02010031 .it h' ..if ..,
OF
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Ev,
'4BUmDINGDIrvtSION"'
' CONTRACTOR INFORMATION:
:. '
BUILDINGADDRES
PERMIT NO.
'20030 RODRIGUES AVE # 7E WALDRON CONSTRUCTION COM ANY ''" 02010031
7N'NER'S NA MC: t ..� I APPLICAt10N'SUIi DATF. ,
LAKE;BILTMORE.,APARTMENTS "' P 0; 2OX' 598 01/0"8/2002
` HONG: SANITARY NO. CONTROL NO.
(408) 377-8186
O-O ARCHITECTM-NG
M-NGINEER: - BUILDING PERMIT INFO
0 BLDG ELECT PLUMB MECH
WE
O
Z6-W
Z LICENSED CONTRACTOR'S DECLARATION ,lob Description
0 Z 1 ncrcM1y nliinn mhld 1 vat Iice,ucJ unJar pmvinlore"(Cbupmr 9lwnanuming
;vhh„ Section 7lgID)mDivi.don3 ofthe B.,inc,,.fd Prnleasion.,CoJc.and my license INTERIOR REMODEL KITCHEN/BATHROOM/WASHER-
in fall m¢e ad neffect.
SEo ` KITCHEN/BATHROOM/WASHER-
is Lie.Of WALL A/C AND NEW FLOOR COVERINGS .
Date, - ' I'Cunnncmr - , tl�'�Y NB�TaE�
W a O G : ARCHI'fECI"S DECLARATION
5 .. .I undiestrnd my plans shall be used a,public recomi,
pO Licensed Processional - Q Qt
OWNER-BUILDER DECLARATION MAR O OOT
u s l he by R Ih I I exempt f the C tma License LaBerths 3 L
G fll mgm (ScI n70315 B .- JP f .Cod Ay ry ly
0 which requinea it porintit toconstruct; h prove.demolish,(it reP any'st I
prion.in intumme,id.reprithic,dic.pplicant forsuch Permit file gned statement
Jwt nq medp my mq thcp .i snot t t r L eCT13Aer9 Sq. Ft. Floor Aiea- ation
(eammX ,g Ins I 7011h1 fD"e 3 fthe Dis do f. a,Cd ) �A I*%t•i ^'�,k.. to yll' dr Area �',r'. `i,!,,
or that Ire to ciitma Ineralh,m"ml the bine for theollrtgedadtl aa.A,yvWlatof
of Section 703155 hY any applicant for a permit subjects the applicant in a civil pcnlilty Occupancy.Type .
-
afggmqmihapr.�hundred dolls.WWI. ,..,
O I' f thepr Pc tyYemployer, inb. d I p f n
ill do U k J the.t I . I interiked or offered for le(Sm.70,14, P'
Bu,aas m1.Pmr si Cad no Contractor's LLaw does n t a,ply!oan 102 - PIER
squired hispeclions '•
v. 1 awnerofp ferly,Wn dd,nr np n nn anti who does wchwork himself 103 - UFER _. ! .. .
l on lhmogh hit own employee,.provided that such improvements are ant inlendW or
-'bRered farsale.IL however,the building or improvcttmnl is sold within one year of
e 'pleinisthenwnennuilderwillhavemcbridenofpmvingthathedidnotbuld.1 104 - REBAR
pat/eJm pmpa„e,a5,me.3:;lr 105 - ANCHOR BOLTS
a,mon<ruf,Ihc Pm'perty.am cielusivcly comrocling with licrniW con
?`" construct me pmjml flee.7W4.1 me.,and Pmfcssions Cade:)The cnntmatnr. 106 - SEWER & WATER '• ,I.
LimiocLowdoe, mapptyinauraw rnrprnncrtywhn land.nrimpn e,,merG,ll, 202 - UNDERFLOOR PLUMBING
and,w'bn ommet far,.wch•prnjcils with a contractors)licensed puna oal to the
Coatmotm's Lim e 203 - UNDERFLOOR MECHANICAL
Dlam c,cl and ler w "B&PCfnr lhis.,n n
ower sale �!o Oa 204 - UNDERFLOOR FRAME',
ORKER. Date
• - 205 - UNDERFLOOR INSULATION
11 by ff J pc Ity Tal y It,tl rII gd moral
301 - ROUGH PLUMBING
:Ihave ant- n t -Cnfct arcn.cmt If tlworkcrs 302' _ TUB & OR SHOWER
oI l u provided r by s t nn) f he I M1 ode for he 303 ROUGH MECHANICAL
Performance
nnhcwbkr wmn,nd,P,I I ,nm. 304 - ROUGH 'ELECTRICAL
Ih d -II halm Wokc sComiscr t 1 . sic q dbySecton 305 - FRAME .
