02060196 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BIl'I11DIno'MVEN SPRINGS P DRAEGER CONSTRUCTION INC 1E1MITF2060196
°p`yR13tf E AND CATHY C 605 COMMERCIAL ST APPLICA6'9UBA25Aj.`2002
PHONE: (408) 536-0420 SANITARY NO.. G / CONTROL NO,
o z z ARCHITEUTIENGINEER: BUILDING PERMIT INFO
z m O BLDG ELECT' PLUMB MF.CH
IciG r= I=1 I_:1 L--7
rJ v LICENSED CONTRACTOR'S DECLARATION �6 escrlption
sz-� nnmtmby afhnn matlam li<en,eau�Cle�t prnWsron>urcnapter9reontmm^c'^s SIDING REPLACEMB'N�
with Section70))o.fivision 1.rZ Buam7psan�ro�sign,Code.mdmyhme..
¢ ¢ I in f c and cct. 111 //YY//__
License Cs Lic.p
13 u.v Y e ARCHITECT'S UF,GL172A I :,'
a O aaa/// 1 ntl mi ,hull he reed v, uhlic record,
to"e'.m OWNr:RdSt11LDF.R DECLARATION
1 hereby off rut that 1 am exempt from mm comment's License Law for the 7y�12 0 0 0
e: a following naemn.(Section 7031.5.Businessland Professions Code:Any city or cuunry
Y—m which requires a permit m cor"cal altar.improc,demolish,m repair any atmemre
adc. prior m its issuance.also requires the applicant for such Permit m)ilea signWamm
teent - -
matneialicaseapursuSnnttothe proasrnn,none commenra l.lvenam La-(cnaptm9 363g5Bt02dojr A&a , r Valuation
a'ommeoeingwim Section 7")o(Division 3 of me Busncoand ProkloomsCode) {., ,1 I.s , .. ,:-e.; ?.''."'., a ti'r `
unbar he is exempt themfrom and the basis for the alleged exc n uhn.Any evolution
-of Sado.7031_5 by any appliuvnt to,a perean subjects the uppllnnt m a civil pen lf,
of not mom than five hundred dollms(SeM). 101APNNQUbIDATION Occupancy Type
102 - PIERS
❑1,as owner nnhe propurty.0 my emldmm=a wino u'asesmmen sale mnmpcnamfop.
will do the work.and the stmelam is not intended or offered for sale(Sec.]OW, _
Businmas and Professions Code:lTe Contractor's License law does pot apply to an Required Inspections
r of property who builds or animists,thereon,and who does such work himself 104 - REBAR
owner
his own employees.pmeided that such improvements are not intended or .. .... ..
offered for sale.If,however,the building or Improvement is sold within one year o1 105 - ANCHOR BOLTS
Innigeeon,the owner-badder will ham,o,burden ofpringthat heslidnmbuimnr 106 - SEWER & WATER
mprove for purpose of sale.).
❑Los awdtunnm'pm�rtY.amexrwsiear=nntrmtmg ilhwensedcnmra=mam 202 - UNDERFLOOR- PLUMBING ,. ' .
iansuuet mm project(Sm.70a4.Business and Professions Codec The Contractor a 203 - UNDERFLOOR MECHANICAL . .
License law dine,nut apply to an owner of praPcny who builds or improves thereon,
and who contracts for such projects with a contractor(l)licensed pursuant to she 204 --UNDERFLOOR. FRAME
Commences License Law. 205 - UNDERFLOORS^INSULATION
❑1 am exempt under sed. .B&P C for this reason
Owner Date 301 - ROUGH PLUMBING
WORKERS COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby.ffira oder penalty ofperjury one of the following declarations: 303 — ROUGH MECHANICAL
0 1 haem and will maintain a Certificate of Consent to self-insure for workers 304 - ROUGH ELECTRICAL
Compensation, as provided lot by Section 3700 of the Labor Code lot me 305 - FRAME
p,homenne side work for which this penal is issued.
