02010030 TY OF
CI6UI DNC DIPVISRIONNO CONTRACTOR INFORMATION: .
PERMIT
❑UILDINGADDRESS:; ` PI7RMIT NO.
'2'0040' IRODRIGUES 'AVE-' H-'1'1' WALDRON .CONSTRUCTION COM ANY _ 02010030
OWNER'S NAME: ^� I,a �• ,, J APPLICATION SUB DNI 17.
LA-KE,,,BILTMORE• APARTMENTS• P 0 BOX 598 ;• .r„ •,., , 01/,08/2002
HONE: ... : ••:. .. ... _. .._ ..._._ .. _ SANITARY NO. .. 'CONTROL NO.
�I '"- (408) 377—8186
w00 "RCHITECI'/ENGINEER: , BUILDING PERMIT INFO
E w BLDG ELF PLUMB MECH
to
to
FF
to
LICENSED CONTRACTOR'S DECLARATION .lob Description
Ili
Z y.o 1 Lerch'+ on tlno I om licensed order p os.,rors of Chnt
rptet 9lcomencing p
pyt� wnnfellorceandefeel. on3rfineBuxinessanJAufesxionsCW.endnrylian'w INT. RENOV. INCL REMODELED KTCHN/BATHS, NE
is info,Class Lc.
a❑eqt .. DRYER, NEW WALL NA/C NEW FLOOR COVERING
Li«dsc cla+x • 'tics a
O a is Date Cnnvaaor
:u� ARCHITECT'S DECLARATION FIN A Y C
t�O,g "' ' 1 nnJcrsl{inJ my plunn xhnl I Iw usnl ns pnhl Ic rccnnln - o i�9�a G
� N
ao .icensedP,rfessimml MAR 0 3 2001
c o 1 OWNER BUILDER front
DECLARATION ,
1 matteereby"(Ron That 1 7031.5.Business
from the CosionsC s LiAny city o for the my
h?G followingmason.(Benton]onsm❑usite,iand Pe,Ilcimi,Code:Any tinyorcouny ' - ''
which4 P II c It alter,improve, I.h or rcI Y trucum
6 3 m poo t i c Isor q rc.the rpfca I r ch perl'l to fl n 'g W d I them
tlht is cn I«gylp i,aU mop fthe C I trL In (CM1 Mer9 S F[ Floor Area n :r:
li11 Sen , yff)b) f D 1ftl ❑ IProfessionsCulO ,•i•s _, q-• y 4, 1P re .7 , - .
or Net hes ext npl therchman and the hemis for the alleged cacmpt on Any violation s ' '• •• : - 1
'"(Seaton]Ol LS by any aPPlicam for a permifmbjecu the opplicam m n civil penalty -
,pmol murp man nvn n,ardral eulwtx(s;lad' t ttb Occupancy Type
0'L as owner of the Pirpcnp ur my employees with wages rs their sole campenmtim. -
will do hework.and ther,mrudnm is not intended m offered for sale(Sec:704C
.Business and Pmre,sioas Code: I it,cumr:acmrs License Law dues not,q,ply to an `”102 ''-' 'PIERS squired Inspections P;/ ni I
owncr
or Property Who builds or improves I ocrem.end who doses such work himself
or through his own croployoces.provided that such iniponIacritcrus are not intended or 103 — UF'ER --1
offered I If.In Rtbld' g -1 t - IJ 'thi •y of .. r.• . , . _ ,
r nmpl l n m< be,la ld ill m ln:d f, ' g that redid o t lhi .. .. 104 - -REBAR '
;an <ro p Ba' r 1 ) 105 ANCHOR BOLTS
1 srwne' nnepr lely. I Ir fenstnr« SW - t t ism 106 SEWER & WATER .
construct the pri(Ser.70a4 Bovtiness and.Profession%Code)The Contractors
,
LiceLaw does,nt p„1yt,onowne,of,ur,scd,whobuld:n npmve+mercnn 202 — UNDERFLOOR PLUMBING
en I who cumin i f such projects with a cm ioneur s)h«med-pursuant to the -
ConlmcmrxLic ,w,_ 203 -UNDERFLOOR MECHANICAL
❑Iamanea,ml argd su )D&refor nisrenw'” 204 — UNDERFLOOR FRAME'
own<r
KI 205 — UNDERFLOOR INSULATION
'WCiR'B C PC S NBATION )ECLdRATION-
Iherebyaf❑m,under,penaRy�fprrjoryourofd,fnnpwingdediumi.n< 301 - ROUGH PLUMBING
302 _ TUB & OR SHOWER
+` ] I have and will maamalin ..Ccitiricuc of Cnrser, u,scl-i....I,rot Worker's
can angina. as pnodded for by Section TIW or me.Lalo, cute. for he 303 ROUGH MECHANICAL
- rformancf of the work(rr whim Nu perms i.,innuW, k. 3 04 — ROUGH ELECTRICAL
❑I n au aim \Wirke,.C ,PersaR In m 2 rescuired by sect 305 - FRAME
y - -work r which thisPermit is
,I F +.. f a, ,....,p +cc of
TdM
Wager c p I 1 . p c d1ur Y , ❑ ; 306-.+ .�. HOLDOWNS
t]fgl the L t pe o
i tit No.: 307 L—,.INSULAT,ION.
