02030216 (3) CITY OF CUPERTINO ' " "
BUILDING DIVISION PERMIT,
- 'CONTRACTOR'INFORMATI -
BUILDING ADDRESS: PERMIT NO.
909 COTTONWOOD DR DRAEGER CONSTRUCTION INC 02030216
OWNER'S NAME: APPLICATION SUB DATE
ASIBLEY ROLAND H 605 COMMERCIAL ST 03/28/2002
r'NONE: SANITARY NO. CONTROL NO.
(408) 536-0420
OOZG ARCHTIECT/ENGWEER: BUILDING PERMIT INFO
m{ BLDG ELECT PLUMB MECH
�a6 r
LICENSED CONTRACTOR'S DECLARATION
1 hereby earth matlem licensed and p visions of Chagl<r9(commencing ]s i DD pp BAIR
Description
,,,M with Section]00d,ftecvision3ofthe Business dProfeuions Cade,ad my license _DRYLr•]a-}{�� �p.IR & PAINT
� with Sectio and effat. Itl��II1�Vp 4/L"]\xl U
s�M< L.a. Lie G l76/U
O a O - Co act.yy
j aHI ECIJQtA
hinders in lanssh icecords APR 19 2002
i�
r
l d o O Licensed Professional
orio(< OWNER-BUILD DECLARATION �'�®'��
='m 1 mu .(tiro thin 1 MorLl exempt from the Contractor's o License taw for the
t iS 0 following eaten.(Section]0313.Business end Professions Code:Any city or county
C p which requires a pesmiva construct,nhcq improv:demolish,or repair any stricture $13000
pnwog�th _
,lim aoc uinlquirtsth siomo for Cohpemustofileesigrc(s ptran
3- (Canna ungwitpSectimw00)of isionsof of the Bounce. nd"aw(CMger9 v, r a, : Valuation
�`r( �sf, {00 �s��s .....
(commencing with Satrefro%aof Division 3 of the alleged
u rod Professions Code) 13 O'J'1"'7:�4's .'lTl7.1',.••. i C Y,'
or mel he of Section 7 exempt saym m end the basis forme subjects
Be esempuoa.Any violation
.of nm Mare don Five hundred dollar($5for a 00).t subjatr tepplicam to esivil pcndry Ap - r
101 N ATION l Occupancy Type
Ol,as owner of the proper,ur, on,employees with wages as their sole compensation, _ JDIERS
'will do the work;end the someone is not intended or offered for sale(Sec.7614,' - - - - -
Business end Professions Cade:The Contractor's License law does not apply to se 103 - UFER Required Inspections'
owner of progeny,Who Wilds or improve:thereon,ad who does such work himself 10 4 - REBAR _
or JZggh his own employees,provided that such improvcmcros art not intended w
-oRired'for sale:If,however,the building or irnyrovarada seld-wimin ooeyeaibf -" -�" .1. ' '_ANC' - -
oomp1mon.the...".wilder will nava the wmen of proving wt he aid riot baud or 10 5 - HOR BOLTS ..
Improve forpwposeofrule.). 106 - SEWER & WATER
-- . .._._. . _. _ . -. .---_-- . .... . . ....... .
202 UNDERFLOOR'-PLUMBING ..
❑1:tr ct the of the progeny.oto Business contracting with licensed covoactors to _ -
comuues Lew
project(See. to a owner
rend Professions Code:)The Contractor's
- Liaenselawdonnwapply toenownnorProperty who Wilds wimprover ereon, 203 - UNDERFLOOR MECHANICAli •
and who contracts forsuch projaclr with a contramoas)licensed pursuer to the. ... ..._.... 204 -UNDERFLOOR- 'FRAME -_ .. ...__... ._......._. . ._
Conareame`.License law.
- - ❑l un exemptunca,Sec. B&PCfasbismI a 205 - UNDERFLOOR' INSULATION
owner Date' " 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby aRmn ander penalty nfpetwy one,o(the mnm.;ng declinations: 303 - ROUGH MECHANICAL
❑ 1 hast and'will maintain a'Cuafieam of Convent t6 self.Inswa for worker: 304 - ROUGH ELECTRICAL
Compsm tion, is provided for by Section 37W or the labor Code, for ase
performance of the work for which this permit,is hand. 305 - FRAME
_ ❑Iluieindwillmince.Worker'sCorn moonlmursome, asrequiredEy,Saaon 306 - HOLDOWNS
37W of the Labor Code,for be pnfomunce 6f the wort for which this pemat is
r issued My Wm1m sCompc tion bosurale er env Poacy bcr ort
Q307 - INSULATION
.. 'C�ilserLJrA2/oa�[ rt: �.aerry 30$ = ;$HEETROCK '
CERTIFICATION OF FROMWORKE.R�' t. ' '.'- (30`9 r-EX-TERIOR'ILA'TH`
,:, COMPENSATION INSURANCE'.:'
_.„_- - .3270';,—.-INTERIOR--LA`I'H _ .._._
Eros senton need not w cbmpinea it the permits for one hundred dollar �••..
