01110069 (2) CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
11570 LAKE SPRING CT DRAEGER CONSTRUCTION ING 01110069
OWNER'S NAME: APPLICATION SUB DATE
TADA MICHAEL B AND LEE_ MARSHA 605 COMMERCIAL ST 11/14/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 536-0420
G ARCHITEC(ENGINEER: BUILDING PERMIT INTO
QBLDG ELECT PLUMB MECH
h C=1 CJ I,--] L,
i LICENSED CONTRACfOR'S DECLARATION
I hereby affirm that I um beensed under provisions of Chupmr 9(commencing Job Description
o »;hSection]arol fDivision3nineBudressendPme,lion,Code.mdmylicenxe SIDING.
,MN is in full fnrcc Linde I 11
5 o 6 Licenu Class Y / Lim.M 0 �a B�p /� ��
13 d.U Dale Comaaurq-,10,O w E Sp A
ta d.Fii RCHITECf'S DECLARATION
5 1 understand my plans shall be used as public records
i o O
Licensed Professional
JAN 0 9 2002
= thatOWNER-BUILDER a DECLARATION
m 1 hereby affirm that 1 i. exnnp,from the Conics orLicense: c Law for the
which
Seniorsconstr,Business and Professions Cork: cit orcoum BUILDING $21000
g mason.l Y Y Y
F O whish requires o Permittomnswn,aha improve,demolish,ore a sir any awcw¢
_pnonoi,s issua,tce_elm rtquim,lie applicant forsuch permino Bleeaig,md onemem -- - -- - -v i-- --
that
__-
- thatNoislicensedpursuplatodFF W,humsof,haCommerce,Lice. aw,(Canner 9 SSn�,-�g F� _
(commencing with Secim.,7 00,1 of Division 3 of the Double.and Professions Code) . 1 ,,�'l f•[3btiiSt4U� � ed%� "s.:' l nl • a nation
or,he,tie is exempt therefrom and the basis for the alleged exemption.Any violation
-of Section]031:5 by any applicant fm a permit subjects the applicant o o civil penalty
:ol not more than.file hundred dollars(55Wb 10ApN 1[FVtDATION Occupancy Type
Cl,as owner of me p upcny,or my employee with wages cut their sole compensation,
-will do the work,and'me'stmema is no,intended or offered'for aside(Sol:7041, 102 I,
Briinesa and Profession,Code:The Corrosion's License Law,does not apply to an 103 - UFER Required Inspections' '
owner of property Who builds or improvesthemon. d who does such work himself
or through his n employers.provided th t such improvements am nor immilded or _ _,,. _ ,..,,,104_„ REBAR,
..:'offered forst If. the h,'Idng p emelt is old within mile of .__. .-.. _.,... _._. .... _._.. .....-._.___...
completion,the owner-builder will have the burden of proving that he dud not build or 105 - ANCHOR BOLTS ' " '' '.
improve to,purposeor,ale). 106 - SEWER & WATER
c
as owners(jbct(Sm.gamBusinessandnwcrisions licensed TheCoeeronto 202 - UNDERFLOOR PLUMBING '
on the pmjcn(Sec.]UtA,Business and Profession,Cade:)The Cnnwnor's '
License Law does nor apply to an owner ofproperty who builds in improves thereon, 203 - UNDERFLOOR MECHANICAL''
.and.who ca.re I'for such projects with a.contractor(s).licensed-punuamac me
Comacmr s License law ,
204--'.- UNDERFLOOR ,`FRAME '
Clams ,m andersgd '' B&P C for this Mason 205 - UNDERFLOOR 'INSULATION
Cbntm ' °a" 301 - ROUGH PLUMBING
WO<TER'S COM SATION DECLARATION
" - 302 - TUB & OR SHOWER
1 hereby affirm under penalty of perjury one nfahe following decimations:
303 - ROUGH MECHANICAL
Cl 1 ends mrd will provided
maintain a CbyiOcum of Consent m xeLathaure for Worker's 3 04 _ ROUGH ELECTRICAL
s
Compensation, as provided for by Seniors tblo of the Labor Cade, for,he
performanm cube won for which his permit is issued;
305 FRAME
- - C I have tie will mainiam Worker,Compensation Insurance,a:required by section 3 06 - HOLDOWNS
3700 of,he Labor Code.for the performance of the work for which this permit is
Bided.MyW kers /� _ - INSULATION
cave1'I Ano 4.1hey,1." oM, DR rss" 9 r 3'081 t- ;SHEETROCK
My C m n au n Insurance ca 'er end Policy nu be m
309 EXTERIOR° LATH -
:L'I" COMPENSATION INSURANCE' ____.