ERR) 017 EXEMPTION PROM,WORKIRS Y ';;5' •" - " -
"' 11 C ii4COMPL'NSATIONINSURANCE`tY 1' l , ..d t, •'i308 '�" 'SHEETROCK ` d
^'IB,,ria),iaaadnnreed;minetibanpl<tedlnnepernthefor one niand,eeanna,n �� � 309''.:-• EXTERIOR LATH.
(El Wl nos less.) .,••, 310 — INTERIOR LATH,
1 _ . .... .. ... .... _
_ Icrlrytht'nm -Per fnot' kfor which his'Pemrl . nsfed 1 - 311 aSCRATCH ,COAT
',hair nm<mplry ary'pe a ma n to ns h Ixw,ic subject In the Workers , .313 - ROOF NAIL 1'
Compcnaotion Laws of California.D.Stc r si ,
"Pp'1f""''"' " ""' 501 — FINAL ELECTRICAL ENERGY
-bOTICL IO AIILICAN] 11 ❑ ki gt11aC tf-a'oft a II n Ym,lm ld
Z hoc hj t1 thewrkceCmprna P `mrinelmla Catill utnnsl 502 — FINAL PLUMBING ENERGY
Q Q forthwith comply with ch p or IM1 pc l hull be J J k d.
•z• T"ii > r,.L_consncucrloNLErvowcAcltncv 503 - FINAL- MECHANICAL• ENERGY,
E+'. "' IhercbyafB,mthmthemi.vamnxwdionlendingaigencyfortheperlomiana' 504 — FINAL BUILDING ENERGY.-
of
D
of the wink for which this peroll is isaaul(Sc,.30R.Co,.C)
aE 505 — FINAL ELECTRICAL
'q .Under',rvam<
PZ I<We.•xndd,gkn�,•!.� ,. _1 , .,. � ',.."', .,"u �i ,.: 506 — GAS TEST , •i. ' .
I,•
U sl«nfyth�:iilo ddG:pHB<r d t. dmtth nos mn;mmBur�fa 507 — FINAL PLUMBING
w.E:, < q n.l.agree to comply with all city'and county ordinances and stale laws relating 508
- FINAL MECHANICAL
Q.0 mlrydii"cnnumnior,:nd herchy iruduuim rcPrcnedaalves hf dak,ay ,,earn upon
Y r� Ndaboo.renu bed pmpcny for ir.pectiun mrosc'`' ' 509 — FINAL GRADE
f.. pn;i (WI)agree to save,indemnify and keen hinolcss the City or Cupcnirs,against
M I abilities,judgment,,cost,aad e,Perses winch may,in any way accon,.,nN said 510 ^ NA P NG
U Cij incorsequnReohne granting of this recant ""' I —
A19'LICANPUNIA!RS"I'ANDS AND WILL COMPLY WIT It Alit.NON-POINT° Issued t�l4 ' N RKS Date
SOUNCH RE(JULAI'1ONK i
Sig I lAPPIuanUC ro t - O t Re-roofs
y _ HAZARDOUS MATERIALS S DISCLOSURE_ / � 1, (.� e 2—
WWith pplcatt f 'building l I it.y , handl.I 'h,'mncr.d Type of Roof l
aJc( Wby the Cu,Rknout M - cp)Citic Clpi912.ad theHllh oWSfty - • ,,
C'ale'Sen 27[12(")] t ( s.: . .:�' -
P"' �' a (¢':e;;.;,�1.. .. All roofs shall be inspected prior to any roofing material being installed.
Will the upjili2an Who-mrc building I,ccrpot use simpti m or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit haiiatinus no wmmroiaE is ns dc0ned by the It,,Act,Air Quality Management
;.delI - - all new materials for inspection. Applicant understands and will comply with
❑Y< oN.+ler naent. nnncr eLa t .._. .. .. . _
all non-point sour ce regulations.
