02050093 CUPE
CI nmLDt c DIIVIISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDR SS' PERMIT NO.
11694 EVEN SPRINGS CT DRAEGER CONSTRUCTION INC 02050093
TYVW11TG-MEI L 605 COMMERCIAL ST b�Y2
PHONE: (408) 536-0420 SANITARY NO. CONTROL NO.
O O O ARCHITHCT/ENGINEER: BUILDING PERMIT INFO
z w G BLDG ELECT PLUMB MF.CH
<iw
�Nz LICENSEDCONnsed ad,p DECLARATION ��h p p
i -o I hereby aRrm the l am licensed under provisions of Chapter 9lrommcnci"g SIDING REI lit—'11 cacti tion
,at; with Section]lKKl)of Division 3ofthe Busxess and Professions Code.and my license
is in fall d end feet. ✓�
< Licpnae c� Lic.. 7Lio pl l®1 A'
o n U fI t _s ont-L `nr3p 6K
tLL H ARCHITECTS RATION b rfaOn
g e and taI myyyns mall tx nand ns public rte"rds 1 U N 2 L L
i L p p tl Proles onai
cer OWNER-BUILDER DECLARATION BUILDING $11000
1 germy affirn that 11. exempt s an cop Contractor's License Law for cop
?a
following rt n.ereaioi ]oastmBusinessand Prokzsnn Cute:Any city orcounty
ase
E p which requires n permit re cions the Aur,improve,demolish, fierepair g any structure
t6 3 Q prion t ' 1 W pr Pions o for Contractors
License aw(Cha mem
such ... .. . . . ..
that he xlicensed' p ahl to the provisions of the Comracmu License low(Chapter ,.36S�gSP1A�dDC AfEa ls - t' Valuation
(commencing with Sort 170110) f D inion 3 of the Business and Professons Code) : t- i • `Y''.2 a�.!1 t.� t,1 s
or that he it exempt therefrom and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty
I of not mart than five hundred dollars($500). 10 APN RE)hWDATION Occupancy Type
°hasowner of the propcny or my employees with wages as their sole compensation, 102 - PIERS
will do the work.and the frearre'I,ant intended m'offered for able(See:9614. 103 - U ER
Business and Professions Codc:The Contractor's License law does not apply to an Required Inspections. .• -
owner of p nfeny Who builds or improves tnercon,and who does such work himself 104 - REBAR
or through his own employers,provided that such improvements menu are not intended m _
- mrstile.Ir,hdwpva:thebtiavet orirdenatprovnsold hedWithin done rearor _. _ 105-
completion.
iprovefor the ower-eds.erwinha��thebdmenofprovingthat heaidbut build or 106 - SEWER & WATER
improve for Puryou of sale.l.
0:a.,owmarddah __ r-y.:mexbwsmelyconnecti�gwithiicensecomtmctotsto 202 ' - -UNDERFLOOR-'-PLUMBING -
Pmpc .. n.• .,
cflusubst onstruct tea.owneroahaertywhobildsorTaeContractors 203 - UNDERFLOOR MECHANICAL'
Litems Law does not apply to owner of property who builds or improves thereon,
.Lind xmo commpia.fdr such projects wnh.a cdmmnor(s)hcenxd.pursnm m the _ _ _ 2 04_._-..._UNDERFLOOR-,FRAME.. .. .. .. ....... ... .._ .. .__. . ..
Contractors License Law' 205 - UNDERFLOOR:,INSULATION
- ' °lam exempt under Sec. _ B&P C fon his reaction
ow'aer. "-' "•'Data 301 - ROUGH PLUMBING
WORKER COMPENSATION DECLARATION 302 - TUB & OR SHOWER
IInner,affirm under penalty,of perj"ry ane ding fc]lc ing decmmddas: 303 - ROUGH MECHANICAL
° 1 nac.e and will maintain a Ccnificam of Consent to selfinsure for Worker a 3 04 - ROUGH ELECTRICAL
Compensation. as provides for by section 3100 of the Labor Code, for the
305 - FRAME
performance of the work for which his permit is issued.
