02010032 ;CITY OF.CUPERTINO
nutyntNG DivtsioN PERMIT'` CONTRACTOR INFORMATION:
11WLIJINO`ADDItNl4i' ' -+,{+r� .. . .. ._. PERMIT NO
03200 RODRIGUES AVEA'VE # 7D WALDRON: CONSTRUCTION COM ANY 02010032
OWNGR'S NAME;i APPLICATION Suit DATE
LAKE'•BYLTMORE APARTMENTS " "P O BOX 598 — " — 01/08/2002'
I ONE:.' SANITARY NO. CONTROL NO.
1 (408) 377-8186
BUILDING PERMIT INFO
OO ARCIIITf:CT/ENGINEGR:,' BLDG ELECT PLUMB MECII
w
a 5 N LICENSED CONTRAcfOR'S DECLARATION ,lob Description
O 9– .,..II hereby aRhm has 1 am licensed acidic provisions archaism,9 mommencing ,
�_CW with Sesti9u 7000)of Division 3 oftbe Businnaaml PmfcssionsCWc,nn(Imylicense INTERIOR RENOVATION KITCHEN & BATHS . NEW
in mu force and effect.
�o License Lic." DRYER, WALL A/C, NEW FLOOR COVERING.
�j Date Contract...
m 3 o g ARCNITCCT S DECLARATION —I NA LE C)
k •_ 1 understand my plans shall he used as public records ; G
EE{ as
Licensed
h o OWNLAf:R DEC,C( n con MAR 0 3 2001
u1 1 < ff II ant
stin11 pt A C t '1 L 1 for the
CYQ full mason (Section](DI511 P Jrc..' Cd 'Ay city lY I t '• '
wh l rats pc ttlin P c do I.b p y.t t ; D
esast ,•. R I JIr" _II 'I, ;i t.l
poo I I e 1. rc9 rc the IPI amf cM1 pc Ito fl g..t t t
bar In licensed pct, a.min p nn c I I r Licinse,Lo (Chapter 9 tt q I S'..Ft -Floor Area
oemnarraAm,withsct l)
7") f ' i oflh B . s andfrf Cod) )r, Ito
onhrt he m exempt Iberd n n nnA the.b,utainr the nllepnl car nBl pct.qny viola do '
..of S[dmn,AD1.5 by mny aprlioml fora permitsubjad the applicant too civil penally — - - -
,nfaol,nnnrc man RVc nu.rerl aullnm lssfne. �,, '''., " ,'. +;'v.; ... tt - it„'.. . . Occupancy Type
01,era owner ohne ptupcny.err my employes with wages as neir role compcnsatiou. 't
. t
n ,r, ',
:'. ., will Jn the wink.and the vmerurc is not intended or offered for sale(See.]bse; – e.
-Raaino..a'and Prom.,,i, Code:The Contractor's Licehre law does not ajiply to an ” eq Ulred Insp,CClIOIIs''
• cua, impenyWndr,
bnlJdsorm,,wmemin;dndwl d.,such work IJtrolf 102 - PIERS
wi, .
• or through his own en,pinyccs.pmviacJ Ib:n such ilnpnwemcnII are not army,.or 103 - UFER
–o@r81'for sale:If,however,the building or improvement ia•sulJ within one year of -"
lildpknon,the owneghuilder will have the burden ofmproving that be did noI build or 104 - REBAR
y�prnv ro.�nvoaeorame.). 105 — ANCHOR. BOLTS-.
•;; nopforesrsigio106 - SEWER & WATER
r. r License lawdoes not apply toanowner ofpmprnywhol,ulld.or,mpromsdmon, 202 - UNDERFLOOR PLUMBING 't
and who coamcis r such rmjecls whip o.comorcoe s)licensed.pinsunnl to the .._ ... _-
'Caa}aemhLi<enahw - 203 — UNDERFLOOR ..MECHANICAL
.ol a. vt ul set -„ ' - ' "' • g�Pcn,.lmrmaran 204 - UNDERFLOOR FRAME
Z VI d6Z
W RKERSCOh `ENSATIONDISCLARATION ZOS — UNDERFLOOR INSULATION
"'
Ihceby vlRmn under recall y`nllioij,itry car,of following dcelem,inm: 301 - ROUGH PLUMBING
IhmaJ If,maimain a cnfictt f Consionri,;. Ir for.Worker's 302 - TUB & OR SHOWER
I.. a, annior. asrn1 l by sed t 3701) of theL thcode, for he 303 — ROUGH MECHANICAL
pr. nldwh kr n n
M1n, p,n n, „e 304 — ROUGH ELECTRICAL
plhaWandwill 6,01 I suck .nmlM i' I . rake "hiredbifS, l,nn 305 - FRAME
3700W the wbor Call f tE peffmn f the ...k for-which Ibis permit cs ,•t .
