02100046 CITY OF CUPERTINO11 �� 4 '�11 'l°
BUILDING DIVISION PERMIT -CON RACTOR�INFORMATION
BGILII1IQ&BL IsESWESTSHORE CT DRAEGER CONSTRUCTION INC PERMrrNT2100046
owrF1SNS1E:JERRY C AND YU-I Y 605 COMMERCIAL ST APPLICATIT ITr/2002
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41 ZONE: 4 0 8 53 6—04 2 0 SANITARY NO. 7 CONTROL NO.
ARCHITECT/ENGINEER: BUILUINC PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
luoo LICENSED CONTRACTORS DECLARAT[ON Job Description
k U H 1 battery anion that 1 am licensed under privemom of Chapter 9 lcommmoing p
<ZU with Section 7artp ufDivision 3 Of the Business and Professions Cook.and my license is SIDING
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'n run Tune and erten.
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OZ O t /0-7. 42 Eurmaclor-n(4 CHL/ CN FI.
w ARCHITECT'S DECLA Al DOW Q OrJ
9 oe-i I understand my plans shall W used as pudic recnNs OrSI 1.7 LO a.
OyU ��ll
LLOg Llwnsd Professional
OWNER-BUILDER
in the Contractors ATION DING
ta�a p I bmcby.(S'e That I I. cxemnl non the ..p,C :Any c Luw fur the BUILDING $12000
m SaO which requires
a.(Serum AI3str Businessand oe. emelLCome:Any city nr county
u x$� which myuirex a prmio re coos the,alter,improve,h permit
i nr repair any structure
Unern
.iv that he
its iemadpursalso
antin the the
s(if mo Coit Trrmiuofile aicenssigned w(sm19 '9„
at Inn me cingwiit pursuant in (fol DivinnsoRWhe oxine. nd Probe
law 1.Code) 9 3 6fT�37U3t3aAhik Valuation
a=� (commencing with Seninn]INMpol UivisionJol the Ousincssund l'rOlessinns Code)Or
y;$ That he is exempt dumfin m and the burns for the alleged exemption.Any violation of
Section 703 L5 by any applicant for a permit subjects the applicant to a civil penalty Of PN-N Occupancy Type
not mnre in..Love hundred dollars(asa). 102 - PIERS
0 I,as owner f the property,or my employees with wages as their sole compensation,
will Jo the work,and the strucmo is nm intended Or Offered for sale(SIX.7114,Basin.
and Professions Cole:The Comaactor's License Law dors not apply to an owner of 104 - REBAR Required Inspections
property who builds or improves thereon,and who docs such work himselfor through his
Own employees.provided that such improvements are not intended orreffeaa for sale.If. 105 — ANCHOR BOLTS
however.the building or improvement s sola within one year of completion,the owner- 106 — SEWER & WATER
builder will have the burden of proving that W aid not Wild or improve for purpose of
sale.). 202 - UNDERFLOOR PLUMBING
01.as names of line propern,am exclusively contracting with licensed contractors to 203 — UNDERFLOOR MECHANICAL
construct the project(Sec.744,Business and Professions Code:)The Contractors Li-
eLaw does not apply toanowner orpropmywho Wnd.or improver;Brnenaand. 204 - UNDERFLOOR FRAME
who contracts forsuch projects with a conbanpursuant ons)licensed pursuano the Contractor's
Liccn,5at Law205 — UNDERFLOOR INSULATION
,
O l am exempt under Sec. .B di P C for this reason 301 — ROUGH PLUMBING
owner Dam 302 — TUB & OR SHOWER
WORKER'S COM PIiNSATION DECLARATION 303 — ROUGH MECHANICAL
19 Ihereby amnnunder penalty ofPerjury one Othe following declarations: 304 — ROUGH ELECTRICAL
1 nave and will maintain a Cenifcate of Consent to self-imu,for Workers Comte
pe
uatinn,as Provided for by Senior 3700 of the Labor Coat,for Ne per fmmance of the 305 — FRAME
work ter which this permit is isaed. 306 — HOLDOWNS
0 I have and will maintain Worker's Cmn,mmion Insurance.in myuired by Semon 3 07 - INSULATION
JAM)of the labor Code,for the Nnu m ores of the work f r which Ibis permit is issued.
My workers Com n Om msarshe carrier andP miter.am: 308 — SHEETROCK
ar: Sa�. U. Fairy n.:—`.�5-�12�s2� 309 - EXTERIOR LATH
CERTIFICA'E OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 310 - INTERIOR LATH
(Thissection ncednln hccompined iftbe permit isforooe hundfcddollars(glfg)) 311 - SCRATCH COAT
11eS') 313 — ROOF NAIL
T eenifr that in the perhourearco of the work for which this permit is ioued,Ishall nor 501 - FINAL ELECTRICAL ENERGY
employ any personn any narrator as to become subjen o the Workeri Compensation
rn
Laws of Califoia'Dam 502 — FINAL PLUMBING ENERGY
Applicant
NOfICETO APPLICANT:If.after making this CeniBcek of Exemption,you should 503 - FINAL MECHANICAL ENERGY
become subject to the Workers Compensation provisions of the tabu Cock.you must 5O4 — FINAL BUILDING ENERGY
O Z fo thwilh comply with such provisions Or This permit shall W deemed revoked. —
z 505 FINAL ELECTRICAL
CONSTRUCTION LENDING AGENCY
[-.L,, affirm Nat Here is construction lending agency]or the Performance Of 506 - GAS TEST
(3$ > the work for which this permilisouned(Sec.3BY7.Cry.C.) 507 — FINAL PLUMBING
Adana
W Lcndc Address
Q 508 — FINAL MECHANICAL
D. ftndcr's
UO 1 cenify that 1 have rad this application and sure that the shove infoo rmom in 509 — FINAL GRADE
correct.1 agree to comply with all city and county Ordinances and state laws relating to
0 Wildingconstruction, Ihorimre representatives men¢ra the 5 FINAL PLANNING
V em you p y Iain
W aWvc.mcnnonreetosay linemnifyian keep harmless
14 FIN I W RKS
G (Wc)agree to Cove,indemnify and keep marina the City of Cupertino against
UZ
liabilities.judgments.onR cosf flue hing expenseswhichmay in any way anmc against sail City /
inconuCAN1c UNDERSTANDS
of this Permit.
q� /
V z APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT' Issued by: Date
SOURCE :GULATIONS.
v-�-� Re-roofs
.doodum of App an"Conlmcrr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Inc applicant or future building lwcupam store or handle nuardou.x material
as defined by the Cupertino Munich Codc,Chapter 9.12,and the Health and Safety
Code.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
ream Or future Wudmt,<ca occupant useequipment meevmeaw�en Ycx If a roof is installed without first obtaining an inspection, I agree to remove
Will mea
pp g pa
nit naa.amOna ser contaminants 4.tl[fncd by the Bay Area Air Quality Management all new materials for inspection.
Dinner? /
O Yea ❑Nn
1 have had Ne barardous materials requirements under Chapter 6 95 of me CaliLet-
mallcalmSmnyCak.Sections 2.5.5)5,25533 and 25534.1 understand that ifthe Wilding �U e�Z
does net currently hoc a tenant.Thar it is my respnmibility W nnuly tW occupant of Inc
rcyuiremema hichmusttomc� tO Snanccn cmficmcofOcro y. 'gnatureof4plicant Date
/ -7 All roof coverings to be Class "B"or better
aammirna asmh D