02070057 (2) OF
CI BUILDING DIIVIISNO
IONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11568 RAINTREE SPRING CT RAEGER CONSTRUCTION INC 02070057
OWNERSNAME I APPLICATIO SUB DATE
STEVEN CHEN 605 COMMERCIAL ST 0709/ 2002
PHONE:
(408) 536-0420 SANITARY NO. CONTROL NO.
'
ARCf11TF.CTIENGINEER: BUILDING PERMIT INFO
�'t'j BLDG ELECT PLUMB MECH
u
S H Z LICENSED CONTRACTOR'S DECLARATION
ZO Z @ c 1 hereby affirm that 1 am licensed under provision.v of Chapter 9(commencing Job Description
rr,_Cw with Section T )ofDivision 3oftheRavines s dPrvr<xsionsCede.andmyu=enw SIDING REPLACEMENT
_ i nId 1 1 (0l o
:;I� 'n fullf or
p w U Lleen e C Lie
Con �-
Eii
%Z-7&I ARCHITECT'S D[CL.ysnT10N
Iii:O S I undenmad my plans shall served as public records
r
pO Licensed Professional
c o
OWNER-BUILDERaamemptfrom
DECLARATION
I hereby.Birth on 1 1. a<mnI s an Ihm Contractor's License Law for me
followingreason.(Section construct,
t,after,
improve,
ve,demolish.
h.or:Any oily or county. A((0 C, Z
uIFo which rtquimsapermit mcom"map¢qid"or .,d<molish. ri upavany sWctu¢ AUG 2���VU o
3$_prior m its issuance,also ugwrcs the uPPlicant fur such permiuo Ble a aigneJ slatemrm
that hens li<ann¢Jp kuanfm In��lp"w"mnsohe C.mracad.l....usc hwlChapmr9 geµ�pcp j'st��O reg + Valuation
(c6mmencingxi'r`m an.)Ls00I of Division Jof the Busing{{and Purofr'n,"CMc) Y_,f.li as 3j6�3'Y U°F�7.- V�pl1 i' t:\f{ 1i�.`
or that n.is exempt Ihe,efmm'and the basis for the alleged cia nptihn.Any violation ; 1
-mf5ectlon 903 LS by an'
upplimm far a pe,mir suhjats the applicom to a civil penahy _
of amt mare mm Eve hanercd douam(ss00). 101 APlI ATION j" t `- ' ccupancy Type
❑1,as owner of me pmPeny,or my employees with wages as their sale cotnpmnsation. 102 - PIERS
will dohewort:and the cumulate is not intended.1 offered for wile sec.7t . -Busin -
owner of and Property
Whom Wild,
rim rove,Contractor's License w Law ,such
not apply himself m an 1 O 3 — UFER Required Inspections' • t'' `
rwne
r or his ow Who Wilds or improves thereon,and who docs rc n work edor
or through sal own employee.,provide)that such vement=mens.are not one am or - - — REBAR
oReNafor sthe:IChoweveq he'l have -
building-or improvcmmt is sol)-within one of 105 - ANCHOR BOLTS
completion,me owner-W ild.r will have the burden of proving that M did not Wild or � • '
improv.for parpasu of sw`'1' 106 - SEWER & WATER
❑1.ssawterofdue ormf iam=actsilel'ycnmrasngwithr«nsedeonuemr.ln 202 - UNDERFLOOR "PLUMBING _
Lnstruct the project(Sec.70",Business and Profceions Csdep The Contractor's '
icense Law does not apply to an owner of property who Wilda or improves thereon, 203 - UNDERFLOOR MECHANICAL ;
and who contracts for,such projects with a contractors)licensed pursuant m the
Contractors License Law. ... 204 - UNDERFLOOR FRAMEI'
❑IamexemptunderSed: ,B&PCfonhisuamn 205 - UNDERFLOOR° INSULATION
Owner Date 301 - ROUGH PLUMBING
- WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
I hereby affirm under penalty of perjufy one of he fallowing declaraions: 3 03 - ROUGH MECHANICAL
.� ❑ 1 have and will maintain a Certificate or Convent to xelf-insure for Worker's 3 04 - ROUGH ELECTRICAL
Comp=nsaion, m provided for by Section 37W of the Labor Coda for the 305 - FRAME
performance of m=work(or,which this permit is isvued.