1f th L I Cat I II Pr,f 'c f d k f ti l d''p rnI Is ..oca Mywrkerxc pc I ninwro c ,nd Poly nbcr afa306 . HOliDCiWNS
„ . y PdlcyN 30,7_, = kINSUliATI0 cI RTIPICAIION OI'I:XEMII ION IROM'WORKERS
1° af,' - COMPINSAI'[ONINSURANCEI ,' '3'O8 `- SHEETROCK
w;1 '-309 .!- EXTERIOR LATH
(Thfor
n +'0 s secuon octal nor be. aplcnd f the pernnl s ne hundred dollar, •y
"ISIro)q len,) n310 -' INTERIOR LATH:
1 Litt in Orae perf imiini'abf the vvorVf6r which this Perini i,issued.1 - 311 - SCRATCH COAT' •_ ✓v I = n '3.
shall not cmplay any person m say mdnncr'so as to became,ubject to the Workers'
Cmip . ruaLaw..alc,11 t.Dmc' - ) - -' 313 ROOF NAIL
App' ' 501 - FINAL ELECTRICAL. ENERGY -'
NOTICE TO APPLICANT:If,after not ki 6th C<dfnm of Lu
snpton you should
• z ben ramhI cm totheW k' Co pen.,al P snnheLaborCode you must 502 - FINAL PLUMBING ENERGY
O man 1, a I,if - suchp n and D ly E.NCYbe cnmrena'kcd 503 _ FINAL MECHANICAL ENERGY -
V� �tI o I' •'t'•i, 'CO[them nONLFNDING AGENCY
L.rr lfinereny llrhrm amt n,ek 1,:aca,n,nnndnn hlmding ageney'rar me performance 504 FINAL BUILDING ENERGY
bf the work for wW6 this11 is iswul Sec.7W 7,Civ.C.)
Pr'” 505 - .FINAL ELECTRICAL
a•Q Isadcr3 Name :.
Lender,Address -. - - 506 - GAS TEST
U O . ^
1 0ryttiflhaccaJth. ,plict `d,7llhnuhcalw f matami, 507 FINAL PLUMBING
;a, oire (g t amply In all city and county
ordinances and state ramming
O.V 16ba11 g, i ere do by ,fan p . If„e, flh.citytonterapnn 508 - FINAL MECHANICAL
hc,pnwe-mcmum,cd prnPW,far m.pecnoo na'rP"es 509
- FINAL GRADE
C~.0.' - (We)agreem, 'fad ryanJk pl Iesltl,eC'ty repcn aasaapt 510 - NA P NG
Cn liabilities.
iah rim c 1 dgu¢is costs
,t and q pcnscx which y n by Y accm. 8 Incl salt
U' City nen . nenf lh g f y ,rdi pe mJ - /',
Cit i NI UNUI?In'A g4 COA111YN'I'I'll NI NDNIt31N'T IsSUCd lT�141 N OAKS Date
SOURCE
REGULATI(lNh. 't, ,•
SigniiiirgtA,ii)liit/Conir;iitor .. D t c Re-roofs
HAZARDOUS MATERIALS,DISCLOSURE
WII Ih ppl cat f t ku'Idng ,cc Ise l t vh dl ha N ,n tonal Type of Roof k.
asJf dby th CPcn M 'c ryl G,W CI pm 9120 IIh-H hh vndR fcty -
CurteScclo25{321tar
All roofs shall be inspected prior to any rooting material being installed.
wRdc pPi ,t future humbling< P : equv I t de simwnch ' If a roof is installed,without first obtaining an inspection, 1 agree to remove
Intl al at t. If 1 by the ID,Arco Air Quality Mnbeneat
Di,m all new materials for inspection. Applicant understands and will comply with
DY , r ❑N, all non-point source regulations. t ift
''' "ho"
`cuddbc ea doue nmolIs eys ren,,u I Av Cb gnir 695 nl the
California Heollh'&S"fmy Cvdc;Semon,25505.25533 and 25534.I nndecaand that
it the building doe,sol carmtnly have a nenam,thin it ie my mspan,ibil lly m notify the
acapam of rhe'icquirentegd'which miu,i be fact Prior to issuance ora Certificaue of
°c„app"`y';.,. . , . I Signature of Applicant Date
^ Dwa2rgraa,m,,d,nn a4ent Date All roof coverings to be Class `B•'or better
r'
OFFICE
' :• •Yr:KNll"1' •••• ` a""�"gAln.0\ivnL�gal7vty
EUIL6U1rrADDRE55 - PERMIT NO.
