02060197 (2) OF
CITY I DIPC DPERON PERMIT CONTRACTOR INFORMATION:
Bu11In1tVTRF9sILVER SPRING CT DRAEGER CONSTRUCTION INC PERMIr.�2060197
OffiJh71E'I-WEN AND CHIU Y 605 COMMERCIAL ST APPICATX3ASJ)&MTJ:2002
Am
PHONE: (408) 536-0420 SANITARY
VNO. LO/ CONTROL NO.
O ce z ARCHITECDENGINCER: BUILDING PERMIT INFO
k F BLOC ELECT PLUMB MECH
8 y 7 LICENSED CONTRACTOR'S DECLARATION Description -
sz`'o IHerebyefrommalIamn«used under provisions of Chapter 9(commencing SIDING REPLACEM�IT
;mtw wivision 3 of the Basin xand Proresaioro Codc.and my license Section 7000)of D
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OWNTR-BUILDER DECLARATION
=' I hereby affirm that I am exempt from the Contractor's License Law for the
r z a following reason.(Section 703 1.5,nmme.+s and pmresaona Code:Any city or county $12000
F O Ishich requires a permit to conswn,alterinnpmve,demolish,or repair any structure
t�d3e� prior to its issuance also requires%he applicant for such permit an file aligned statement -
a. Ihalhcisheansedpershurguiheimobe,ofthe ComraclmhLicense Law(Chapeor9 " gs Y1.QPefer..@fQa,i•,. ,•1,- -_I:
(commencing with Section 7000)of Div lsinn 3 of the Busine,,and Professions Code) - 1 3Valuation
"
or that he is exempt thfimfrom�and me basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a penuil suhjeais the applicant to a civil penalty
of not more than five hundred dollars($500). 10 IAPN NEWMT ION Occupancy Type
❑1,asnwnerofthe propony.or on,employees with wiii,,sasmeirauto compensation. 102 — PIERS
will do the work,and the structure is not intended or offcrcd for sale(Sec.7n44, _
Business and Professions Cole:no Conmcror i License Law does not apply to an Required Inspections
of pra,ny who builds or improvos moreon,and who does such work himadf 104 — REBAR
or through his own employees.provided that such improvements arc not intended or
.(Tema forme.If.however, he Wilding or imponsemcm is.old wilbin one roar or 10 5 — ANCHOR BOLTS
inpletion,me owner-builder will have the burden ofmov-ingthat hedid no,Wild or 106 — SEWER & WATER
mprove far pury.re.f sato.),
D1.m he,of M1
on,and schrively onrushing o
licensed onourrsl. 202 UNDERFLOOR PLUMBING
ft _.. -
construct the pmjco(sec.7044,Ba.me.s and Professions Coded no Common;' 2 O 3 — UNDERFLOOR MECHANICAL
License Law docs not apply to an owner of property who builds or improves thereon,
and who cotnraos for such projects with a contractor(')rconxe pursuant to ho. . 2 04 - UNDERFLOOR FRAME . . ...
COntmnmS License Law. 205 — UNDERFLOOR INSULATION
0l am esempl under Sec. .B&P C fur his reason
301 - ROUGH PLUMBING '
Owner Date
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
Iherob, M.order ponioflet one.nhornnowingdoclamli... 303 - ROUGH MECHANICAL
{*❑ 1 naso ane tutu nnainlmn a cenrecam of Consent to solr-insire for worker's 304 - ROUGH ELECTRICAL
.yJ Compensation. as provnled for by Section 3700 .f he ],.hill Code. for he 3 0 5 — FRAME
performance of the work for which This pertnit is issued,
306 - HOEDOWNS
Of have he will mCarlo, Worker's Compensation Insumn fill
as rtquircd by$'thou 3 0 7 - INSULATION
3]00 of the Labor Code,for the perf.mmncc of the work fur which this penuil is
qMrw.rker''cnmpcns.0onInsurance cancer and Policy number am: 308 — SHEETROCK
r, 309-1 =,:EXTER-IOR- ;LATH
", CERTIFICATION F E%FA1 N FROM KCRS" - -
,. , 310____.INTE RIOR_.LATH..__ _... _ _
(This'.odihmneed dotthe c.mpletodifhepermitisfor nnolumdroddo)[ars 311' — 'SCRATCH COAT .
1ao0)nness.) 313 - ROOF. NAIL
I comfy that in mb'poatumance or me work for which this permit is isst;ed.1 5 01 — FINAL ELECTRI CAL 'ENERGY
shall nor employ any person in any manner so as a become subject to the Worker'
Compensation laws of California.Dam 502 — FINAL PLUMBING ENERGY
AppBcmM1 - .
NOTICE TO APPLICANT If.after making this Cenificam of Excnplion.you should 503 - FINAL MECHANICAL ENERGY
Z Wourresublout to Ou,Worker s Codrpcu'mion provisions of the Labor Code,you must 504 — FINAL BUILDING ENERGY
O O has,lhcomply with such pr..isimns or his permit'ha I be deemedev
roked.
z, - 505 FINAL ELECTRICAL
- CON$TRUCTIONLFNDINGAGENCY
> Iherebyal'fimnthatthereisaconxwc(innlendingegcncyfurmep'erfommnce 506 - GAS TEST
or the work for which this permit is issued(Sec.3097.Civ.C.1
— ' -- 507 - FINAL PLUMBING -
p t.eneeL.Name
Under',Address
D O 508 - FINAL MECHANICAL
1 canify mal 1 have read this appfication.ad clot mal me above information,s 509 — FINAL GRADE
O0 F;, 1.buil.I agree r comply wins all city and mumy ordinances and sat¢laws o, Peg
U tnbuildingcons(onion.andM1ertbyvumorizerepmsenmtivuofmiscilymen¢rupo^ 510 — FINAL PLANNING
moan.(We)agreeI.sanad opndemnfyandikepuoposos. 514 - FINAL PUBLIC WORKS0.
>, (Wmenlioemmve,ind for ifyectionphposes. the City.fCupenino against
an liabilities,judgment',costs and expenses which may in any way'Come'$ain't said
U .Z. City in conod,uhu eof the$Toni I ddii,pormiv. /
AO 4pT t(" R. 1' AND NV11PLY WITH ALL PINT Issued by: r Date (�(�
C
.ig, mop:Appfi mar.om so Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
"win the. ppficam or comm building otoupam store or handle haradow mammal .Type of Roof - .. ...
as defined by the Cupenino Municipal Code.Chapter 9.12.and The Health and S'kly 1' a
Cade.Section 25532(.)7,: , - ' . _' ., t
ores ., _ All roofs.shall be inspected prior to any rooting material being installed.
N'ifi the applicant or future buJdi occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emir hazirdoua air comdminan(s av J d by(M1c Bay Arca Air Quality Management
Di,,I off? Nn all new materials for inspection. Applicant understands and will comply with
D. all non-point source regulations.
1 Imve read me hamrdum materials requiremems under Chop2r 6.95 of the
California Heahh&Safety Code.Sections 25505,25533 and 25534.1 understand that
if he building does nor cunenrly have a meant,that it is my responsibility to nmiffethe
ccupani of there oil menus
w bh mus el prior to issuance.(a Certificate of
°ecu °nay. - Signature of Applicant Date
tun to 'atone en. ;, ate All roof coverings to be Class "B" or better
• _ - - - OFFICE