Liui My WokersC ore at Insurance -nil Policy nWnber arc ',)
306 HOLDOWNS
Car I" I col yN .. 30'7 p 1 iINSULIATION. • .
! r'Cr RIn ILArioNOriDOEM"ION.ROM kWOR KERN' E
nil 1• + r r COMPENSATION INSURANCE,[•., e.' ' - 308
8_
1!'yYrnis1wcticmnednot,hJ<d309 ' EXTERIOR.LATH -.!'.
mpiel.,r5nap�m;,irrrnru�nunal.agilarr . . . —
(aioobo,teas) Ir ..:310 ,T, INTERIOR LATH' +
;K
l<am card fyna itjir tire f, a In in r 1 bJl r n't issued,l 3 11 313 — ROOFTCH NAI COAT' u. ). :L;, P.)'� •h%1 ._ .
all n edify y Y,K Y y 'o, i hien 1 the W mkem '
Compensation Lows or Calf rata Dino - - L .. •_ T .' .
A .
NOTICLTO APPLICANT IL afmnnnki ng lhsCen hate of Eae npt'nn you should 501 FINAL" ELECTRICAL ENERGY
z bd<nmaaabjetlmdartVkcrrcompeno,bornmvian,nrothe Labor,Coal ymrmust 502 — FINAL PLUMBING ENERGY
Q C ronn'wi,li'complywRh such provisions or mar return shall he deemed revoker,.
503 - FINAL MECHANICAL ENERGY
VJ •li,;,v:""' ::!CONSTRUCTION LENDING AGENCY' -�•'" - '
Ih .ffim;shuuhYmi.aceyaderionlendingvgencymrtheperfomuhcc 504 — FINAL BUILDING ENERGY
5 onner',Nom�wniai,fniapem„ir:j<:uwlse<.3om:ci.'.c.) 505 = FINAL ELECTRICAL
w'Q Lcndcr's Name' .�uL. .'; :.• _ .
Lender's Address. -
tz . L . . . ” , . . 506 - GAS TEST
U.p Ie'anihJ;at17facemadthisavpr.a;lorr�ndaute;hin"healuor, of.lnwmnis 507 - FINAL PLUMBING . ..
Ls. [� coi.eci.I ngrte m comply withall city and county andram r and seem laws relining
building c.nsmtclim,and hehny truth orim'mpm nhuives ofthis city to enter upon 508 - FINAL MECHANICAL
a w
me nbove-niennihi.pmNrty for in<mchon purposes. 509 — FINAL GRADE
F„ pct. (We)ag t e . ,,fy sendLet,hyin ane ay ripe ltnag w 510 ; NA P NG
ti m Cit II 1 Ig e e 1qr rs hi .'sunt v against id
V City .ul DIor:RS Tcgm Ing W Nal"W '" r
SOURCE REGUCIi IONS, I AND WILL COMIIYN'1'fII ALL.NON'I OINF'` Issued l 4 ' - N RKS DeIC
SOURCE RLGULAI'IONS. I. l
Sib 1 m fAppll anUC llct - t Unm , Re roofs .
IIAJARDOU5 MATE RIA)S DISCLOSVRE
W II tl ppl u 1 f t ce la'Id1g p t o or handle hanvrdm r material C Of ROOF
— bZ
T'
codd.ncdby[beCupertinoMunicipal C.9 Chapter q.12and lbcllcallboWSafdy - `]p •' •�y }. i h� ' _ ,, . , , . ,
C.e.$ut on 255121101 ,t.If h r'4 PI' 'k rl•. . i- 'r
' 4"';•'• -. a' : �j All roofs shall be inspected'prior io any roofing material being installed.
° wum' rgr 1 r tb II g R 1 'chic p ;wnion If a roof is installed without first obtaining an inspection, I agree to!i-cmove,
1 roil) vd iouttrationals.,s firlboodby the Buy Axa Air Quility Management
DA Incl ., .h understands an c I y.with
'b No all new materials for inspection Applicant unci 'lands • d will •ant Il w'
. :• all non-point source regulations. . „•
'1 h rcaJ the I r J rucrials requ mmena under Chapter 6.95 of the
Cnliffi nihneallh&Snfit,Care,Seedonx 25505,25531;1.,[355W.I toxitmond that '
if lh'b Ir 6I sell dy l' d t i'. y .p .'nityl tify the
-' Ip tl fdi eqn l m' Ibl air.,1, l'airn...issucautc or a Cen Rsm of
tkcupan
Signature of Applicant Date
oa.,nero;damoa:.ag<„. ..,•- Da,e - All roof coverings to be Class "8"or better
"r , OFFICE
. .. ..'