20030 RODRIGUES AVE # 7E WALDRON CONSTRUCTION 3ANY 02010031
OWNER'S NAME: - - APPLICATION SUB DATE
;. LAKE, BILTMORE 'APARTMENTS P 0 BOX 598 01/08/2002
rr 1 PHONE: - SANITARY NO. CONTROL NO.
(408) 377-8186
ARCHITECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB NIECE
LICENSEDCONTRACTOWSDECLARATION Job Description
azm I hereby affirm that l am licensed under previsions of Chapter9(commencing
pr3 {vitnfullfa e1andefect. on3oftheBuainexxondPrafessionaCode.ondmylicenxe INTERIOR REMODEL KITCHEN/BATHROOM/WASHER—
once
in Tito fame and effect.
uanx aa& Liemr WALL A/C AND NEW FLOOR COVERINGS .
3 a° Dam' .'comracwr
El
p+7 ARCHITECT'S DECLARATION
Y durWemmnd my plans ahlll be used os publi<rtcama �
0 Licensed Professional
o0 j
re OWNER-BUILDER DECLARATION
(firmexemptj a
I hereby. that 1 Pmunexemnempt from @e Condos o License taw for the
a
followingueaua.(Section construct,
t,Business and improve,
demolish.
Code:Any city or counre Q�
E4 oe which its tam a permit re connmm,alrer,improve,h Permit t or repay any lmommen
prior toitscensaiec,also requithe the Ipplicem for such come.Lfilessignedsmmment
(courn i Bar,ea Pme n to 06)ofhe i,gona n 3 he of thememra Lind Pro few ons(Chapter 9 S F[. Floor Area
(cohitthe_gvY{nth1Section]000) fDi Innis lof the Buser r and Rol yam Codel v q� i ) , UffiIOn
or th t he I ! pr the ffo and the Innis for the alleged' pe pt"b A y yr I r
of Sat 7431 5 by y pp1 ant f permit mbjecmihe&PPI c t t til penalty
of nos core than five hundred dollma($500), Occupancy Type '
01,as owner of the prOferty.Or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7006,
Business NE Professions Case:The C°ntmcmr's Licenu law does not apply m sm 10 2 - PIERS equired Inspections
owrmr of property Who Wild.,or improver thereon,and who don such wort himself
or through his awn employees.provided that such improvements an not intended or 103 UFER 1
ofleered for sole.If,however the building or improvement is sold within one year of
'completion,the owner-builder will have the burden of proving that he did not build or 104 — REBAR
p/oSar1-fthpurpose orsalE.). ' 105 — ANCHOR BOLTS
i as0 tther und.pmpeny,rte exclusively communing with licensed Coname m
cohswat me proiero(sec.7006,OwnrEntire.and afty who core:)The Ca themons 106 — SEWER & WATER "
a whLawton orsuch,ut apply aanaswthAcontrawhawlldcaripursntnt me 202 — UNDERFLOOR PLUMBING
end who sLias for such,projemx with a comronor(s) licensed pursuant m Ne
cal mcro/auce e w 203 — UNDERFLOOR MECHANICAL
n-pply
❑lam ase tar cr B&P C for this rwun Data 204 — UNDERFLOOR FRAME
Owner ORKER OMPENSATIONDEC lRAra 205 — UNDERFLOOR INSULATION
_ I hereby affnm under Penalty of perjury one of the following declarations: 301 — ROUGH PLUMBING
❑.1 he.arid wit[mairimin 6 CertiOeme of Consent to self-insure ter worker's 3 02 — TUB & OR SHOWER
Compencalmo. as provided for by Section 37W of the tabor Cade. far the 303 - ROUGH MECHANICAL
peearnance or Run wall ter which this Permit is iaaagu.,' 304 ROUGH ELECTRICAL
01 have ad will maintain Worker'a Compensation Insumoce,n required by Amnon 3 0 5 — FRAME
3700 of the Who,Code,for the pei/ormaace of the work for which this permit is
W,tied.'My Workers Compensation insurance camEr'and Policy number ini: 306 - HOLDOWNS
Caide7,. . :r..PabcYNa.o .,'_ ..INSULATION
CERTIFICATION OF EXEMPTION FROM WORKERS'
" COMPENSATION INSURANCE 3 08 SHEETROCK
"('Kris Section need not be comPleled if the permit is for one hundred dollars 3 09 — EXTERIOR LATH
310 — INTERIOR LATH
I certify'that in the perroorim a of he work for which this'pemul is issued,1 3 11 SCRATCH COAT
'shall not employ any person in any manner se am to become subject to the Workeri