°I have and will maintain Workers Compensation Insurance,unrequited by Section 306 - HOEDOWNS .
c_ 3700'of the labor Codc,for the iicrforumnec of the work for which this permit i. 3 07 - INSULATION
is tied.My Workers Compensation I saran a er and PdI cy - be me:-
_ - 308 SHEETROCK -- - ---
armar: S'�A?!e' cw P�. 1bS 8(a6 6 1309-.,!:,EXTERPOR:ILATH, •
CERTIFICATION OF F.X y ION FROM WORKERS*,
s CGMItEll" ON INSURANCE',` - .. .__.310.----INTERIOR—LATH— --- - -
(Thialux nneednetle,cumpidedifthepermitisforonehundreddollars 311tt.-, SCRATCH COAT
313 ,r .ROOF_.NAIL.... _. �
I certify that ithe pert f theo k f which rh perrii t
naaea,l
501 - FINAL ELECTRICALIENERGY
',,hall not employ arty tie:tin in tiny man a. vi became subject to the Workers'
Applicant. Lawsawaorc stn ..Date, ' 502 - FINAL PLUMBING ENERGY
NOTICE ToAPPLICANT:If.after making this Cenircae,ofExemption.you sho-rim 503 - FINAL MECHANICAL` ENERGY
Z became sobject o the Worker's Coarro inti provisions of the Labor Code,you most
ZO friar,mcomply with such provisions wedo.permitsbell bedeamcdrtvdkcd. 504 - FINAL BUILDING ENERGY
h " '"•' CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL :.•,_,.•_ _ _- __ ... -
1 hereby officer that there is a construction lending agency for the portion aare
nrtne'wdrk for which mm pe7mit is issued rspp.3ov],cw.al . 506 - GAS TEST .
y'p LindersName ,...•:• .-• •.•-. "'- - :.• .507--- FINAL 'PLUMBING _. . ._. _, . .._.. __ .._ .....--.
D Z <napranaaress " 508 - FINAL MECHANICAL
I certify that 1 have read this application and state that the above informmion ix
notes 1 agree m comply with all city and county ordinances and state laws mating 509 - FINAL GRADE
O,V td building construction.and hereby aathorimrepresentatives ofthis city toenter upon 510 - FINAL PLANNING
r.W the above-mentioned property for inspection purposes.,
.yW'magree toaare.indemnify and keep harmlessthe city'orCupertino against 514 - FINAL PUBLIC WORKS
f0 liabilities,judgments,costs and expenses which may in any way accrue agent,said
f] Z Ciry in consequence of the granting of this perch. ' ' '
OPLGANN UNUF ' ND, ND W 'OMPLY WITH'ALLNON O Issued by: r Date
'.
PPI'" IG ARDOUS MATE DISCLOSURE 'Date Re-roofs /
Will the appellant or fm re bu Idiiig beef,.( mmi or li5ndle haiardesis material Type of Roof
as defined by it¢Criterion Mu a'Pol'Code,Chapter 9.12.and the Health and Safety _
Code Secret 2553.(a) l t s .. 1 ,: F„' . . i
°Y' °N ItAll roofs shall be inspected prior-toanyroofing,material being installed.
WII N ."plica t fat Wilding occupant equipmento de «:which If a roof is i nstalled'without first obtaining an inspection; I agree to remove
emit nary n em"carnms re defined by the Bay Area Q Ity Manicmcm
Distrito all new materials for inspection. Applicant understands and will comply with
°Y04. ij,' r• ;°N all non-point source regulations.
C.1 1 havelrnd the hazardous materials« «mems qu under Chapter 6.95 Jim
California Health&Sefny Code;Sections 25505.35533 end 25534.1 raidersned that
it the building does not currently have a moot.that it is my responsibility to notify the - -
dacapant of the mquiremeniswhich:muu be'inct prior so issuance of a Certificate of
Oce enc.”
" `< " Signature of Applicant Dale _
r oat eared ugat-.. All roof coverings to be Class"B•'or better
OFFICE