04040005 (4) CITY OF CUPERTINO + `t
BUILDING DIVISION PERMIT CON'I'.RA.CTQR INFORMATIgN:
ter.,,
BUILDING ADDRESS: DRAEGER CONSTRUCTION INC PERMITNo04040005
9500 PRUNERID
ER'S NAME; PERMIT ISSUE DAIS
IRVINE APARTMENT COMMUNITI S605 COMMERCIAL ST 04/14/2004
ONE: SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDC ELECT PLUMB MECH
voo LICENSED CONTRACT'OR'S DECLARATION
tat 1 hereby affirm That 1 am of Me
under provisions of Chapter 9(commenting Job DOSerlp ,l SIAL
SZ with Scctiereby of of Divisionm licenBusinessandvisionslOrahapter nd my 9(com(commencing
is ®btu
in full force aad.ffcc,. STAIR REPAIR
ED
EJ 4 Liccnsu Class Lic e
n h O Dam ContractorARCHHl /�
y < 1 unticrsl.ad my pl nsahal M us ed public recordsN�/V 6Q
2004
D O t; Licensed Pmfessienal
on OWNER-BUILDER DECLARATION ^ `y peed, 8
: 1 hcrchy affirm That 1 am excmpl fru.the Contractor's License Law for the ■`rr(7 I L■U�
4 m 0O which mg massa.(Section IIonstr Business and Professions Code:Any city nr county
K m W which myUlma d issuance,also
reconstruct,alter,improve,demh permit
t fie a signed
statement
ecture ment
yZa the,pooin heslits rndpuruntto theres the
ovisiosofcant the forsuch Law(Chapter
EZO That MenciaawdpSectio7").1Division3oftheBMirerandProfesw(Chapmr9 Sq.F[. Floor Area Valuation
X� (tom a is exe exempt
Section7")Me Division r M the alleged
eis xempt on,Any
Code)of
y
that io is exempt themlmm and Ne basis it Ne subjects
th tl applicant
to Any violation of
Section than
anyapplicantfor subjects the applicant to acivil penally of
not more than live hundred dollars(SSW). or Occupancy Type
❑1,a owner of the property,or my employees with wages as their sole compensation,
will do Nc work,and Ne structure is not intended Or offered for Sale(Sec.7844,Business
and Professions Code:The Contractor's License Law docs not apply to an owner of Required Inspections
property 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.U.
however,the building or improvement is sold within one year of completion,Ne owner
builder will have the burden of proving chat he did not build or improve for purpose of
sale.).
1,as owner of Nc pfopcny,am exclusively contracting with licensed convectors to
con n the projca(Sec.]044,Business and Profe emens Code:)The Communal's Li
cense Law tics sol apply to an owner of properly who builds or Millions thertun,and
who contracts f such projects wi th a comractor(s)licensed pursuant to Ne Contractor's
License Law,
❑lame net c. ,B&PCfrlism on
her Date
S CO PENSATION DECLARATION
I here affi der n y of perjury one of the following tlRlafallUM:
I have and will mai crtigcam Of Consent to self.insum for Worker's Coni
tion,as provided for by Section 37W of Ne Labor Code,for Nc performance of the
work for which this permit is issued
❑I have and will maintain Worker's Compensation insurance,as required by Section
3]W of the labor Code.for Ne performance of Ne work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy Mohr am:
Cmricr. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSU RANCE
(This anion need not be completed if the permit is for one hundred dollars I$INS
sr less.)
1 certify that in the performance of the work for which this permit is issued,l shall not
employ any person in any manner so as to become subject o the Workcrd Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you mus
.JO fnrlhwith comply with such provisions sr this permit shall hm
Ise occurred revowd.
Z� CONSTRUCTION LENDING AGENCY
[r I hereby sprint that there is a construction lending agency for the performance or
FL> Ne work for which this permit is issued(Sec.305D,Civ,C.)
WU Q
Leaders Name V
.7 z Lender's Address
1
V Q 1 certify that 1 have read this application and stab:that the above information relating is
CF. coiled.I agree to comply with all city and county ordinances and citta laws relating to
U aboutngcanstrudproend hereby amhorimmpresenmtives of Wis city menmr olio the
fJ.l ahovc*AE
uged nts,property rat inspection purports
gy (We)agree m ave,indemnify and keep harmless the City of Calculino against
In nts,costs and expenses which may in any way accrue against said City
U 7 t E Snting of this permit.
is
ANOR AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
t� T S. Re-roofs_.e nVC n acre, aroHA A DOGS MATERIALS DISCLOSURE Type of Roof
ri Mare building Occupant store or handle havafduus material
10,
defined by the Calendar Municipal Code.Chapter 9.13,and the Health and Safety
dic,Section 25532MC All roofs shall be inspected prior to any roofing material being installed.
Yes
Will the applicant or utnm bofldiag Occupant use equipment or deices which If a roof is installed without first obtaining an inspection,I agree to remove
it haeardsus air contaminants as dcrnN by the Bay Arca Air Quality Management all new materials for inspection.
Jn❑Yes
I have mad the hvardsus materials rcyuiremcn a under Chapter 6.95 of the Califor.
Hoahh .lycl.Seeduas 25505,25533 nd 35534.1 undersand Chet if the building
es t c m .I rte t that it is my reapunsiM1Tliry m nndly the acupnt of Nc
ut cot mu:. t rraCONbcaOra y. Signature of Applicant Date
All roof coverin s to be Class "B" or better
nc ora hat dead m Dam g