02100047 (2) CITY OF CUPERTINO I. ,,
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:,��,,
BulLIAI&yayESSEVEN SPRINGS DR DRAEGER CONSTRUCTION INC PERMITS®2100047
GWRAYMOND CHAN 605 COMMERCIAL ST APPLICAT191VUBos�2002
ONE: _74-08) 536-0420 SANITARY NO.// V V ''// CONTROL NO,
ARCHI rECTIENGINERR: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�00 LICENSED CONTRACTOR'S DECLARATION Job Description
p 1 herchy off rm that I am licenud under provisions of Chapter 9(commencing SIDING p
(5� with Section 7000)of Division 3 of the Basins:xsa Prnfcxsionx Calcand mylicense is
ZOgLifull Lina and cffc t. /' / D — {
? LicenmC l.ic,N ^L! ,/
FZ"� Date / — Ji Contractor L��i$Fv '
ARCHITECTS DEL�sRAT10N TJ
OQ�, I undersand my plana shall be uttd ns public rccnNs 1 j -a
XOyU
WFLLO
Licensed l'rofcssinna M1
OWNER-BUILDER DECLARATION
4 o�v i I 1 herchy affirm that I em exempt from the Comrannr's LicenseLaw fur the 12000
a—p 0 following reason(Section 7031.5,Business and Professions Code:Any city or county —
$ which requires a permit at construct,alter,improve,demolish,or repair any structure
Fit poortoitxiceuance,alsrrequirestheapplicantlinsuchpermiuofileasigned'amement Valuation
Q < thatheislicensed pursuant to the pnrvisionsoftheContractors License Law(Chapter9 3 619.]ftDefs3d.A1@m
�$ (emomencingwith Section 7000)of Division 3 ofthe Businessand Professions Cale)or
3— Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit ubjects de applicant o a civil penalty of PN-N Occupancy Type
not mare than five hundred dollars($500). 102 — PIERS
❑1,as owner of Ne property.or my employees with wages as their role compensation,
will do the work,and the structure,is not intended or offered for sale(Sec.mad,Business
and Professions Code:The Contractor's License Law does not apply to an owner of 104 - REBAR Required Inspections
property who buildsor inefori flaromr.ad whodoessuch work himselfor through his
own empmyem,provided that such improvements are not intended or offered for sale.If. 105 — ANCHOR BOLTS
however,the building or improvement is sold within one yew of completion,the owner. lO6 — SEWER & WATER
builder will have the burden of proving that he did not build m improve for purpose of
role.). 202 - UNDERFLOOR PLUMBING
E]1.as no,of the propert,am exclusively connecting with licensed canuacmrsm 203 - UNDERFLOOR MECHANICAL
construct the project(Sec.7004,Business and Professions Code:)The Conumtots Li-
censeLaw does not apply manowner ofproperty who buildsor improves themun,and 204 — UNDERFLOOR FRAME
'
LCescontracts for such pro}eetawithaenntracto(a)EanxedparaaammmecnmmemrineLa205 - UNDERFLOOR INSULATION
l am exempt under Sec. .B A,P C for this person 301 - ROUGH PLUMBING
1370()
ner Date 302 - TUB & OR SHOWER
WORKER'S COMPENSATION DECLARATION 303 - ROUGH MECHANICAL
I hereby"on under penalty of perjury one of the following declarations: 304 — ROUGH ELECTRICAL
I have and will maintain a Cenifcate of Consent to self insum for Worker's Compcor
ion,as provided for by Section 3700 of the Labor Code,for the Performance of the 305 - FRAME
rk for which this permit is issued. 306 - HOLDOWNS
I have and will maintain Worker's Compensation Insurance,as required by Section 307 - INSULATION
of the labor Code,fm the performance of rhe work for which this Permit is issued.
y Wmker'aeo Persadorl a ander and Policy number we: 308 - SHEETROCK
mera Cae_1/ rf_Pnli J�0� 309 - EXTERIOR LATH
CERTIFICATE OF EXEMPTION Ot 4AY0 KERS'
COMPENSATION INSO ASCE 310 - INTERIOR LATH
(This section need not he completed Ella,Permit is furore hundred dollars D RXE 311 - SCRATCH COAT
irless) 313 - ROOF NAIL
I certify ohm bribe Performance of the work for which this Permit is issued,I shall not 501 - FINAL ELECTRICAL ENERGY
employ any Person in any manner so as to betnme subject to the WorkersCnmpenmtion
Laws ofcalifornia.Date 502 - FINAL PLUMBING ENERGY
Applicant should 503 - FINAL MECHANICAL ENERGY
NOTICE TO APPLICANT:If,after making this Ccnifcnc of Exemption,you
become sohjecuo the Worker"Compensation provisionx of the later Code,you must 504 - FINAL BUILDING ENERGY
OOforthwith comply with such provisions at this perm it shall be deemed mocked.
^' CONSTRUCTION LENDING AGENCY 505 — FINAL ELECTRICAL
[..i l hereby affirm that there is a conswcrion lending agency for the Performance of 506 - GAS TEST
C> the work for which this Permit is issued(Sec.3097,Cie C.) 507 - FINAL PLUMBING
W A Lendch Name
Z) z Len w',Addreas 508 - FINAL MECHANICAL
U O 1 certify Nat 1 have read this application and auto that the above information is 509 - FINAL GRADE
W (~ concur.1 agree to comply with all city and county ordinances and stain laws relating to
0U building conswction,and hereby auNndrempmwnwiivesofthis city toenmrup.do, 5 FINAL PLANNING
W aMvc.mjudgdpropanymrinspection
nseswhichma 14 FIN�RKS
Cls (We)agree to save,indemnify and keep harmless the City of Cupertino against �i
lq liabilities,consequence(if
costs and expenses which may in any way secure against acid City
U in conacq NT of DERST N of this Permit.
�-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE ULATIONS.
Re-roofs
G rc of ApplicanUConuecmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building secupaw store or handle haeardous material
as defined by the CoNnino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ycs
Will me aPpbcam or mere nwmmg occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
mit hazardous air contaminants as defined by fie Bay Arca Air Quality Management all new materials for inspection.
District/
❑Ycs
I have read the li mardous materials requiremenks under Chapter6 95 ol'the Califor-
nia Health&SafctyCode,S.Oons25505,25533 add 255M.1 undersmn l thw lithe building
does not currently have a tenant,that it is my responsibility to notify the rccuPano of the
mquiremema which must he net t cissa of Cortircate ofOc Y. Signature of Applicant Date
oz
aothori.d agent Date All roof coverings to be Class "B" or better