01100041 (2) OF
CI BUILDI G DIIVISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS, PERMIT NO.
11793 TRINITY SPRING CT DRAEGER CONSTRUCTION INC 01100041
OWNER 5 NAME: APPLICATION SUB DATE
BOWER KEITH D AND HELVIA B 605 COMMERCIAL ST 10/08/2001
PHONE: (408) 536-0420 SANITARY NO, CONTROL NO.
ARCHITF.Cf/13NGINEER: BUILDING PERMIT INFO
w C BLDG ELECT PLUMB MF.CH
NU w L-1 1.--I LJ L--.l
a6
5 N z LICENSED CONTRACTOR'S DECLARATION Job Description
z_ 1 hereby affirm do I am licensed under,mvi,idm of Chapter 9(commencing
w with Section 7000)of Division 3ofNeBusiness and Professions oe.ygdmybccnse RESIDING EXTERIOR.
[x d,.as, is ce full force and ell / V
c z e a License Class _ LIc.tf (O
aO y U Dale COnlrall- l/Jy�y-
O ti. ARCHITER'S DILCLAftATIUN
I understand my plans shall he used as public meords
3 m p O Licensed Professional
OWNER-BUILDER DECLARATION
of �` 1 hereby affirm that 1 and exempt from the Contractor's License Law for the
F" < following rtason.(Section 0031.5.Business and Professions Code:Any city a county $169( 0
$S o tubi h q 'rcs o perms l t o alter impm a demnl'ah p a y ssrvcwm
i 3 m poo tot e.ado req do applicant fo such pcmutto file signed sutemenl. ,�4 ,�'�aa� p,r.bat he licensedpunu ttotheprovi n fth,CommctohLtt La (Chapter9 „f•[3��'7'SV7'YC.'l7� at I i 'r Valuation
(commencing„th Secl170of of Division tfthBusiness rd Pmfe. tons Cndc) .',j� O7J'V7".Y "l7
or mar he is eaempl thFrtfrom and Ne basis for the alleged riemprfoh.Any violation
of Section 70316 by any.,he.,for a permit subjects the applicam m a civil pevhy
of ao,more man Five hundred dollars($500), 101` PN 4tMhqnAT ION •t Occupancy Type
C Let owner of me property,or my employees with wages res their sole compensation,
will do the work,and the structure is nut intended in offered fur sad:(See.70•1,1; 10 3 — UFER Required Inspections
Business and ProfessTh
Protrusions Code: e Com
ntnm's License law does not apply tom q p
Owner of property Who wilds or improve,therton,and who dues such work himself 10 4 — _REBAR
provided mtarn
or through his own employees.provided improvements arc not intended or
offered for sale.If,h raidn.Ne Wilding or improvement is sold within one year of
completion,the owner-builder will have the when of proving that he did not Wild or
105 — ANCHOR BOLTS t.
improve for purpose of sale.). 106 — SEWER & WATER i
01,as owner of the properly,am exclusively municting with licensed contractors w - 202 — UNDERFLOOR PLUMBING
ransomer be project(See.7044.Business and Profession,Code:)The Commelm's 203 — UNDERFLOOR MECHANICAL '
License law Edea not apply to am own.of property who Wilds or improves thcrson,
_ and whu.rortmms.for such projects with a contmctorts)licensed puts...I re a 204 — UNDERFLOOR FRAME
Cuntmcmrs Lire,Law.
❑IamescmPtundersed B&PCforthisrrawn 205 — UNDERFLOOR•' 'INSULATION
owMr 'Dale _ 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
Ihereby affirm under Penalty dlperjuryOne ormefollowing declamrons: 303 — ROUGH MECHANICAL
p ❑ I nave odd will maimain a Certrecne of Consent h,self-insole for Wurhea 304 — ROUGH ELECTRICAL
`i.... Compensmi... as providW for by Section 370d of the Labor Code, for the
Performance of the work for which this:Permit is issued., 305 — FRAME '
El 1 haveand will maintain ivmrkdi Cumpenwlma hommdce.'as rcgdred by section 306 — HOLDOWNS
W of the ,for the famed....of me w for which tis permit is _
ab° Code, 307 INSULATION
?7ued.M W”'0 a C pe . I sumnn c5mer cid of cy numbs arc:
cs;ter' &5LPu1crNO �. {; J's ; x30•,81, - -SH.E,) TROCK.,: .
