04100125 (2)t
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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
GONTRAG "OR INk'ORMA.TION
Bu1LDINGADDRESS:
500 PUUNERIDGR AVE
DRAEGER CONSTRUCTION INC
PERMIT N04100125
OW NCR's NAME:
PERMIT ISSUE DATE
IRVINE APARTMENT COMMUNITIE
605 COMMERCIAL ST
10/19/2004
NE:
SANITARY NO. CONTROL NO.
(408)536-0420
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB
PLUMECH
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LICENSEDCONTRACTORS
SDECons
Job Description
of CON
I hereby affirm that I am liceeBu under o(C
under 9 (commencing_
with Section 7pM0 of Division Sof Ne Business end Profcssinns Code. end my license is
and Professions Civic.
in(mlmneandeffea.
TI --UPGRADE ENTRY/LANDSCAPE
License Clan Li,. X
Dale Connector
ARCHITECTS DECLARATION
1 i n ocrsland my puns,hall W used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Comracmr's License Law I'or the
following masun. (Suction 7031.5, Business and Profestinns Calk: Any city or county
which mquires a permit to concoct, &Iter, improve, demolish, or repair any structure
$95000
Sq. Ft. Floor Area - Valuation
Prior m its issuance, slut requires the applicant for such Permit to file a signed uantment
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 0(Ce Business and indications Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicants to a civil Penalty of
31AINON&TOOccupancy Type
not mom Nan Ave hundred della. (S500).
FZA
❑ 1, as owner of the pmperty, m my employe" with wages as their mlc compensation,
will do the work, and the structure is not intended in offered for ale (Sec. 70,W, Business
end Professions Code: The Conmcmfs License law does not apply lf owner of
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sthercom&mdwho nsucbwmk himseBed through his
buildsmed
ownpropertywho
provided that am not intended mplenrtd for sade.Own If,
this mchvent Traps
owneer,
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the building or i cold wt in
however, the building or improvement is told within one year of completion, the ase of
builder will hove the burden of proving that M did not Wild or improve (m purpose of
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wr
ole.).
s70
1, as owner of the property, em exclusively contracting with limnedonnvaoon to
construct the project (Sec. nano Busmen end rty who Profession Code:) The Contractor's n
mesand
rove law oma not apply ts owner of proper( who build& or improve Centro, and.
/s
whocontractsLacu for such projects with a contractor(s) limned pursuant m situ Contncmr's
e
,P
License Law.
❑tem &aero n r ee. ,Bk PCfm Nis son
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Owner Date
ENSATION DECLAR N
I hereby rmr nal f pedo, one oft owing decl."nums:
I have and will maintain •Cemlficwe of Consent to self -insure for Worke's Compere
cation, as provided for by Section 37M of Ne labor Code, for Ne Performance of the
work for which this permit is issmd.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the labor Code, for Ne per rimomee of the work for which this permit is issued
My Workers Compensation Immense artier and Policy number tic:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissectiun moil not W crmplesd if tk (s omit i, fnr one humdred ,obis (SIIMI)
or lass.)
I cenify that in the performance of Ne work for which this permit is issued. I shall not
employ any person in any manner an as m become subject m the Workers' Compensation
Laws of C&lifomia. 0.1
Applicant
NOTICE TO APPLICANT. If, after making this Certificate o(Excmpion, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this Permit shall be decreed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that Marc is comnction lending agcuy for the perfmmanm of
the work for which this permit Ts issued (Sec. 309E Civ. C.)
Undoes Name
Lender,Addmn
I certify that I have read this application and sate that the Orion information is
COMCL I agree to comply with all city and county ordinances and state law, relating to
building ConsWCtlon, and hereby authonoo representatives Of Nis City to enter upon the
.have -mentioned property for inspection purposes
(We) agree to save, indemnify and keep humlmS the City of Cupertino against
liabilities, judgmunts.cosu and expenses which may in any way ammo against said City
in consequence o(Ne .,an, this permit.
APPLICA UNO TANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE UL ON
Re -roofs
I'
Signed c tic nV coo arc
H"DO S ATERIAIS DISCLOSURE
Type of Roof
WTII epplicanto umr ilding occupant store or handle hwaNuus material
As de0ned by the Cupertino cipal Code, Chapter 9.12, and the Heald, and Safety
code, Section 25532(.)?
❑Yes XNu
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building mcupamt me equipment or devices which
it haaardous air cnntaminanu u defined by the Bay Arca Air Quality Management
all new materials for inspection.
idols?
❑Ycs X.
I ban real the l omNous materials requirements under Chapa:r 6.95 of the CalifnP
w
nu HwIth,W Selcry Ccdo Sccdum 255f15,25533.d 25534.1 undcrsund Caif tM Wilding
does not cumentl ass i E and hal' a my msponsibility w mstify the ucupmt of Cc
rcquirtin d m cmc r�ftdoemt 'CcniMasof cpalcy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
r tithe
, seg sat DW