01100102 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
10016 SPANISH. OAK CT DRAEGER CONSTRUCTION INC 01100102
- � OWN'ER'S NAME: APPLICATION SUB DATE,
LEE CRAIG M AND NANCY J 605 COMMERCIAL ST 10/17/2001
PHONE: (408) 536-0420 SANITARY NO. CONTROL NO.
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BUILDING PERMIT INFO
Q zO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
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a u
8,an
S TZ LICENSED CONTRACTOR'S DECLARATION ON lob Description
_o I hereby a m that 1 m licensed under provisionsns of Chapter 9(commencing ELECT UPGRADE. '
,mCm wirh Section 7( DivomU31dth[Bulinus and Professions Cad Imy license
y y j is in full fort[and c m
'.ow Li[ a Z ADD 3 LIGHTS IN KITCHEN, GARAGE REWIRE,
:0:iZtLL6 pine U Con" Or
ALTER WIRING IN HOUSE .
O i- A CHITECT'S DECLARATIOt
t� 1 understand my plans shall Is,used as public re
J W}
a O O Licensed Professional
OWNER-BUILDER DECLARATION
o m I hereby.(Bede min 11. exempt from me C Professions
Code:AnyLicense law for Ina
I-2Q Ohichfolhaiinguiresa Permit
n]OJL4Bualnus and Professionsh.ornyar orcounly
cture
f F❑ wh rt ts pealitt construct. Iter,improve dcmolnh orupar anYswcwnt - _ _ - _ ......
-
Oil
t e.also ng4 rta me inions of for the Cohmrmtlnfbse Law inatarm9 - - - - - - r - - -` --
3- mat be s licensed pbn ons Ib the pro ns of the Conuacmfs Tatem Lew(Chapter 9 Sq Ft Floo;.Area. r r uation
(cummmrm g.wrmSec. '/000)ofDivision 3oftheBouse pnaPror[xxtanxead[)' C C i F.Au_l_7,a I.t: v �:��[.1., x..�_ $201di�
or that he'ix exempt therefrom and the basis for the xlllged traptbh.Any violation
of Section]03 14 by any applicant fm a permit subjects the applicant to a civil Penalty'I
mon...of no,m.than five hundred lona s(s500). 3 4 2'S'b?'5nl M Occupancy Type
❑1,d owner of the neoteny,to my employees wide wages fool[compen-7044.
win eco dend Pro and m ode:notore is un intended e offered Law doe vale-asps to
10 3 - UFER Required Ins Lection"
mans,o and Profusions Cade:The Co.sionco and w Lew docs not ndc hi m an q P
mans, improvementsdoes ammself304 - _ROUGH ELECTRICAL
or df. his awn employees_providen mm such Impmvemenu arc not intended or - _
cRemd for sale w however the building m r proof proving is said wildid one year or -- 505 - FINAL ELECTRICAL,", -
nprove fn,the ownenb lle.).will have'he buMen of proving that he did nm Wild or
improve fm purpose of sale). I
_. _. ......... . . . . . . ng licensed
e _ act ..i ._. _ .. .. _..
co1,asowner pof hthe proper%am eusinesslacomrxtingwithode:)The Contractor's
construct the project(Sec.]to a,Business o and Professions Code)The Contmcmr's F I�p p y C p .., r s -. l
License law dos .f apply man cts w of progeny who builds or sed pmvu de[reon, r G C FA iH,`G
and who cmnuacts.for such project with a commcmr(s)license)pursuant to me.
�C nwmor'a License law.t , n• ' aB&P C fm oris rammr '"
Iam ex[mpt Us arI ev, _ Uri -2'5'2001
Onvncr ..:..
Data t ...:
WORKER'S COMPENSATION DECLARATION BUILDING
1 ' 1 �a�/'�
I hcomy affirm mider,pewlty of pnjug doe of dee following declarations: p Y'LDI NG
❑ I have and will maintain a'Cenificme of Consent to self-insure for Worker's
Compensation, as provided for by Session 3700 of me Labor Code, for IM
'performance'of the work for which this permit is issued.
El 1 have and will m usild.Worker's Compensilion Imana,Ic,as required by Section
3]00 Of the Labor-Code For mms
e perforce of me work f h ch m a p<rrtit is
iss tl
Ciroej��-'¢{ Q�a` palt°•u
.CERTIFlCATION OF,EXEMPTION FROM WORKERS t
• .;. ENSATION,IN$URANCE l t' ._._._ ...____ . .....�._ .__.,.. __ ._. .. _ .-._ _.. _ . . __ _. _ ._____
(This union need mm M mmpleied if dee pemit is for one hundred dollar
1 cell the,in ti-flerfihomhrhhe of mwalk,fm which this permit is issued,I -
'sh 11 not employ any person in any manner sin is to become subject to the Workers'
Compensation laws of COifomra.Dile
.-Applicant
NOTICE TO APPLICANT 1f,after making this Certificate of Esempdon,you sbould
babme subject to the Workefs Compensation provisions of the labor Code,you must'
forthwith comply with such provisions or this permit shall be deemed revoked.
rZa a^' nd : - -�- - .
rq "
'CONSTRUCTION LF.NOING'AGENCY'e'
herebyaffirm thann
here is a conduction lending agency for derw
e perfornce "
IW.Q ofrook far or which th pcmit is issued(Sec J09],Ci¢C7
GD 'Lenn d N mesi
C.1 0 1 ttnify mat 1 have mad this application and state that the above information is
"W t... cortin.I agree to comply with all city and coanty,ordinances and state laws relining
m bold g const ction,nidiberebyrs, on prembastiveslin'this city to enter upon
h bov-mentioried praPerry for inspection p apo.
ti y (W) gree toss ehismnifY and lap hormle the C tY f Cupertino agnamet
0
labihnics,1 Jg ems.costs and expenses which may in any way amme against said
V.
Or neo u ffl g t gofm frmti "
'APPLICAN RSANISANDWILLCOMPLYWITHALLNON-POINT Issued by: Date -2-el
sign m A he dC r m . . pate'. Re-roofs
+ AZARDOUS MATERIALS DISCLOSURE, ,
` c to'fmre WrldiniosTupanttorib,wwlehiutdomnuterial' Type of Roof ' -.'..' - '.• ' _.._
as d fined by Cupent pal Cole Chap1. 9 12 and the Health and Safe,,
Codes ion 255J2(a)] '"�` / rte - `! 7 , 5 .jt' I��)! ' ',v .,•fl� '.s_l ,`-e-1`'d:
❑Y �rsN , All roofs shall be inspected.prior to any-roofing material being installed . . -- _-
Willdeeapplicantoifuwu'buildingOccupantuse equipment,ordeviceswhich'I If a roof is installed without firsmbtaining an inspection,I'agree toremove
\cmit hazardous air mrourina is as defined by the Bay'Aua Ar Quality Management
Dimiia7, all new materials for inspection. Applicant understands and will comply with, -
-' ❑Yes . Na ,
;'. Ir ' , . � , ''' all non-point source regulations.
' '1 have mirdnhe'haiartloui mutuals requirements undcr Chapmr 6.i95 of.the ..
California H 1myY Safety Code;Sections 25505;25533 sod 25534.1 Undervaluation
if me builpl if g dols not curenHY have a mount,that it is my responsibility to notify dee'
- dcc p f dee qu rem t h h mu I the at PH.,ro issuance of a Certificate of
Ocpgp - Signature of Applicant Date
to d
Owner 's it. gent .ia Date, All roof coverings to be Class,.B"or better
4 OFFICE. t :