04040003 CITY OF CUPER'11NO
BUILDING DIVISION PERMIT ,+,d9nSrz',.aev tis .x;�n%dN'k2+ wr4B.z_ MdlxwA�TwI-yO'_-N vinz
BUILDING ADDRESS: DRAEGER CONSTRUCTION INC PERMITN0.04040003
NF.R'S NAME: PERMIT ISSUE DATE
IRVINE APARTMENT
ONE: SANITARY NO. CONTROL NO,
(408) 536-0420
ARC)IITECrfENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
w0o LICENSED CONTRACTOR'S DECLARATION
fs F I hereby affirm that I am licensed under mondons of Chapter 9(commencing Job Description
a� with Section 7M))ur Dtviaion 3 ofihe Business and Professions Code.and my license is
j ?d incasell lass rten' STAIR REPAIR
License Class Lic.N
Date Contractor
ARCHITECTS DECLARATION
1 understand my plans shall he used as public recordsto
Q
S u Licensed PmfcssionH ^ y
OWNER BUILDER DECLARATION Conin ON /(�
ED O hcmhy affirm thus 1 1. exempt from the Comms Cm An,c Lew for the //
O D which re reason.(Section 7101.5,Business sod improve,
dcrtons Code:Any can nr county
$ which requires;a pcmrit m construct,ahcc tmpmv,ruttish ,.it
h or repair any structure
the,poihniuissuaOcpursuarequites lhovisio sof Contra tor'lLice ss Law(Chaptermed l
pp < Nrammenlicng ensed purstionm the Q)ofDivision
ivionsn ortheRtracmusandPnulsonsCodmr9 Sq. Ft. Floor Area Valuation
y $ (he,he
exempth Sereion romad of Diaiis for ofthecgcd exempton.Any
Ihat he Is exempt Ihcrtfrom end the buffs for she alleged exemption.Any violetlon of
SCc1Ion 7031.5 by any applicant for a permit subjects the applicant to civil penalty of 32deNM&2er00 Occupancy Type
not more Nen five hundred dollars($500).
❑1,u owner of the pmpcny,or my cmploycu with cages u their sole compenutlon,
will do the work and thcswnure is not intended orn0crtd for.1.(Sec.7041,Business Required Inspections
and Professions Code:The Conlrutori e ns License law docs not apply to an owner of Q p
propeny who builds or improves thereon.and who doessuch work himself or through his
own employees,provided that such improvements are not intended or offered for sale.IL
however,the building or improvement is sold within one year of completion.the owner.
builder will have Ne burden of proving that he did not wild or improv for purpose of
sale.).
as owner of the Property,am exclusively contracting wish licensed contractors to
au t she project(Sec.704,Business and Profusions Code:)The Canuxtar's U.
see Law does not apply to an owner wf property who Wilds or improves thereon,and
whoconwacts fofsoch p cls wish a contranor(s)licensed pursuant to the Contractors
Lkenx La
❑Ism ea on c. .B&PCfor loon
er Date /rtf_
KE 'S 0 PENSATION DEC LAR N
Ihcrtby under yofperjuryore ofthefallowingda)arations:
1 Nva and will maintain a Certificate of Consent to se)Finsu a for WorkersCo rram-
anion,as provided for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
1 have and will maintain Warlmna Compensation In....as rtgUtred by Seaton
37M or Ne labor Code.for the peormmance of the work for which Nis permit is issued.
My Worker's Compensation Insurance carrier and Policy number art:
Cartier: Policy No,: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not hccomp)eted If IN fermi)Is for one hundred dollen(510()
or less.)
1 certify that in the perform man,of the work for which this permit H vowed,I shall not
employ any parson in any manner an as sh become abjecuo the Workers'Comp nsation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:Ir,after making this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
,JO forthwith comply with such provisions or Ibisptraill shall be deemed revoked.
'E .n CONSTRUCTION LENDING AGENCY
F" I hereby aMrm Nat there its constructinn lending agency for the performance or
Cl the work fur which this permit Is issued(See.3097,Civ.C.)
WMA Under's Name
]z Landeri Address
V O 1 certify Nat I have reed Nis application and sate Nat the above information is
LIrF cored l agree to comply with all city and county ordinances and state laws relating to
0 building construction,and hereby aulhorim representatives of this city to enter upon the
4 above-mentioned pmpery for inspection purlrosu.
(We)agree to sore,indemnify and kap har adeo the City of Cupenino galut
ti p)
liabilities,judgments,costs and expenses which may in any way accrue,against said City
fJ 7 in cnnuq ncc of he granlmg of this permit.
•^• APPL T ERSTAN S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
U E E TIONS
Re-roofs
Signa eo p icanl Bchi
HIZARDOUF MATERIALS DISCLOSURE Type of Roof
lift psi nl or m wilding Occupant norc or handle hanAous material
u defined by the Culhaina.Wicipal Code.Chapter 9.12,and the Health and Safely
e,waiver,25532(a)7
❑Ye All roofs shall be inspected prior to any roofing material being installed.
Will the applicant rotor wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
tit huvardnus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
Nutlet?
0 year
I have mad the hnuNnus materials mquirements under Chapter 6.95 of the Califor.
Iia Health 4 Safety C ,Secduu ZR)5,25533 and 25534.1 understandshot ifshe holding
dors n mrof that itis my responsibility to nosily the Occupant of thc
mqui swi pdorto issuance of a ccoirmam or occup.nrg. Signature of Applicant Date
owner r Inn �d g I D- All roof coverings to be Class "B" or better