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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