310 ` •.:INTERIOR LATH
-IIThii axion need no,be compinrd if permit is for arm hundred dollars '_�-
fsI001 ar leap) .. 311 - SCRATCH COAT
cnmpe ation Lows of CaliforniaDate ono orkt ..Hien thi 'issued Tl ..31.3•• '•-.•..ROOF".NAIli•'... .. .
1 of fy d t in,h pert ratan perm, _....• ., .. ., .._:.'.•,,. •-• .
,hall n r crop).,any pars n m any mmhc t become object m,hewn ker` 501 - FINAL ELEI.CTRICAL ENERGY
._Apples, - - - :.:-. .502" FINAL" 'PLUMBING ENERGY .- _ _ ..... ._._.
WOTICE TO APPLICANT If atter making the Certificates
01E rapt you'should t .
z Accome bjentothe Worker's Compensat provisions
tt n ofthclabo Code,you must 503 - FINAL MECHANICAL ENERGY
h Mcomplywi,h uhp ns Orth . 1. n_. - arenkee. _504 - -FINAL .BUILDING- ENERGY....- ...
z - .. . . . -
a Q Leaders
a 'CONSTRUCfION'LENDING AGENCY
IheAby 0- thtthe,. sacnswtlo lendingagenyfrtheperfrmence 505 - FINAL ELECTRICAL
of,M1 k for hich U permu Issued(S i09]'Crv.Ci
e Name" nf/ 506. .-. GAS TEST .
z LenarsAdd „' .' T—"41L 507 - FINAL PLUMBING . t..t
UO Icenify thotlhavc reed,his npplicena stem Na,Ne above information is 508 - FINAL MECHANICAL
$,o�+ cortebl:I egrce,a comply with ell city and county ordinances and state laws relating 509 - FINAL GRADE
rQ C.2 ,0 building construction,and hereby'oathorize reprcsanmtives of Ink city to enter upon
...� heaboe pungpropen ,f nspectionpr 510 - FINAL PLANNING
y' (WaJ gree to sae indemnify and kap harmle ,hefty fCupertinoagainst
W) liabilities,psgivena,costs,andeapeal,,whichmay nany wayacc gins said 514 - FINA PU IC WORKS
-U-Z City to consequence of grnnung of this permn.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ACL'NONPOINT
SOURCE REGULATIONS!,I y':',"' Issued by: Date
Signature ofApplicomisConlinshin
( "1 "'Onm' Re-roofs
'1 HAZARDOUS MATERIALS DISCbOSURB I !
' the
ca p a i al Type of Roof _.. .__. ..... _.._.,_ -
W II the applicant i future building a pant stare Lir handle hes.) an moven -
m def ed b ,h Cu n n Municipal to 9 13 entl,he Nc 11n end sat,y t a ,.
Code °Yes 355J 'a) I L "t it 1 ,, t J' .' s . 4- . 1 x. \, 1` .. .: .;
SSI" _All.roofs shall.be inspected prior to any-roofing material.being installed.
W11 the pplicant
for: building occupant use equipment or devices which If a roof is insta'lled'without first obtainin an'ins ecnori; I a ree to remove
mm
' it he ardmma ism defined n h Ba Ams A Q al ty M nagcmem g P g
n tr=t all new materials for Inspection. Applicant understands and will comply with
V °Ye t9 all'bon-point source iegulatlons.
1 have lead the hazardous conedidsmIldrensiall audit,Cuinic,6.9i 0(the
California Health&Safety Code Sections 15505.25533 and 25534 1 muderouland,him
if th.cililldingdoes not currently have a tenant,that it is my responsibility i ou(ytheoccupant of thequim to hrbh mon he , no suers erf' CeaBcea of
rc, p
oa° an Si nature of Applicant Date
es;rwoe ser ntta flan Data All roof coverings to be Class "B"or better
_ .