01110124 (2) TINO
CITY
t BUILDING unESiONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
11578 RAINTREE SPRING CT DRAEGER CONSTRUCTION INC01110124
°t " IN 605 COMMERCIAL ST AP11/295yy/2001
( PHO
N
E'' (408) 536-0420 SANITARY NO. CONTROL NO.
z^0 o z ARCHITECr/ENGIh'EERo BUILDING PERMIT INFO
wBLDG ELECT PLUMB MECHz so
c
i LICENSED CONTRACTOR'S DECLARATION
z_ I hereby affirm mut turn liccu,ed under provisions Of Chapter 9 commencing RE—SIDING. Jo Description
wr- with Scctim70D0)o D'iTon 3 e BumrxmdP Ix"mm, e,wson 'cense
in full once and r
r n 6 6 License Class Lie a
O U pateCarl.,-RiA
u 3 a v II EUFCLAunderstandC
°g understand my plan,shallsshall bo use Liao as punb<mcntasrl
j
Y �L
v i 0 9 LicensedPmlcssinnal
o u aROWNER-BUILDER DECLARATION
u�= 1 hereby tm Ill.,1 vin exempt from He Contractors License Law for,he
t 3< Iidlowing reason.Serum 7031.5.Business and Professions Code:Any city or county 18 900
€o structure
y which bt qu,a pc of construct. hr,imfor su demolish, rcw your
tilla.3se prion , l:1-requiresm Wocant forsucnnormn is grcdxmmmcm - --- - --' - --
(com dressed Sexi taodte of i nrthe,ftheBusinesL Law(chapter r , . 4� @fi!I ' a , : i Valuation
(commencing an 6 t om a f Division 3 of h,rad e, d exemption.
Anions Code) f ':�„ 5 •�., s
or than he is cnempt any applicant li and,he basis fns,he mts the exempniw.Any l Penalty
of Section 103 n iv any ll for a permit subjttts the applicant m e civil Penalty
'of nor mom man n«nnnarw sonars asla). 101°sPN I'$tOO1tIDATION Occupancy Type
❑L as owner of property.or my employees with wages as their son compensation. 102 — PIERS
will do the work:and the suucmm is not intendedor offered for.ale(See.70641, 10 3 — UFER .
'Business and Professions Calc:The Commcmr's License Law does a.apply m a-1 Required Inspections
ownerthrough
of progeny Who Wilds or impmms
vcs,hem...and vino doe.such work himself 104 — REBAR
n,through his own employees.provided that men vementemcma are not intended or _ _
Offered Torsole. -Howevereme Wildingor improvement of pontis wilt he did a., year or 105 ' ANCHOR BOLTS
'mnmlalmn,meowmer.nwleet vire nine me Bonen arpro.mg that 1-e did no,M1aile or 106 - SEWER & WATER
improve for purpme of sale.).
❑i.s"o"erohne'pmpeny.am excwsivO.y contracting with licensed]sontraemrs to 202 UNDERFLOOR PLUMBING
construct the project(sec.76 ,Business and Professions Cade:)The cnmaemra 203 — UNDERFLOOR MECHANICAL
License Low does no,apply man owner of property who Wilds or improves,hereon.
cad who.cammns rnr.aucn projects wim.a commctur(s)licensed pursuanem the 204 - UNDERF-LOOR FRAME - —'
oIamexespeunders«. B&P C for this mason 205 - UNDERFLOOR" INSULATION
Owner Dale 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
Ihereby affirm under mnaly of perjury one of following declarations: 303 — ROUGH MECHANICAL
t•0 I have and win maintain a certificate of Cmaml to selMosum for Wnkct 3 04 _ ROUGH ELECTRICAL
Compensation, or provided for by Section Boo of me Labor Code. sur me 305 FRAME
performance of the work for which this permit is issued.
C1 have and vim maintain Worker Compensation Insurance,a;rwuimd by Section 306 — HOEDOWNS
3700 of rise Labor Code.for,he performance of rate work for which,Ids permit is 307 - INSULATION
issued.My Workers Comfersatbn mmrancgcamerana Paicr number ue: .. .-.-. --._ -_ - . •-. .. '-
308 - SHEETROCK-
Carner / CERTIFICATION OF EKEMPolicPfION FROM WORKERS'• . 305. -;,'t kTERI OR ss LATH
. ,, _.
COMPENSATION INSURANCE -_. ._...._3.10----,INTERIOR' LATH---- -- ---: — -
(rds section need no,Be completed if the Penni,is for one hundred dollars 311 ' - 'SCRATCH COAT
siDo)oneaal 313 - ROOF NAIL
i orrery that in he p rforlance of the wo,it far which this Permit is issued,I 501 — FINAL EliECTR'I CAL 'ENERGY
shall not employ any Person in any manner so as to become subject,o,he Workers'
Compensation Laws ofCalifornia.Dale 502 - FINAL PLUMBING ENERGY
Applicant - - - - - -NOTICE 10 APPLICANT if.after making this Certificate of Exemption.you should 503 - FINAL MECHANICAL ENERGY
Z became subject the Worker's Compensation provisions of me lsWr Cade.you-11-11
ZO forthwith comply with such provisions orthis permit shall bedeemed tcaked. 504 — .FINAL BUILDING ENERGY
m CONSTRUMON LENDING AGENCY 505 — FINAL ELECTRICAL
E
7 Ihereby affirmthat here inaeonsmscomallending ugencyfar thepoomunce 506 - GAS TEST
of the work far which this Permit is issued(Sec.3097.Cie C.) -
yG ""' -' - 507 — FINAL PLUMBING -`
lenders Name "
z Isndcr's Address -
U'O I emdy mal I have read this application and state mm me abom i rfamotim i1 508 FINAL MECHANICAL
g"Ea correct.1 agree"'romply with all city and county.nJinwae end van law.r=..ling 509 - FINAL GRADE
O r) to Wildingcon.,ruction.and herebyoumorimmpresenu,iverofthis city to enter upon
510 — FINAL PLANNING
y �] the above-ntemioned property far inspection purposes.
E alWejagmetocove.indemnify too keepharroarimeCity ofCorona.'spurs, 514 - FINAL PUB IC WORKS
.a to liabilities,judgments,cost,and expenses which may,in any way,mane against laid
r] z City in consequence of the gonalial of this paint,.'
'APPICAKf UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
Date
f F.R lUL i N y'
w"ConD 2
App HAZ Date Re roofs
HAZARDOUS MATERIALS DISCLOSURE v �= f
vin me vpPlicant f,rc Wilding <pant vo or ha d. nava in m mmenal Type of Roof
as
defined by me Cupertino Municipal C Chapter 9 12.a d me Health,M Sefay
Code.
6d Sec,nn 5532(.) �
❑Y a No rt T All roofs.shall.be.inspected prior to any roofing material.being installed. .
w0 to applicant p future Buld g po,use equipment or devr«s which If a roof is installed without first obtaining an inspection; I'agree td remove
eoilh b cont uby the Bay Area Air Quality Management
Drsmm all new materials for inspection. Applicant understands and will comply with
r� - - oY , N all non-point source regulations. ,
s„9 I have;cad,he hazardous materials require areas under Chapter 695 of the
Calif rria Hearth&Safely Code.Sections 25505.25533 and 5534.I understand that
Hrhe building does not currently have a tenant,that it is my msponsibiliy to notify the
occupam of the requirements which Cott ba me,prior to issuance of a Cenof
py
Occuc, Signature of Applicant Date
..';. <ro,aumoda agent. Date All roof coverings to be Class"B"or better
OFFICE - -