' I'hrve'iead incl J quo per f.95. 1'the ,
Califomia'Hcallh&'Sirety Code.Sectinnn Z5505,25533 and 25534.1 understand that .if the buddingdoes net currently Lout,atenant,than it is my responsinility to notify the - -
acopant'd!the iequinmc Is,wliich masa Be t P ab'r to isuamc of a. 11,innuf
lk2nrarey:' : Date
' •r••, L,•, ' • � Signature of Applicant
owr a�mba.<aaggnt_I ._ Liam.
All roof-coverings to be Class "B" or better
«u,
' ',I ,. 11
OFFICE
v suu.nrNGDIVISION PERMIT , •'C;CJlV1KAla1,V K:uVP�n viN,.,.. ..
ra
BUILDING ADDRESS.; s• �� u � + .•�r.: !'' PERMIT NO.
`�d0461!RODRIGUES 'AVE H-1"1' WALDRON CONSTRUCTION ANY 02010030
OWNER'S NAME: APPLICATION SUR DATE
LAKE, BILTMORE APARTMENTS P 0 BOX 598 01/,08/2002
PHONE: ._- ,,, __ _ ... SANITARY NO. - CONTROL NO.
� ,
(408) 377-8186
BUILDING PERMIT INFO
ARCHITECT(ENGINEER:
BLDG ELECT PLUMB MECH
wSLICENSED CONTRACTOR'S DECLARATION Job Description
0 Z: . . I hereby affirm that lend licensed under provision,of Chapter I lcommencing
El 1:., with Section 7")ofDivision 3ofthe Business and PmfeasionsCode.and mylicense INT. RENOV. INCL REMODELED KTCHN/BATHS NE
I.full forestial effect.
uceo:eela., Lida DRYER, NEW WALL NA/C NEW FLOOR COVERING
3 a Dam Conuactar
ARCHITECT'S DECLARATION
1h 0
I understand my plana shall Cased E public TION
Licenced Professional
ecords
$ OWNER-BUILDER m DECLARATION
/
ro I hertby.(firm chat r t. .5.B sine from the D Professions
ars r:Any c Law for theroliv
whowingreroia porc(Secul t ]03 consumer.cat, and Improve,demolish,
ormny any
structure O which requ res a pemso re consumer.ober,Improve,demolish, file
e a g any awctort
$ priorto s isauan9a also to the the provisions o for Contrauch ctors
Lice s Law(Chapter
— IEipthgialice rsaei punato to the provisions of the Contm,torn Licenselaw(Cnapmr9 Sq.FL.FIOOC Area. :
natlOn '•
ommencin&wiN Section YDhg)of Division J of the Business end ProRxaions Code) s
r dor he i,exempt therefrom and the basic for the alleged eAmip nd.Any violation '
of Section 703 IS by any opplia t fora pasnit subjecta the applicam m a civil Penalty
If nm more than five hundred do rs(s5no). b Occupancy Type
❑I,a awmraf the pmpeny or my emplo1.yee with wages as their sole compensotlon. '
will do me work,nal be,structure I.not intended or oRered far..[a(Sec.700.4:
.Rmme..and Prefecii.m.Caste:The Cmanicmrx License law does not apply to an10 2 — PIERS eqi fired Inspections: -• .i '
owner of property Who builds or improves thereon,and who does such work himaclf
or through his own employees.Provided that such improvcmenu are not intended Or 103 — UFER .
'9Rcted for ole.If,however.the Wilding air improvement is sold within one year of .. ••
pl Ian,the owner�buildec will have the When of proving that he did oat Wild or 104 — REBAR
sup nrorpurpose ohme.)' 105 — ANCHOR BOLTS
coh mgwncr of}he property,am esclusively cmmcting with licensed ommatemc to 106 — SEWER & WATER
canswct the project(Sec.7044.Bushman;and Processions Code:)The Contractor's i.
