04040006 (4) CITY OF CUPERI'INO
Bu1t,mNc oIVlslon PERMIT CONTRACTOR INFmORMATIQN .
;
DUILDING ADDRESS: DRAEGER CONSTRUCTION INC PERMIT NO04040006
19500 PRUNERIDGE AVE
ERSNAME PERMIT ISSUE DATE
IRVINE APARTMENT COMMUNITI S605 COMMERCIAL ST 04/14/2004
ONE: SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
0 C 0 0
Y00 LICENSED CONTRACTOR'S DECLARATION
1 herehy afprm mal l am Rae Bu under and
Professions
onsChapter 9 my Because
Job Descri ��
c with Smmian7tlfgB of Division Sof the Business antl Prufcssion Cotic.and my liccnseis 1 @pm
infnumrceandeffect STAIR REPAIR
5U? License Class Lit.#
�Q`Qp DateContractor ryn
I understand my plmas'hall he used s public rr corrds DEC 2004
Jyu
L Wo t�, LicnzeJ Pmfessinnal
S OWNER-BUILDER DECLARATION
BUILD����a'
f 1 hereby alfirm that 1 am exempt from thee Contractors ON
License Law Car The D V U
O o following reason.(Section 7031.5,Business and Professions Code:Any city or county
<$� which requires a permit to en stated,alter,improve,demolish,or repair any structure 6
Rea
,mm La its iswmncc.r1O,R p.ifcs The applicma for such permit to file a signed statement
mm< that he is licensedpursuanunthep,nvisionsoftheContractor'sLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
yl-$ (commencing with Section TIME of Division 3 of the Business and Professions Cnde)ur
y
that he is exempt therefrare and the Lazis for the al lewd exemption.Any violation Of
Section 7031.5 by any applicant for a permit subjects the applicant to:civil PfimhY of
not more man five hundred dollars(s500).not Type
❑ 1,Sea owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.701 Business
and Professions Code:The Contractor's License Law dors not apply to an owner of Required Inspections
property who builds orborrowers mason,and who does such work himself or Through his
Own employees,provided that such improvements are nut intended or offered for sale.If,
however.me building of improvement is sold within one year of completion,the owner.
builder will have the burden of Proving mat he did not build or improve for purpose of
sal.).
r of the
property,am exclusively contracting with licensed contractors to
cons a eet the project(Sec.7044,Business and Professions Cade:)The Connector's Li.
cele Law docs not apply to an owner of property who builds or improves thereon,and.
Who contracts( such projects with a emoractor(s)licensed pursuant to the Contractor's
License Law
❑lam ea pl a c. _,B&PC far oa
mer Data
W K, PENSATION DECLARATION
I hereby ofi tie pc I of rejury mm of The following decuratians:
1 have and will maintain a Cerlificatn of Consent to self-insure for Worker's Compen-
lion,as provided for by Sbarred.rn of Ne tabor Cotic,for me performanre of The
work for which mpermit
this iss issued.d.
❑1 have and will maintain Worker's Compensation Insurance,az required by Section
371M of the labor Code.for Ne performance of Ne work far which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not 11ecomPlced if The permil is formic hundred dollars($torp
lifix)
1 certify Nal in the performance of the work for which this Permit is issued,1 shall not
employ any Person in any manner sen as to became subject o the Workers'Compensation
Law.of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Dead Retire Of Exemption,you should -
become suhjeel to[be Worker's Compensation provisions of the labor Cork,you must
,JO fonhwi Be comply with such provisions or this Perm i t shall be,deemed tevoked. -
zt y CONSTRUCTION LENDING AGENCY
,L+ Ihereby:Rum that there is a construction lending agency l or the Performance of
pi r>-t Ne work fur which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
z Lender's Address
U 0 I certify that I have read this application end hila That Ne above information is
ly F COMM,1 agree To comply with all city and county ordinances and state laws relating to
0U building em'nctioq and hereby anthmnaercprescmeawl of this city to enter upon the
W ahovomentioned property for inspection purposes. 1
(Wit)agree to saw,inma and keep harmless the City of Cupertino against
rv.t p) Iiabililies,judgmenu.coals and expenses which may in anyway Scenic against said City
U z in conWfA
anting of this permit.
t—' APPLS AN SAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURRe-roofs
Signamp icanUCo chr ale
IIA S MATERIALS DISCLOSURE Type of Roof
Will the applica0 o re building ac cap.......0 or handle harudus material
az tle0netl by the Cupe nn unicipal Cade,Chapter 9.12,and the Health and Safety
lDiatrictl
de.Section 25532(:)? All roofs shall be inspected prior to any roofing material being installed.
Yes
Will the applicant or uwre building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
't hazardous air conmminanV as defined by the Bay Area Air Quality Management all new materials for inspection.
` /
❑Yes DON:
inUy�.'
the armature,materials requirements under Chapter 6.95 of the Califs.
Healthc,Section515,25533and255341understindNmifOm building
s a re iui mest be cl n trance oft Cerdfcam of ecu c. Signature of Applicant Date
Owae ra ar;.cda t I bece"' All roof coverings to be Class"B" or better -