❑1 have and will'maimi in Worker's Compenwlion Insurance,as required by Smtimn 3 06 - HOLDOWNS
- _ 37W of he Lab.,Cade.for the pe,f.mmucii Orme work for which this Fermin i. 3 07 - INSULATION
c issued.My Wm ker's Compensation Insurance carrier and Policy number arc:
. .. __........
c�ia;., tIF .TION OrrSEcyN4�-ZC(lD SO I�� .. 3,08 SHEETROCK 'v -
• lice FICATIONOPEXEM$iJbiJ'ROMWORKER$'r' - 30'9t,—�`EXTERIOR''LATH' '•
COMPENSATIOtNTTINSURANCE-
310 -' INTERIOR LATH___....__. ....._ ..__........-- .............
l (Phis section teed not be camplmcd if the pert is for one hundred Dollars .. -
tal(x»ml,as.l 311 - SCRATCH COAT )
y per - -313 ROOF NAIL
o-1 cenil that in'hi""forinunce of ibv work for which rM1is p:rmit is issue:l,I -
a„B not pmpmy any p,rson m any manner m ne Ira become.abject m the'or,,
501 - FINAL ELECTRICAL ENERGY '
Crua'asption Lows or Catharia.Dade '
App''a°^t 502. FINAL . PLUMBING_ENERGY_
NOTICE TO APPLICA,VC IL ober making this Cenif<ae of Exemption,you should ,
Z becomesubjecnndwWe"er'sCotnpcnsaimnprovision. ....LaM" "youtnun 503 - FINAL MECHANICAL ENERGY
0 0 rmnnwimenmplywim.uch'o",iron.m"ispermhemm�ncdecmedrevaked._ . - 504. . FINAL BUILDING. ENERGY.. _
CONSTRUCTION LENDING AGENCY
I Ecrchy a�Rrm that h,uvkacnn,nowimi virding agency 0th the performan,c 505 - FINAL ELECTRICAL
W O
of k for whichthis pe trissuedS 3097 . c) 506 - GAS TEST
Le
y nde N - - - 507 --- FINAL PLUMBING '- (✓
D Z L J Address. .
U O 1 certify havethat I =dtl application J mi that b information N
nn is 508 — FINAL MECHAICAL
F =t ' 1 g . t .comply m uctyand county J and scale lwaniting 509 - FINAL GRADE '
O w bmlJng conaructi n and hemby vuih reprevemaivc. r,h hyt cuter upon
theh nI ncd p p ty f sp,u ri p P 510 - FINAL PLANNING
[r 0. (%%'a)irma,to save,tJmnfy and keep h v the City fCpenirioogainst ,.
V) liabi lities.judgments.costs d expenses which may in.any ay ac gatmt said 514 - FINAL UB C WORKS
'.0 Z CY 9 c nh C t gonM1-p t
'�' AFPLIC 'vTUVOERSTti bS Aa�l1t COMVLS'R'ITH ALL VOV YO CT
Issued by
y Date
naturemnrpB,anvca avmr at,
Re-roofs
' ' bl.\TEI11AL5 DISCLOSURE, '
fl.\ZARDOUSoilAing accdpam sort or haWle bar Nous rwmnal _Type Of.ROOf
Will the Applicant or(marc b
as d f cd by Ih Cupen nr M rp CWe.Chapmr 9 13 d Ih H hh J S fay r s ""
Cd S t 255. p1 ' s l ' f ... r, s+ '� t,q , .'q •s._ '
'All roofs shall=be Inspected.prior to any rooting material being installed.
u Rut pp` ns rut n Id g:eeuP'nt 1 p I.,device,wnch If a roof is installed without first obtaining an inspection, I agree to remove
<mn h d m I m d I eJ by IM1e Bav Al ca°F r Quality Management
-, _ .
novel, all new materials for inspection. Applicant understands and will comply with
.,all
non-point source regulations.
1 have rend the haeaNnus materials requtummuts under Chapter 6.95 of the
Cnliforam Health&Safety Code,Sections 25505,25533 and 25574.1 understand that
if the building docs not curendy havcumnant.omit is my rcsponsibilitywnorify the -' - - - -
icupam nfdhe uquiraments w ei prior m imm�c<of n Cenifcajj or
Oc , cy. Signature of Applicant Date
—�
cr or aumorixed agcm Dam All roof coverings to be Class "B" or better
OFFICE .