04040004 (2) CITY OF CUPERTINO M",AT, '
BUILDING otvlsloN PERMITT �CONTRACTC�R INI?,OIiAT.ION:
BUILDING ADDRESS: DRAEGER CONSTRUCTION INC PERMIT N004040004
19500 PRUNE
ER'S NAME: PERMIT ISSUE DATE
IRVINE APARTMENT COMMUNITIlIS605 COMMERCIAL ST 04/14/2004
ONE: SANITARY NO. CONTROL N0.
(408) 536-0420
ARCHITECiENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
00 LICENSED CONTRACTOR'S and.,
ri,im RATION lob Descri t(jSil l p 0 � ® O
1 hereey afnfm[heti am licensed under provisions of Chapter Y(commencing p CC_ I®�i�
With Section 70(,1)of Division 3 of the Business and Professions Code,and my license is
ZmmRmrceandcffic". STAIR REPAIR
License Class Lic.p
Date Cmbwc,,
ee¢�¢ �® L ARCH TECTS DECLARATION AI5[004
y 8'� I understand my plans shall he used as public rccurtis NO('rt/
Dyu
leO� Licensed Pmfessionel
.'�i S OWNER-BUILDER DECLARATION BUIL®I
a 0 1 hereto affirm on 1 oro exempt from the Convenor's License Law co @e
00 followhich ire teres Permian Ao sr,Business andProfessions
ve, eci old Code:Any city nr county
K which re6uires a petted(to ennsvun„elteq improve,dcmollsh,m mpair Soy evunum 3 9
yZT priorto its issuance.also requires the applicant forsuch permit to File asignedsiaument
FgSp that he is licensed pursuant to the provisions of the Contractor's Lictrise Law(Chapter 9 Sq. Ft.Floor Area Valuation
yt- (commencing with Section 7”)of Division 3 of the Business and Professions CSWe7or
i
that he is exempt therefrom And be basis for the alleged exemption.ermit Any violation our
Section 7031.5 by any applicant for A psubjects the Applicanup A civil penally of
not more than five hundred aalara(S5,M), �,VJRer Occupancy Type
I,As owner or the property,or my employees with wages M their sole compensation,
Ne work,and the structure is not intended or offered far sale(Sec.7W,Business
and Professions Codc:The Contractors License Law docs not apply to An owner of Required Inspections
properly who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.It,
however,the building of improvement Is sold within one year of completion,the owner
builder will have the burden Of proving that he did not Wild or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.704,Business and Professions Code:)The Contractor's Li.
cense Taw docs not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)Iicensetl pursuant to Ne Contractor's
License Law.
❑lam eaemp( rSe. ,BAPCfm hisrc
137Mer Date
O 'S C PE S TION DECLARATION
I hereby AIB un rpen of j ry saw
of the following declarations:
have and will maintain a Cenificne of Consent m sel6insum for Worker'sCumpen-
,as provided for by Section 37W of Ne Labor Code,for the performance of the
for which this permit is issued.
have and will maintain Worker's Compensation insurance,as required by Section
of the Labour Code,for the performance of the work far which this ermit is issued.
Worker's Compensation Insummu carrier and Policy number arc:
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed Blue permit is foronc hundred dollars(5100)
,it ICas.)
I ccnify that in the arnformance of the work far which this permit is issued,1 shall not
employ any perwn in any manner so aA to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:Ir,after making this cmi6caw of Exemption,you should
become subject to the Worker's Com pe random provisions of the Labor Code,you mail(
.J 0 forthwith comply with such provisions or this permit shall he deemed resider.
,z.t h CONSTRUCTION LENDING AGENCY
'raI hereby affirm Nat there is a construction lending agency or the performance of
ai > Nc work fur which this permit is issued(Sec.3097,Civ.C.)
W
A
Lenders Name
LeV
Q z nder's Address I
V Q certify that I have read this application and stain that the above information is
(y bonen.1 agree to comply With all city and county natives of and stain laws relating upot e
QU hundingconswNmn,and lyhereby inspectiorimrcpresema(ivespf this city to enter upon the
W shove-ms,judg d probably for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
Tap inceises,juuccorthe rano expenses which may in any way accmc against said City
V 7 APP Noce of Nc STA ser this permit.
t� APP NT RSTA SAND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOU E TIO
Re-roofs
Sign re o Ap an ant d De
HAZA D S MATERIALS DISCLOSURE' Type Of Roof
Will the tore building occupant wore or handle hazardous material
as defined by the Cupertino Mu pat Code,Chapter 9.11,and the Health and Safety
c,
Section 25531(a)? /`a7as-g`/su. All roofs shall be inspected prior to any roofing material being installed.
Ycs
Will the applicant or marc npimmg occupant equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
OR hazardous air c tnammots a defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Ycs 'No
l have mad the beta tut materials reyuircmcnB under Chapter 6.95 of Nc Cali for
ria Hcal "Sao, Codc,SeNons 255115,25533 and 25534.1 understood Nm if the building
Jwe a n0j ave a vnan,th usury wgxrodihin(y a noul'y the wcupant of the
r
ep
o
I `n¢ Irhmpl fp�n'orrinhsuanceOra Cemrralenrommtp LySignatureofApplicant Date
own r atom ri ed ear D, All roof coverings to be Class "B"or better