04040002 CITY OF CUPEW11NO £_. a -.
BUILDING DIVISION PERMIT ,CONTRACTnRINF,OBMATION -
"l,DD4GADDRESS: DRAEGER CONSTRUCTION INC PERMITNO04040002
.R'S NAME: PERMIT ISSUE DATE
IRVINE APARTMENT
ONE: SANITARY NO. CONTROL NO.
1408 536-0420 SJ
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
yJ�/ BLS ELO
PLUMB MEOCH
X00 LICENSED CONTRACTOR'S DECLARATION
"r1 I hereby affirm that I..licanxd u r nriamm car cnapmr 9(commencing Job Description
withnd
Seatio ))uf DIVI,10030(theB ness ufcalnna Cade.emylicenxis
m eSTAIR REPAIR
p�?
License
nu Llc.p
n f•� nl Oni,
pp ARCHTECTCOS EC
I
�aU lundc and my plans shallbeuuda lees
g
Licensed censed Professional
OWNER-BUILDER DECLARATION t
gx I hereby affirm that 1 am exempt from the Contractor's License Law for the
y pe 0 follnwin rens...(Section 1117 1.3,Business and Rofeasians Codc:An cit car taunt \ 1
which rcyulrca a permit m construct,elle,Improve,Jemnlixh,car repair any nmcturc !�,__
5�y prior m its issuance,elsu sequims the applicant(orsueh permit to file a signed stamp -_�
TCthat he is licensed pursuant m the provisions of the Convector's License Law(Chi q.1Ft. Floor. C9 f Valuation
H (commencing wi th Section 1000)of Division 3 of the Business and Professions Cnde)or it �-
y�S Nat he Is exempt thcmfrom and the basis for one alleged exemption.Any violation of
Section 7DJIA by any applicant for a permiuubjects the applicant to a civil penalty of p —
erlO0 - Occupancy Type
AM mora Nen five handled dollars($500). -
❑I,u owner of the propeny,or my employees with wages as their sole compensation,
will Pr fework,ands: he Conisnor's Licensoroffereds nele(Sec,1044,Business
will Professions Code:The Cnnvanori License Law eats not apply to an owner of Required Inspections
property who build,or improve thereon,and who dura such work himself or through his
own employees,pmvided that such improvements us not intended oroQered for ale.It.
however,Ne building or improvement is sold within enc year of compledun.the owner.
builder will bars the burden of proving that he did not Wild or Improve for purpose or
pale.. -\�
1,a owner of Be propcny,am exclusively contracting with liccnutl convenors to n
coA et the project(Sec,7M,Business and Profusions Code)The Contractor's Li.
came law does not apply wan owner of property who Wilds or improves thereon,and,
who contracts for such projects with a commetor(O licensed pursuant m the Contractor's V
License 4Uw.
❑ lamc. .BAPCf thicrMPENSATION DECLA N
n tY of perjury oar of Brc following deduaiam: -
Ihavesndwillmainuioe cnificucofC.mnnoulf-insumforWorker.Compen-
sation,az provided for by Section 37W of Ne Labor Code,fm the performance of the
work for which this permit is issued.
❑1 ham and will maintain Workers Compensation Insurance,as required by Section
37M of the Labor Code,for the performance of the work for which On permit is issued.
My Worker's Compensation Insurance carrier and Policy number art:
a r: Polity No.:
CERTIFICATE OF UEMPf10N FROM WORKERS'
COMPENSATION INSURANCE
MIA sttiton reed not becomplewd lithe permit is(moot hundred dollars(SI0(B
less.)
1 ceni(y that in the performanca of the work for which this permit is issued,I shell not
employ any person in any manner an az in become subject to the Workers'Compensation
Laws of California.Dose
Applicant
NOTICE TO APPLICANT:IL after making Nis Ccntficarc of Exemption,you should
become subject to the Worker's Comfaratim,provision of the tactor Code,you must
.JO forthwith comply with such provisions or Nis Permit that]be deemed mmkcd.
Z► CONSTRUCTION LENDING AGENCY
[—i Ihereby affirm NU Nene is a construction lending agency for the Performance of
Ne work rut which this permit is issued(Sec.309l,Ci,C.)
W�Q Lender's Name
7-. LendM.Addreu
V Q 1 certify Nn I have read this application and sure that the about information is
U, P correct.l agree to comply with all city and county ordinances and state laws relating to
0 abovengconswd construction.and hereby wiNomemimseL representatives of NisCity reenter upon the
W shove-(We) gree to coy forinspectionkeep eg
v) (We)agree to cost,indemnify and kith hasmle Be City of against against l
z liabilities,ngments,cosuand expenses which may in my way accmc against aid City I/
V z zr
Aeonxy nee of Ne Ding of this permit.
APPLI N AN AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR94
EG IONS
Re-roofs
$ eL
p H AR OU MATERIALS DISCLOSURE D e Type of Roof
WlNee nbcan building Occupantsmm or Wndlcheaudousmarcriel
A,defred by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Akre,Sc❑cYA`25512(¢)? ANo All roofs shall be inspected prior to any roofing material being installed.
Will Inc applivanLor fu1urc building acupanl sex eyuipmcntor devices which If a roof is installed without first obtaining an inspection,I agree to remove
II hazardous air emunnhunts a dclined by the Bay Arca Air Quality MVlagemcnt all new materials for inspection.
tricB
0 Yca �n
I have mad the houndoas materials requirements under Chapter 6.95 of Ne Caliber.
MaHculN&S cry Cotle,Sucmu255115,255J3md255J4.lunan=dNUlfNc building
dace not tone ly h m nanL N I it is my respamihibly m mtdfy the mrc.m.t of Ne
recut cn ich tbem onntssganceofACertiOcateof Signature of Applicant Date
weer ser Izc age ate
All roof coverings to be Class"B"or better