ts100)all.;) 1 SCRATCH COAT '
:•,3-
”' ;Al
rarity pdyhat in eson in mlynommer i Work for a eh ubr}CrNl is
a Worke.1 13' ---'ROOF =NA'I'L'-"'-• -_•-" '-' �• -'--
'shill obemploy any Person in oily manner so as to become subject to the Wwkoi 501 - FINAL E LE CTR I CAli -E`NERGY
Com'pensaaon laws of C.lifomie.Due � '. •. '..
Applicant. .,, ,. 502 . -_ FINAL-.P
_... -_.... ... o _... PLUMBING ENERGY-- _ . ..
NOTICE bj APPLICANT:1(Noropmter eng this Cenifica¢of Excmpaon,yoshouldmust 503 - FINAL MECHANICAL' ENERGY
z become so omp y the mekcri Colons or ion pmvisiotis of the labor Code,you must
O O fonhw heomplywithmcnprwiCTIONLENDINO masa. a wok d. 504. -- FINAL BU.I.LDING_ ENERG` ._.
shlim that
is a construction
LENDING AGENCY"',' ' - -- '"
ofthm.kfie Biim that mere is econswcaon lendinga for the r' 505 - FINAL ELECTRICAL - "
a � aga p ouKe 506 - GAS TEST
r which thii pcmdt is nssued'Sm.309],Ci¢C.
.w.Q _of the work toe.••_. . ,. u.... .. ...�.... -.-._:�_..�,...r.._�_...-.:..a. - . - .. _ . ._.. . ... i .
Ot mwuam conrwcfion.lendh •. .. _....
'renders Nem `•_' ' 507 FINAL PLUMBING
�..'� Ixnda..r sa .. .
U O l acniq met 1 neva grad this epplj taaon'and rum wnhe above inramnion i� -
508 - FINAL MECHAN I CAL
F cbrieit lag --reply 41 city end roomy aNi a.r ad state laws elating 509 - FINAL GRADE i
t) g hereby 510 - FINAL PLANNING
W the above-mentioned property for inspection purposes.
.tae' (WTI)agree to ave,indemnify and keep h my'-the City of Cupuuno a t
h c ty an co judgmen4 forts eM expcnsaI which they in any way ream.egeivs8 aid 514 - FINAL PUB I C WORKS
V.� A) in coo ne of me go "Permit.."
A LIC ERST A h1PLY WITH - NON=PoINT''
uRc no `y y Issued by: Date
�igvamre_.AOiCanUCF1AlARDOn MATE,1.•. . ��._,:.t..-•... '..Dare':'.
•y;;, R(Ats DISCL'OSIiRE •:''': Re-roofs
t
Will the aypbwint a!adore building attv(v„t tree«b.adle h.ardws umicriel Type of Roof... _
N defined by the Copectmo Momcil d Code Ch Chapter 9.12.and me Health end Safety -
CadaSecuon25532(.)7 ;.:t:-
x( No_ ,:. i a 'r. It ir. __ i � C
z. All roofs shall be inspected prior to any.roofing material being installed.
Win the ar coni imir wfuied cup t use ayAegap alay Mmijer ch If a roof is installed without first obtaining artinspection, I agree t(;remove
Mir hazardous n coram na re as d-toed by theBay Ata Av the ry Men r mint
m`nall new materials for inspection. Applicant understands and will comply,with
48/ ` all non-poin['so rce"regulations.
t 1 hove need the hazsndo sreasuands requvemenp under Chapter 6.95 of the
Cdt(mre Health&Safety Code,Sectors,25505;25533 eM 25531.1 understeM Jut
-;
Base budding does not oumpJy have a tenant,that it is my maWnsibiay to wtJy the ._.. -
oa'vpuit of cru w h mu be'met prior m issuance of A Cmificaa of '
meow.
team
...._Signature_ ofApplicant Date
_Uwnerm'otl. agent.,'. -„ nota All roof coverings to be Class "B"or better
OFFICE