1' JI
PutDING DIVISION . PEKM1'1' - •�.'„� `,i':';;.1'"- . • ' • - ...
- Y PERMIT NO.
BUII-DING�ADDRESS: ,
20030 RODRIGUES AVE 7D WALDRON : CONSTRUCTION AAPPLNfcAno suBDATe 2010 3
LAKE BILTMORE APARTMENTS , P 0 BOX 598 01/08/2002'
SANITARY NO. CONTROL NO.
PHONE:���
(, (408) 377-8186
BUILDING PERMIT INFO
ARCHITECDENGINEER: BLDG ELECT PLUMB MECH
NLICENSED CONTRACTOR'S DECLARATION Job Description
Zts Z 9 ... 1 hereby affirm that I vm licensed wJc"lowinma of Chapter 9(commencing
pip wt'Sahon7000)ofDivjii..3.fmaB.inescarMProfesionsCode,andmylicmae INTERIOR RENOVATION KITCHEN & BATHS . NEW
Sfsee iamfull
cacimw and effect. Lieg DRYER WALL A/C, NEW FLOOR COVERING.
p a License Class r
iPilj O 6
Data - S ARCHDELLA
3 tornm usedisCLARATION
1 undersand my plans shall be used as public rccaNe
} \ �
Licensed Professorial v ,rte
R OWNER-BUILDERapt from
DECLARATION
Coal. J �r
I hraso.(sent dim 11. exempt from the Cessions o Any.was law for the O
t; >- followinerwon.(Sation 70]L3.Business end Professions Code:Any city orrcom, „
33yxp,p which regwms n permit m ams the alter,improv,ll Permit t rr masa any mitemem \\\
3�
Poor its issuance,alsorcquires the applicant fa sahpermit mfilee signd stampent .tion
a.333 tsar pq ianaiwed pat.asst to the provisions ofthe contactor.Lianxe Law(Chapter S,q..Ft. Floor Area' l .
tdommedcing with Section 7000)of Divisart3.f,he Business and Prgfeuiona Code) 'i T,+ - ,_ ,
or that he is exempt land the basis for the allejed.almprmn.Any violation
ofsecaon.7411.5 by any aPParapt rot a p=mtu aabiart me apphranuo a ants pe^^Ito Occupancy Type
mf not mare then Bw,hundrcJ a
It 15500)..
D1,as owner rthe progeny,or my employees with wages as their sale compensation, —
will do the work,and the nratme is not intended or offered fir axle(Sat.7844, a uired Ins ections,
Business and Pmreasiom Code:The Contractor's License law does nor apply m an 102 — PIERS 9 p
owner of property Who Wild,or improves,hemon. adwhodoes such work himself -
or through his own employees,provided that such improvements are not intended or 10 3 — UFER .
offered far sale:If,however,the Wilding or improvement is said within one year of 10 4 — REBAR '
'completion,Ne owner-Wilder will have the buNen of proving that he did not Wild or
ornewmrpurposeofecle.). 105 — ANCHOR BOLTS .
l�W�/1' as owner of progeny.am exclusively contacting with licensed contractors,o 106 — SEWER & WATER
hra t the project(Sec.7049,Business and Propositions Crdatl The Carried., 202 — UNDERFLOOR PLUMBING
License Law does not npply to an mw an,of propcny who but m oulan .,tmomn,
and who convncin r such projects with a.contmamfx)licensed pursuant m the 203
— UNDERFLOOR MECHANICAL
cwbactor's License vw.
❑fan eze pt nd Sat &PCfor thinreaxon 204 — UNDERFLOOR FRAME
Ga�, 205 — UNDERFLOOR INSULATION
Dwyer - W RKER'g COh ENBATION DECLARATION
301 — ROUGH PLUMBING
I hereby salon under Penohyof perjury one of the,following declinations: 302 — TUB & OR SHOWER
❑ 1 now$nd'wll)mainoda'a Ccnifcare of Consent to teff-insrre for Worlot 303 — ROUGH MECHANICAL
.'s Compcmgtion, as provided or by Section ]700 of the Latin, Code, for the
permrmlandeonM1a'work far which this peral issued. 304 — ROUGH ELECTRICAL
01 have and willnma rcon Worker's Compenmtiou'Instmme,as required by Section 305 — FRAME
3760 of the Labor Code,for me perfom,anedof the work for which mos permit is 306 — HOEDOWNS
isiued.My Worker's Compensation Insurance carrier and Policy number arc:'
carrier: f *Policyboa:
`
307. i INSULATION
CERTIFICATION OPE%EMPTION FROM WORKERS'. .308 — SHEETROCK
•"' COMPENSATION INSURANCE s'
"n'"•'Thi.sedionnoed am becompmtediflhe permit i,fim.ach^nnrdnar
doa 309 — EXTERIOR LATH' - '
O100)orfos.) 310 INTERIOR LATH
" 1lcrtify that In the performunce of,hc woa for whiclubm peml....i...eJ,'1 311 — SCRATCH .COAT `
m.01 not employ hay Peru in any manner sr as m heroine nan"ot m the Work
crd 313 — ROOF NAIL
Compensation Lvwsof Califon. Date
AppEramr 501 — FINAL ELECTRICAL ENERGY
NO Form 'APPLICANT:If:star mokin6 this Cenifcva of F}emPlan,youshould
Z bicomexubjeito, WarkeraCnmpcnsaliobprou-raof'heLaMrCode,yaumust 502 — FINAL PLUMBING ENERGY
p ronhvato plrwthxarIs 2ami hit air".
