04040008 CITY OF CUPERI'INO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
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BUILDING ADDRESS: DRAEGER CONSTRUCTION INC PERMIT N004 040008
ER'S NAME: PERMIT ISSUE DATE
IRVINE APARTMENT COMMUNITI S605 COMMERCIAL 04/14/2004
NE: SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEER: BUILDING PERMMNFO
BLDG ELECT PLUMB MECH
0 0 0 0
Y00 LICENSED CONTRACTOR'S DECLARATION
dy C 1 hereby affirm that l am limned under pm,ilmes or chapter 9(commencing Job DOSCfIptlOn
_z�ty with Section 7")of DivisoM3 of the Business and[InitiationsCode,and my license is
jqZin full force and effect. STAIR REPAIR
License Class Lie.0
F p
Came.Contractor
7W ARCHITECTS DECLARATION
I understand my Plans shall b.used as public records
U
G t; Licensed Prol
fessiona
S OWNER-BUILDER DECLARATION
i�Z 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
a.0,modern.(Section 7031.5.Business and Professions Cotte:Any city or county
— which requires a Permit to construct,eller,impmve,demolish,of repair any nrocture4
i
prior it)its issuance.also requires he applicant for such permit to rile a signed statement
r< that he is licensed Pimum,tothe provision,ofNeConuacka'aLiroseLow(chapter 9 Sq.Ft. Floor Area Valuation
$ (commencing with Section 70110)of Division 3 or the Business and Pfofessi.m Code)or
that he is exempt Nemfrom And the basis for the alleged exemption.Any violation of
Section 7031.5 by any spiritual fan permit Subjects be ePplic..,to A civil penalty of )MiBZer00 Occupancy Type
ore Nen five hundred dollars(SSW).
AS owner of the pmpepy,or my eroployeaswith wages as their sole compensation,
do Ne work.end Nealmcmre is not intended or offered for sale(See'
90x4,Business Required Inspections
d Pmfnaions Code:The CantnnarE License law dao not apply m m owner of
property who builds ar improves thereon,and who does such work himself or through his
own employees,provided that such improvements arc not intended or offered for sale.IL
however,the building or improvement is sold within one year of completion,the owner. LXP
builder will hove the burden of pmving that he did not Wild.r impnew for purpose ofI1,as owner of the property.am exclusively contracting with licensed coni ectors tocon mel the project(Sec.]044,Business and Professions Code:)The Contrecm,a Licome law does nal apply je en owner of iniops who builds or improve Coname end
who seLacts for meA projects wiNaeomnetor(s)Iicenmd pumuenuo Ne Contudolr
License Law.
❑tem sae .H&PCr ism a
1[33Z
ool Date
K PP.NSATION DECLARATION
I hereh M der pe I of perjury one of.1101 lowing declarations:
I hese endwillmaintaina mutation of Consent to self-Insure for Worker's Compere
ion,m provided far by Section 37011 of the labor Code,for the performance of the -
for which this permit is issued.
have and will maintain Worker's Compensation Insurance.ss required by Section
of the labor Code,for Ne p rrormence of Ne work for which Nis permit is issued.
y Worker's Compensation Insurance Cartier and Policy number am:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
OMs section need not heeomplemd If HAS permit is for one hundred dollars DIW)
Or less.)
1 certify Nal in the performance of the work for which this Permit is issued,l shall Out
employ any person in any manner so AS to become subject a the Wink(mi COmPemalia t
Laws of California.Dole
Applicant
NOTICE TO APPLICANT:IL after making this Confined,of Exemption.you should
become subject m the WOrkCr'e COM,emation provisions of the lahor Cale,YOU must
,J O forthwith comply with such provisions or this permit be dcemcd revoked.
ZlZI CONSTRUCTION LENDING AGENCY
t—t I hereby affirm that there is a constriction lending agency lar the performance Of
Ne work for which this permit is issued(Sec.3097,CO.C.)
W�Q Lendce.Nam.
.7 lender.Address
U Q 1 expiry that 1 ban read this application and mm,Nn Ne Above information is
IL (~ coifed.l agree 10 comply with all city end county ordinances and state laws relating to
0 building commotion,and hereby Authorize mpresenuties or Nis city in enter upon Nti
kkj above-menlionod Property ror inspection purposes.
W (We)agree to Save,indemnify and keep harmleas the City of Cupertino agaimt
V3 liabilities,judgmentacests and expenses which may in tiny way accrue against said City
rJ 7 iAnPPLI yes cc oN eRTADS
remain of Ihis permit.
AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
r7 SOUR TIO S. I�
Re-roofqlals If
Signature o A li n on or brue
HA Z OUS MATERIALS DISCLOSURE Type of Roof
Will NCA heart lu lure building occupant store or handle hazardous materiel
m defined by th. Municipal Code,Chapter 9.12,end the Health end Safely
ale,ScctYeius n23532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑ Nu
Will he applicant atm beading«aapanl.,.,qulpmenl ardevima which If a roof is installed without first obtaining an inspection,I agree to remove
II h teiadaua air comsminants AS defined by the Bay Area Air Quality Management all new materials for inspection.
70amor—.,,5mdoH.&.t
strict?
❑Yes
I have re ad the bora mmatcriela fequit.Me.ts under Chirac,6.95 of the Califor.
Health Sarcty Code,Sectors 255115,25533 and 25534.1 undsocard Nod if the Wilding
s no n, a cone thm it is my ramunsihilky m notify the mcumnl of the
ulm n w us our MIsuenceof.CcNfaacofa'. .y. Signature of Applicant Date
ale
All roof coverings to be Class"B"or better