds or improves themor, and who does such work himself
104 - REBAR
or through his own employees. provided mal such improvements am not intended in
..off{¢dInitiate. If. howeer.- the baddineeriinprovZmm a-suldwithinodeyearbr---
_
.eomplemo. the owner-Wua):will have the burden ofpro.ingthat hedid not Wild or.
106 SEWER WATER
improve purpose, of
- &
"p l; ay owner of me.propeny. nm ennnsivefr eammatingwith licensed contractors to
2'02__._-UNDERFli00R' PLUMBING"_.._—P.ui
construct me proper (See ? W , Business and Professions Codec The Common`s
2 03 - UNDERFLOOR MECHANI CAL '' i;a''-
License law data not apply to an owner of pos amy who Wilds or improves thereon
..aad_a,W.commO,. for. such. projects.wiih. a.co:mactm(5)- Bcensed.parsuant.m. me.
___._._..--2 04-_..__.-.T-WDER'F-LOOR--"FRAME...____._...
Contmcmis Liters, Isw: r„ (� i •�- ': •, 1 __ L'.'
❑ I am. estrum aper Sm." :s' ?C far Niaewpgn
205 - UNDERFLOORljiINSUL'ATION
_
o '<•:' "''brae ..• •..
301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION _
302 - TUB be OR SHOWER
Ihereby o0im:anamPenalty,of.Perpby,one ofthe rrlowmgdmlamtlrnc--
303 - ROUGH MECHANICAL
❑ I hilleond will 'maiitain^a'cadlncale•nf consent to .Self-inmre far Workers
304 - ROUGH ELECTRICAL
Compensation, -as, provided -for by. Section 37W of me Labor awe, for the
'performance
305 - FRAME
of do work far which this pcmdl n issu1.ed._ , v
❑ I have rirrdwilllrrirdrdaln Wok 'S CUmpc tit Insurance, as myuimd by Section
306 - HOLDOWNS
37W -fm La Ccl r me krfirsonconce oftheorkrr whichthsPetmt is
307 - INSULATION
issued, My W romance carrier d Policy ..other
)F""°,
-
308 -SHEE ROCK
Cn _
s ��'L 13709'-'.TEXTER'IOR�:L'ATH I•
q,s jUnal IFICATiONOF EKEMPTION FROM WORKERS
COMPENSATION IN SURA NCE
,
,_--, .^ —-.....-.-.
310 INTR30R -LATH- -- - -
r: y(Thislscctinn need r01 W Completed d the perm t is for ora hundred dolimsrc I
311 -' -SCRATCH COAT
yonypa iat in (tic xl `M1
io
501 - FINAL ELECTRICAL"''ENERGY`
"h ll'It empdj�l
rm�rieF a; beor come oj«ttgitiewark«<
Co tPensatiun Lgws f C fl Dnre�
'
5.02__ -...FINAL ING.._.ENERGY-_--_-- _....._ ._
-'/+ppllvant �
- _-- -..PLUMB ._._.
503 - FINAL MECHANICAL ENERGY "9
NOTICETOAPPLICAT If oft k m gEm C n'fc reo(a pt youshould
N
h Walker: Cclpenstann pr nsd the Labor Code,ym ones
betime-bjecl Yo mat
Tonhwith comply wittixde, provisions or this permit shall be deemwl:evoked.
FINAL BUILDING ENERGY
'CONSTRUCTION LENDING AGENCY' '' ' 1
_ _504
505 - FINAL ELECTRICAL
Ih by offinallaq iliere N on ton lending aBncYfar thep,Gsran,ce
"'rkf
506 -GAS TEST i...l. ri -
of me which lh ip':: _S 3UY'/civ C) u..�.r _.".
Lender ' Ilashom "- n' `
_
507 - FINAL PLUMBING --
Lender'r AJdrese �: •..• ., ...
- ')r;o.''i::-; ';;,, •-. ...... , ,., . r,.:. ;
:1(, .
508 FINAL MECHANICAL"'
. ..
,. Imany that i have mad this application and state that the above information is
50 - NAL G DE
curmr: 1 agree to complY,with all city and county, ordinances and ntmc laws rclming
Ito building construction, and hereby authorize reprc5enmlives of thii city to enter upon
510 - NAL P G
I the chew-mentimtettpropeny for 'i",m ioq pu.....c .. ..,
fWe)agrce tolaveandeninay dna keep harmless the Cir or Cupeniho aga:nat
51 - NAL B RKS
1 Ilubilities, judgments, colla nnJ enpemer which may In any any n<etue against said
City m consequence f the t ng'of Butpermit ' _
�APPLICANT UNDER$TA\TiSANDWILLC/IPLY WITHALLNON-MIN"f
'St,
Issued ; Date
URN' ReCULATIONS "is - '
'/'
y
4"i,
�' •7-�'�te
Re -roofs
re'nl'API!IlcanV mructoq,:"SI i;
,HAZARDOUS MATERIALS DISCL OSURE
Wll the pplcnto fdm buildingbuildingoccupanim handle M1 day occupant once
Type -of Roof ... ._... .-.... _.. ....--.- _ :.�.-,
a. a Riad by theCpen Municipal Coda Chapter y 1,..
2 d the Hcalm d Sof ry1
r n 't1 , .. - ,• '
' an ' 41
Code Secto'255J fa -
oY i C ` -
^ .1
All roofs.xshall be mspected.pnor to any roofing material"being installed ._-.... ._.
Wdi to VPI c t llmrc building part age l p t roe is .hen
If a roof is installed without first obtaining an inspection; 1 agree'to remove
,;,
emahazud cora moat a Jef J by th BiyA AQlityMng t
II
- r ores No
_ all new materials for inspection.. Applicant understands and will comply with
all`non-point-source regulations..,,; nn+ q -
1 1 have readthe Waadom unme6e, requ Cements ander Chapter 6.95 of the
r„i>•!;
.Califnrriti Neallh A Safety Code, Sections 25505.'_5533 and 25534 1 understand! that'
- -
-- ”- -'- - -- _-' -'
-'ifthe Mindingtlnesnot cu:sendy have insists. In., it is my responsibility m notify the.
-----
occupant oLthe mgamarnenie which man be met prior to'issovnce of a Cmdfcste of
° cap
/
Signature of Applicant,_ ._ - Date.
IZ
-.,_.._.,-„. -
All roof coverings to be Class "B” or better ,o.
thtraea t
c _t )
Lcs.�i.va"'•_- .:- -...,. _ ..... _.__.OFFICE..