01110070 (2) CIaDmnsONO
BUILDING iNPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11544 EVENING SPRING CT DRAEGER CONSTRUCTION INC 01110070
OWNER'S NAME: APPLICATION SUB DATE
AM KAU KENNETH D 605 COMMERCIAL ST 11/14/2001
PHONE: (408) 536-0420 SANITARY NO. CONTROL NO.
E O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
ad--j ELECT PLUMB MECH
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SN' 1mmbyofirmmeEDnONTRAdunOR S rprovionsofChaper9(commencing Job Description
RATION
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F=do with genion]IXro)of Division of the Business and Professions Cai and mylicense SIDING.
e da ia 5 is in full force and a.
0 i U License Class Lie I'
M6
O m Dote Canimaor_[]
ARCHITECT'S DECLARAT N
},a,. 1 undersand my plan,shall be used as public.ecoms
OC Licensed Pmfessim.]
o OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
z< following reason.(Section 7031.5,Business and Professions Code:Any city or county $14000
Y s❑ xh h q permit t constrict.n Iter,improve,demol.h o p any stmre
cm
3m -pr t t alsorequires theapplicant for such peanut fl signed summent
that lieilg1 d proem to flatIAvi.car,of me Cmume or.License La (Chapter 9
(commencing with Set ](Hql of Division 3 of the Business d Professions Code) .v $Sgyp, i�i�Opr ,t T, Y *'Y. l Valuation
or that he if exempt merefrom`end the hasi,far the elle ,4 exam tion.An ``3 6 tl L,tJ'J V' V i Y. i f f,.,
p g p is violation
-of Section]031.5 by any applicant fora permit xubjens the mapplicem m o<ivil'penalry p y Typ
:ar not more an Rae hundred dollars(asoo). lO1ApN� DATION -"' ^' OCCu ane e
❑I,ns owner of the progeny,or my empl n�s4p �kth' sole roto nsaion, _
,Will the work:and the swcwre'is054, 103 - LIFER i
r Bbsineesnnd Professions Coda The Cnmracmii Litlhlfi3A' a an Required Inspections -
owner ofpmpmy Who builds r imp es thereon,and who docs such work himself
or through his o employees.Provided that a a�^eAp or t n enI d r 104 - REBAR
apparel- far ale (f 6' he bode nS ori �Q{ �/ tg .�gd ye f _..._..._.._.. ___. .. __.
completion the owner-builder will have the human of proving that build or 105 - ANCHOR BOLTS
ns er pryoeaf Te.). 106 SEWER & WATER
_ 0 __.. ..
1.as w fins P pnv am ei.amdyr pq�m rumors 106
202 - UNDERFLOOR PLUMBING G:, — ._._......
License the present(Sec ]044 Business an gY�!{Aentmrror's 203 - UNDERFLOOR MECHANICAL
License taw aces not apply man owner th properly who milds or seimproves thereon,
.aordrax contracts
for such pmjms.with a rommaor(s7.licensce pursuant to _._...
Gentaevernp,trade S --- -204 - -UNDERFLOORS--FRAME _--._-----
❑lamexemPt. s ,emPerarmiyress0 205 - UNDERFLOOR INSULATION
i
301 - ROUGH PLUMBING
EPENSATION DECLARATION3O2 - TUB & OR SHOWER
I hereby aRrtn under penalty of perjury one of.the following declarations:I have and will mahatma a'ceriircate of consent to self-ins. 303 - ROUGH MECHANICAL
reror werkcr'a304 - ROUGH ELECTRICAL
ompensation,-as-provided for by Section 3]00 of the Labor Code, for the
performance of the work far which this permit is issued, 305 - FRAME
Cl 1 have end will maintain W mer's Campe.mon haromce as required by Section 306 - HOLDOWNS
sued M Workers ode for the perform of the work f which this permit s 307 INSULATION
Cam r �at o Insom artier end P icy n bar are
o the or
My Ys �,$
"E iscysi C {� L. _. F y308 s, . BHEESROCKr a t
t CERTIFICATIOMOF EXEMPTION FROM WORKER '4 3'd 9 - EXTERI ORr`LATH"
.. .n' COMPENSATION INSURANCE _.__..... __ .�_._ ...___
310 1.-. INTERIOR- L'ATH
' (Th sect need nor be completed if the permit is for one hundred dollars
311 - SCRATCH COAT
' a
lmiythatit,mptfa
eee'onn workforn this 'ta'asea,-I -313' -"ROOFNAIL'° -
shun notemploy anyPerson inany a astabeemo subjemtatheWorkae 501 - FINAL ELECTRICALtEN1ERGY
Compensation Laws of Cabfamu Daren
BING ENERGY
ANT.If.after
Applicant - -- Exemption, ,. 504.-..— FINAL....BU502 FINAL ILDING ENERGY.
NOTICE TO APPLIeCONSTs Compensation
Gcute ofE pt 'yoush old
,Z bac subject thaw k Cmpe in i naonn tab cod youmost503 FINAL MECHANICAL ENERGY
0
forthwith comply with such provisions m m permit shall be devoted k d.
oFC AGENCY 505 - FINAL ELECTRICAL „
I
hereby fins,th tui ac�nst m I D ga< f to m
8 Y Pert
i.Q ae Nme nem p tt ,:nL( 309] cis.c) 506. _-._GAS_ TEST
p,z Lena` Akh" 507 - FINAL PLUMBING
v o
1 mfy mut 508 - FINAL MECHANICAL
I h mad ed th v epplic t and suite that the above information is
c&irecvI agree to comply wins all,city and coumy,ordinances and state laws relating 509 - FINAL GRADE
°O:.V I iliing constrvetion:mid hereby auNbriie representatives of this city to enter upon
mealwve-memionedpmpcny(orinspectonparposes., 510 - FINAL PLANNING
ly (We)agree tosave,indemnify and keep harmlesslhe City of Cupertino against
-v liabilities,judgments,costs end exp eyes which may in any way eorm,against said 514 - FINAL PU I C WORKS
V.z Cit in consequence of the g it.,of thi p rmri '
APPLICANT UNDLkSTANDS AND WILL C&PLY tsi'ALL NON--POINT -
" SOURCE-REGULATIONS ) r F'" Issued by: 4 Date
Sign t rcof Applicant/Comme., Re-roofs
y perunoMUSMAngdo,Chtt'r912adtheHrlthanat � - �'PeofRoof - . .. .._-..._ .-...-. ,..,__ .
H TERIALS DISCLOSURE
WIIm Pp'humt crfm building DH or handle hazardousm
claimed mins, pa p Safety - - - -"
Cue Sect o0 25532 14)
�aY a All roofs shall be inspected prior-to-any roofing matenatbeing installed.
Willtheairapplicanteo Tutu buildingoccupant equipment li d i e.em h If a roof is installed Without first obtainingan inspection"I'agree IO remove
Oist ri, tea A Quality Manage cm
} _ y all new materials for inspection. Applicant understands and will comply with
emthazard tamnat d nngb the Be A
. . .., .
Y the N t all non-putt t source regulations:
1 h e t iSa h er' rm tions qu em33 an 2 Chapu unders'16 95tand
of he '
Calf in Safety Cade'Seci ons 25505;255]3 and 25534.I und<rnand mat
if the buI It does theormntlyhu must np mantis to
-
J Oca p t f th`iequir ms hien' 'must be met prioro isocance of o C n'ficate of
�ati _ Signature of Applicant
1Date
m ( Date All roof coverings to be Class `B" or better
L
..,. ., ' _ ._. . . . _'_ ,.._. .. . " � ., ... . . . OFFICE - . .