aeemcdrawked. 503 — FINAL MECHANICAL ENERGY
..
v� CONSTRUCTION LENDING AGENCY
1 hereby M.char Nert is acons,rvdion lending ugenry far the peAomsa'nce 504 — FINAL BUILDING ENERGY
of one Work to,which this permdisissued(So,.3M7.Civ.C.) 505 — FINAL ELECTRICAL
Q lender's Name
a'z Lendcr'sAddress 506 — GAS TEST
U.O Ice ni.1yim.,Ihaverend,hisnpplicmion-ad"-todot dashow nfolarnalia 507 — FINAL PLUMBING
W �y I cmrar.I vgrca,o comply with all city vad calmly rduances and state laws mining 508 — FINAL MECHANICAL
C V to building connromion.and hereby nmhrrixe rcprrsenmtiw.rf this clay to cnarupan
.;i„ Gil the oWvc-mentioned pmpeny for inspection prrpous. 509 — FINAL GRADE
(•^ pHl (W.)agree allow.indemnify and keep harmless rhe City of Cupemim agoing
rn 4. liabilitiesjupgmems,rate and expemcs which any in any way..me against aid 510 NA P NG
V City is can
sequrnceof be
groutingorrhmpnar.
APPLICANTUNDLRSTANDSANDWILLCOMPLYwiniALLNON-POINT Issued
�4r N RKS Date
SOURCEREGULATIONS. .
Signaurcrf APPlicaData Re-roofs
iAZARDOUS MATERIALS DISCLOSURE
Will the anuicunturruam sildmgoccommai anor handlchamrdo^s material Type of Roof 6
as refnd by the Cupertino Municipal Cod=,Chapter 9.12,and the Health and Safety
Code,Section 25532017
❑Ye.• PNo All roofs shall be inspected prior to any roofing material being installed.
Will the applicgmor future Wilding occupant use equiprom or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hX111 sair crnmminanoraxdefinedby the BoyAmi Air Quality Menagemem
Dual con new materials for inspection. Applicant understands and will comply with
Yet ❑No. ' all non-point source regulations. .
I have read the hazardous materials requirements under Chapter 6.95 of the
ClUfomia Health A,Safety Code,Sections 35505,2551]and 25574.1 understand that
if me building dues not currently have a tenant,ilia,'u in my responsibility,o notify the
occupant of the requirements which must be mer prior to iauanee of a Cenifmate or
Daupiney. Signature of Applicant Date
Owm<r o,out
naread oplan Dare All roof coverings�belass "B" or better
OFFICE
• CITY OF CUPERTINO
BUILDING PERMIT APPLICATION FORM Db3Z
Building Address: .�D
-�,ov&qoOR.fC>UES `;
Owner's Name: Phone N1LAYZ ,
�fb
Contact r: License o:
otlOONSr2urn0a nlc.
Contact: Ppg�vr i ww— Phone N . 59t.- 6'iS
Architect/Engineer License No:
zotaumpSII4uBEK NG MR
Appligant/Co trac or:
IL 6 MAe M Dim
}�IBuildin=Permit Info: (circle one)
Elec Plu Mech
Job Descri tion: l p� VA'I lotil IuC NG RENW00.�0 ICl C3ATFI
W-W (Al'cr (OR�f� NEw WKL, fd�i New "p— C&MIx*
Residentta : �y Commercial:
Sq. Ft. Floor Area: DD O $/Sq. Ft.:
S.
APN # (Must provide): W1- 0
3 609 Valuatio io6O
Type of Construction: Occupancy Group:
Qty. if Fee !D 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 BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
• ZADDCHG Address Change BUILDING
�s �t , 7o