306 - HOEDOWNS
❑M of and the Labor
Code, Worker's Cmmanct, if the
okfor hick required by Section 307 - INSULATION
3]W of me Labor Codc,for the perfomnancc of the work for which this permit is
asued.My W'orker's Co pensation Insurance career and Policy number are: 308 SHEETROCK
.30,9 -EXTERIOR LATH,: .
u'' ,•, CERTIFICATION OF EKE N OM WORKERS' s -
. _.. .
COMPENSATION INSURANCE .. ... .. ...-_..310_.-__INTERIOR.. LATH.,__-.. .... . - -- -.__... .
fneia scorner need not he completed if the Permit is rut one hundred dollars 311 - SCRATCH COAT r.> .. ..
(Slwl nness.J . .313 ROOF. NAIL .. .
I canify that in theperfdnnance of me wort:for which this permit is issued.I 501 - FINAL ELECTRICAL.'ENERGY
nm
,ba11 employ any person in any manner,o as to become subject to be Workmrs'
Compensamn Laws of California.Dale 502 - FINAL PLUMBING ENERGY
NOTICE
-'
NOTICETOAPYLICAN'I:If,nfmrmnkingthisCmiEma¢ofExcmption.youahould 503 - FINAL MECHANICAL ENERGY '
'become subject o the W'orker's Compensation'precisions of the Labor Code.you must
O O nwim comply wire .on prc,kiarls or this permit shall be deemed revoked. 504 - FINAL BUILDING ENERGY
mtt
? 505 - FINAL ELECTRICAli
= •'
CONSTRUCTION LENDING AGENCY
Ihereby affirm dal there isdonnatmeignlending agen=yrntmeperform ana 506 - GAS TEST
of he worktot which his perch i,issued iSee 7097,Civ,C.1 507 - FINAL PLUMBING
Cjs Q vender s Namr'
'Lend Add esu'
u z0 508 - FINAL MECHANICAL
I cagily that)have mad allcilplicaiounty sto¢that
cesadstat inawsreionis 509 - FINAL GRADE
W(.4
correct.I ogres to comply with all sty and county representatives
and shite laws e,upon
O U mbuildmgconswmdonoperty hereby
for
Fepossematiema of this may memo upon 510 - FINAL PLANNING
Fym<abo(We) Srce to Property for inspection purposes.,
IWjudgmem.costsandexpenses hihmarein@a,aeyfCupeniruatsaid 514 - FINAL PUBLIC WORKS
to City m moo
judgments.costs end expenses which they in any way ecmroe againzt said ^ _
U z City in con quenee of the 6mndn ofWILdtmit.
APPLIC NT :TAN tiD N'ILL Y WITHAL Cf '�P mT Issued by: r Date
5f"' _ . ATI ''
are Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
'Win dr,aPun=ant m mare buldins occupum mere nr handle na:umnus material Type of Roof .. - . . .
m defined by.the Cupenino Municipal Cade,Chapter9.12,and the Health and Safety
'Cole,Section 255321x17 . / f s `
11 Yes ':,ANO All roofs shall be.inspected.prior.to,any roofing material being installed.,
W511 me epplicam or(umrc building nccupam uw eyuiprnenl on dcriccs which If a roof is installed without first obtaining an inspection, I agree to remove
emithareakus air cimr mitmnw ds defined by the Bay All Air Quality Management
Diem=tn. �� all new materials for inspection. .Applicant understands and will comply with
aOYP. - all non-point source regulations.
-.� I haw read the hazardous materials requirements under Chapter 6.95 of me
Califomia Health&Safely Code.Sections 25505.25533 and 25534.1 understandtr _ /• nf^)
If me building does nmcurrentlyhave.,tenam.that it is my respons.bility}p ora Y'm
occupant of the requite s x ' us,be m ar to iss w &ific of �E L
°rap in - Signatur pplicant Date
un am sen, - ' >atm All roof coverings to be Class"B"or better
.. .. .- OFFICE