Compensation Laws o(Califamia.Date 313 — ROOF NAIL
Applicant
NOTICE TO APPLICANT.If,Iter=king this Certificate of Exemption,you should 501 — FINAL ELECTRICAL ENERGY
Z become aubjecuo the W"r,ces Compensationpnorknum, fthe Labor CM,you mud
0 0 fasrhwahcomply wimeach pmvidaasorthi.s .it&ha0bedeemedrtvoked. 502 — .FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY
WF Ihereby aRrmthat them i.sacondmnionlending agencyfor the perfumvnce 504 — FINAL BUILDING ENERGY
Q bndewark Nmrwhi<nlni,.p<,mltniwaw(sa.3o9],Ci..C.) 505 — FINAL ELECTRICAL
Lender's Name
z
Lender'snadm 506 — GAS TEST
O
I ocififY that I have mad this application and state that die above infoomation is 507 — FINAL PLUMBING
E.. correct.Lagree to comply with all city and county ordinances and seem laws miming
O V to Wilding mnaractme.and hemtiyauthorize representatives ofthiscity to enter upon SOS — FINAL MECHANICAL
pro
ase
the above-mentioned property for inspection purposes.
rP.` (We)agree tosave.indemnify and kmpharmlcaause City ofCupertino against 509 — FINAL GRADE
W liabilities,judgment&,costa and expenses which may in any way acerae against said 510 F
City in eonuena quof thegamin,of perna, A P NG
SOURCEURCE REGULATIONS APPCANT SAND\\'ILL COMPLY WITH ALL NON-POINT
Issued b�,14 r NNORKS Date
Signature ofAMIic nVCommmor Dan, Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
wB the applicant err future Wilding°ccuponi,atom or handle Onionskins material Type of Roof
n definepertin
d by the Culotta Municipal Code,Chapter 9.13.and the Health and Safety
Coda Section M532(a)7
nYes 0Na r All roofs shall be inspected'prior to any roofing material being installed.
Will the oil iicmtarfmure building by he"O uu quip tmeat or devices which If a roof is installed without first obtaining an inspection, I a Tee to remove
Emitict, atter conmminann mde0ned by the Bay Ami Air Quality Management g
District,
0Yes ON. all new materials for inspection. Applicant understands and will comply with
t " all non-point source regulations.
1 have sound the hzaimlous materials requirements under Chapter 6.95 of Ne
Cortisone Health&Set,y,Code,Sections 35305,25533 and 25536.1 understand that
if the building docs no,cmmonly have a tenant,that it is my aspomibility m easily the
ae<upont of the n quiremat5 which must be met prior m Issuance of a Certificate of
Occupancy.
Signature of Applicant Date
Owncrm mmonmeal an Date All roof coverings to be Class"B" or better
.1
OFFICE
CITY OF CUPERTINO
• BUILDING PERMIT APPLICATION FORM -`—
Building Address:
ZOD 3D
Owner's Name: k � Phone N 59fo 5�
Cont act r: License o: '
o CIONSf2uCTiU11 Nc.
Contact: Phone N
� PRo7�cT MNCsR. rb.. 596- 5�8
Architect/Engineer License No:
lcllk STxwB� uc Ma-
Applicant/Co trac or:
1. It E t�PA¢TMtfT
wBuilding Permit Info: (circle one)
Idg rElect Mech
Job DescrI ti n:T44TVF40 VA'n011 IuC WG ?&'V
.� E1�0 14l C314Th}
NEW yjm* DR�lat N&w OKL, me",
wVW M46M. C&Jt t#Zr
Residential: L11� Commercial:
Sq. Ft. Floor Area: $/Sq. Ft.:
DDD s•
APN # (Must provide):
/q� D3 bOg Valuatio 1j (obi
Type of Construction: Occupancy Group: ,z
7� 5 LUocl'-> Porno «as�dxp
Qty. if Fee ID C/ Fee Description Fee Group
Applicable
BTEMPPERM Temporary Bldg Permit BUILDING
BCONSTAX Construction Tax BUILDING
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BOVERTIME Inspection Overtime BUILDING
BPERMFEE Bldg Permit Fees BUILDING
BMITIGAT Housing Mitigation Fee BUILDING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BREINSPECT Reinspection Fee BUILDING
BSCBLVD Scb Specific Plan IBUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
ZADDCHG Address Change BUILDING