03050127 CITY OF CUPERTINO " '-A* ^ '''T ' " '"" '" `
BUILDING DIVISION
PERMIT ICON ia"GT`OR INFORMATION "
F'3�u'
BUILDING ADDRESS: PERMIT NO.
DRAEGER CONSTRUCTION INC 03050127
M PERMIT ISSUE DATE
EWS'A605 COMMERCIAL ST 05/27/2003
SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG BLECT PLUMB 0
100 LICENSED CONTRACTOR'S DECLARATION I '�`
l0 1 hemhy affirm that I ata lira ed under provisions of Chapter 9(commencing ,Job CS iI, t100
with section 70111)of Division 3 of the Bu wand Profog 1.Code.and my licenne is
in full( deft �,�
rare enr Or REPAIR DE K
A;Zi fI ECTS ATON mb
5s undersand my phu still o tae uhilc mc -
5
s are
Licensed professional
Oat I am cUnDER DECLARATION
Z O i 1 hereby affirm that 11. eempt from me Contractors Co License law for the
is 0 0 which
reuon.Permit
h 711313,Business and Professions Cade:Any city m county
3 S� which rt9uies a Permit m construct,crier,improve,demnlixh,m reair any strmmm
fJ^ prior m its Issuance,ale requiter lite applicant fee such Permit file a signed statement
F that he is licensed punuam m the provisions of the Comments Limen Low(Chapter 9 Sq.Ft.Floor Area 8Ol Otion
3 a (commencing with Section 700D)of Division 3 of the Businwand professions Code)or
f mat he Is emmPt thomfrom and We buts for Ne alleged exemption.Any violad9n of
Section 7031.5 by any applicant fora permit subjects the applicant o a civil penalty of 3 5�( 2� e�0 Occupancy Type
not mart than five hundred dollars(M).
0 1,u moon,of dm property,or my employees with wager or Noir sole compensation, [�
will do the weitmd the structure 4s not intended or offend rte ask(Sm.7044,Business 101 — FOUNDAR ��sssaland Inspections
and Prefesaiou Code:The Communes Licem Law does not apply m an owner of Sys` p
property who builds or improves thomn,and who does such work himself or through his 102 — PIERS
own empkyms,provided that such improvements are not immrodW moff"for sale If,
however,the Wilding or improvement is solo within one year of compWton.the taper- 103 — UFER
Insider will have the When of proving that he did not Wild or Improve for purpose of 104 — REBAR
sale.).
❑1.u owner of the property,am exclusively contracting with licensed mnvmmra m 105 - ANCHOR BOLTS
construct the projea(see.7W,Business and Profession Code:)The Contractor's Li- 106 — SEWER & WATER
come law does not apply to an owner of property who Wilda or impmm thereon.and,
who contracts for such pmjmu with a contnctor(U licensed pursuant to Ne Contractor's 202 - UNDERFLOOR PLUMBING
License Lawexempt 203 - UNDERFLOOR MECHANICAL
❑ umpt underSm. .B&P C for this mama
204 - UNDERFLOOR FRAME
Om` WORKER'S COMPRNSAnONDECLARTION 205 - UNDERFLOOR INSULATION
I hemby affirm under realty of perjury ram of the following deelmtions: 301 — ROUGH PLUMBING
❑Ihow and will malmin a Certificate of Cement W oOlfdnsue for Workers Compete 302 — TUB & OR SHOWER
wur°k°for°which NA(pen it is modest.
of the labor Com.rte the performance of the 303 — ROUGH MECHANICAL
I have and will maintain Worker's Compensation Insuranm,as numbed by Section 304 - ROUGH ELECTRICAL
3700 of the laWr Code.for are ixrfmmanm errthn work fm whim Nis pnrmh is Wood. 305 — FRAME
My Worker's Cnmsemtia luuame nmio and Policy number are:
306 - HOEDOWNS
eaMertr; * A-4rxwr �, Poney eywe�'ooG2y
CERTIFlCATE OF EXEMPI7�MWORKERS' 307 — INSULATION
coMPENsnnoNl ANCE 308 — SHEETROCK
(TNR ec0on mod not W completed if the Permit is for one hundred dollan(g 1011) 309 - EXTERIOR LATH
or less.)
1 Unify Net in the performame of the work for which this Permit is Issued.I shall not 310 - INTERIOR LATH
employ any poen in any manner sat u In become subject o the WorkcrCCompensation 311 — SCRATCH COAT
Law,of California.Dam
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:If,after making this Cedlacate of Exemption,you should
Wmme subjmt to the Worker's Comismuon provisions of the labor Code.you mug 501 - FINAL ELECTRICAL ENERGY
.JO formwim comply with such provisions m this permit W deemed revoked. 502 — FINAL PLUMBING ENERGY
?r'-r CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
[ti ti I hereby aRmn that then is a momoo,don lending agency for the performance of
L> the wortmrwhich this pemiue�med(Sm.3097.Co.C.) 504 - FINAL BUILDING ENERGY
aQ andnesNatne 505 - FINAL ELECTRICAL
=Z Lender's Addrw —
U O I Unify that 1 have mad this application and some that mat move Information is 506 GAS TEST
1,, correct.l agree m comply with all city and county ominames and sate laws relating to 507 — FINAL PLUMBING
Wilding construction,and hereby anmofice mpmsenutives of this city to order upon the,
abovcmentiaed property for inspcction purposes. FIN MECHAN CAL
a (Wer)agree to an,indemnify and keep harmless the City of Cupertino against 9 F I N
to IiabllWes.judgmenu,msumndexpcmu which may In any way acemc against said City
U7,a Inconsequcacorthe gainingofthis permit. Issued 51 — G WORKS Dale
•7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT yh _
SOURCE REGULATIONS. J
c 5r -*2 ;�o7 Re-roofs
Signa ApplicmttComnaor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or(mute Wilding acupant atom o logalk haalloa material
u defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
AM ode,section 2s532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yat y No
Will the applicant or flumen building occupam m equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous mi,mmandogus u dernand by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes �Mu
1 have mad the husmas matarials requirements under Cluster 6.95 of the Califor.
niaHeslthgr S°fcly Code,secdmu 25505,25533 md25534.1 undetnond thalfNe Wilding
does rd mnentlyhew a tenant mu It u my mspondhllity b nn fy dm mcupant of tint
mqu not which mustbeme,poorInisuanceor.cempUse Ocm Signature of Applicant Date
�r.5, - eM' b �So?x°j All roof coverings to be Class"B"or better