.Rr C NOFEXEMPTIONFROMWO I 309" '`EXTERIOR LATH''
COMPENSATION INSURANCE"' " '1 ' _ ..-. _ _ .. .. .
INTERIOR" LATH:. _. _.
'(This,section neZd not he completed if the Permit is for one hundred dollars 311 — SCRATCH COAT "t
1$10(0 oneas.) ,. .. .
313 -- ROOF NAIL
It empll thatinthe n in a nn sof the work for which ubj permit to is orke,1 '
shall not employ my person in any manner so as to buome subject to thcWorkcri 501 — FINAL ELECTRI CAL � ENERGY
Compcnsygon lawn of GbfomP.Dale 502 — FINAL PLUMBING ENERGY
A heart
pp
NOTICETOAPPLIC.--firm making this Certifies",of Eaemgfon,yoq shuOla 503 — FINAL MECHANICAL ENERGY '
beco..'subjmt m the Worker's Cord msauom Prov nouns of the Tabor Calc,you must
p fOrnwithrOmplywdmm�hProvo,is Orthdper,ndmad,Ine, earcvukea. _ 504. — FINAL BUILDING ENERGY . . _
E_ 4 s CONSTRUCTION LENDING'AOFJJCY 505 — FINAL ELECTRICAL "`
7 ' '1 hereby arm that mem on
is'.csounion lending agency fom
re perfmn
nnoce —
ofthe wads for whichthii'pennitisi.ssucec.
i(S3(197,Civ.C.) 506 GAS TEST
a Q Leader's Name
.'7 507 — FINAL PLUMBING
Leader's Z Ler's Address ,• . .
U O I cerify that I have mad this application and state that the above information is 508 — FINAL MECHANI CAL
W ' cored.1 agree to comply with all city and county ordinances and state laws rcladug 509 — FINAL GRADE
0 V lm wilding construction,and hereby aumorim repmsenmtives ofthis city to enter upon
the above-mentioned property for inspection purposes. 510 — FINAL PLANNING
(we)agree to save.indemnify and keep harmless the City of Cuperiirio'against 514 — FINAL PUB IC WORKS
h liabilities,judgments,costs and expenses which may in any way accrue again said
V City m consequence of the griming of this pgnot.
APPLICANT UNDERSTANDS AND-WiLL.COMPLY WITH ALL NO 01" Issued by: Date
Signaturewuf me a
HAZARDOUS DOUS MAT ale Ty roofs
.. DP Wilding s.
HAZARDOUS MATERIALS DISCLOSURE' p
a tarda s material TYPe of Roof..
Occupant Hort nc handle M1 � ..-� V .
as
defined b the Cupertino Municipal Code,Chapter 9.12. cid Ise Health and Safety 111 •
Coda,Section 25532(x)?. , I .f tri . .i�t} �'l,:'I,,'p ,'t:�:lis t: i �x r. t. t
❑res oNo; s<'tir+v'i'i All roofs.shall.be inspected prior to any roofing material being installed. - -
Willtheapplicantorfuture Wilding occupant use equipment or devices which If a roof is in$talle'd without first obtaining an inspection; I agree'to remove
emit hazardous air conlaminanle as defined by the Bay Area Air Quality Management
Dwricla all new materials for inspection. Applicant understands and will comply with
Elves; ONO all non-point source regulations::
I have rtad the hazardous materials rnqurenum s under Chapter 6.95 of the
California Health&Safety Code,Sections 25505.25533 and 25534.1 understand that
if the building does not commody have a tenant,that it is my aiponsibilhy la notify the
odcupam of the recuimments which must he mel prior to issuance of a Certificate of
i
Occupancy.;
Signature of Applicant Date
7 Owner or aulhorixd ag<m Date All roof coverings to be Class"B" or better
OFFICE
t ' � 4