` License Lawdoes no,apply toadOwner Of Painterly Who Wilds orimproves thereon, 202 — UNDERFLOOR PLUMBING
and Who contracts Y such pmlects with a communing) licensed pursuant to the
Contractors License mw 203 — UNDERFLOOR MECHANICAL
❑l am exempt nCe 5 B&P C for this rcavon 204 — UNDERFLOOR FRAME
Owner' ENS
/a�Da 205 — UNDERFLOOR INSULATION
W KER'SC PGNSATION ECL RATION
I hereby,alarm under,penohy of peDmy not:of following d.b.,om: 301 — ROUGH PLUMBING
❑ 1 have and will maintain a Cent Meat e of Consent to self-insure for Worker's 302 — TUB & OR SHOWER
Compensation, as provided for by Section 37M of the Labor Cade, for the 303 — ROUGH MECHANICAL
perform.nse of the work for which illi,p<mid is:,oast,. 304 — ROUGH ELECTRICAL
O l have and will'mSintain Warkcr'x Compensation Inadrdnoe,as required by Seetion 305 — FRAME
17M df the Labor Code,for the performance of the work for which this permit is
Issued.'My Worker.Compeovstian Insurance carrier and Polic$number arc: 306 ' — HOLDOWNS t
cmae'rr PoheYNa.: 307.:.—,.I-NSULATION ,
CERTIFICATION OF EXEMPTION FROM WORKERS';
COM PENS.ATION INSURANCE"" 30S 1 1 SHF'ETROCK
•'(This aettion nt tl notal.campmted if In. .it for ane hundred dalmw 309' EXTERIOR LATH
0100)mtas..) 310 — _INTERIOR LATH _
1'certify thatiin the performance or the work fn,which this permit is issued,1 3 11 — �S CRATCH COAT,
,Hall not•employ any fiction in any manner m'a,to become subject to the Workers' 313 — ROOF NAIL;
Com,ansximn laws of cahtnmia.Date .. .
AppE`""f" 501 — FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT:'II.atter making this Certifcot!of Exemption,you should
Z. bbummesoh'acitothe Worker'sCampenaatlonproviO.m.flheLaWrCcde,yoanm'q 502 — FINAL PLUMBING ENERGY
Q O forthwith[amply with such provisions or this permit shall be deemed invoked.
CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY.
� I^ I therebyafrm that them is it consbuctimi lend'mg iii for he perfurnisme 504 — FINAL BUILDING ENERGY
G of the,work for which this permit aissued(See.3m7,CO.C.) 505 — FINAL ELECTRICAL
L Q 1<rider'.Name
D z Lender,AddreU 506 — GAS TEST
U O .I certify that l have read this application and state that the above information is 507 — FINAL PLUMBING
eTnE~ odheci.I agree to comply with all city and county ordinances and.state laws relating 508 — FINAL MECHANICAL
V to Wilding construction.and hereby aathoriie representatives of this city to enter upon
y W the salve-mentioned pmpeny for h,peedan mrpo,cs. 509 — FINAL GRADE
Fr ry . (We)agrte to save.mdemni ry and keep harmless the City of Cupenina against
liabilties,judgments,cost and expenses which may in any way accrue against said 510 — F-INALij P NG
U City inc.maclosma or the granting or this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI.NON-POINTIssued 14 — N RKS Date
SOURCE:REGULATIONS.
Is' Signature of ApplicanlfCommnmr Dam Re-roofs ®
' HAZARDOUS MATERIALS DISCLOSURE Z-
��
Wdl the epplismii Or loom Wilding bccupam acme or handle hamdmus material Type of Roof
ea defined by the Cupertino Municipal Cale.Chapter 9.12,and the Health and Safety
Cade,Section 25572(1)], "
❑Yea . °" [IN. All roofs shall be inspecte'd'prior to any roofing material being installed.
bell the applicant or future Wilding occupant on equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit huedam air cmarrom u;as defned by the Bay Arca Air Quality Management
District' all new materials for inspection. Applicant understands and will comply with
❑Yea ❑NO all non=point source regulations.
'1bvve read the hamrdaus materia(.,tequirements under Chapter 6.9 5 of the
C11i'fomia HwHh&Safety code,Sections 25505,25537 and 25574.1 mderatind that
if the building dons not currently have a remain.Ihal it is my respsmibility to notify the
occupantof the requirements which must be met prior to issuance or a Cedinca¢of
G""Pa"`Y' Signature of Applicant Date
ownergr aamoriaed agent Data All roof coverings to be Class"B" or better
OFFICE
• QQ3o
• CITY OF CUPERTINO
BUILDING PERMIT APPLICATION FORM
Building Address: �,00 D
Owner's Name: Phone
Rt✓ 6TH
Cont act r: License o:
orl Ci0NST2lACT7UrJ Nc.
Conta t: PRDTCfR- Phone
Architect/Engineer License No:
RhIM STquBEaz uc MR.
Appligant/Co trac or:
I L E MAQI"M t9JTs
I v Building Permit Info: (circle one)
tdg Elec Plu Mech
Job Description: Z4 _4AMoa IIJC rJG R�Ni00L'It6O Kl C3ATFF
NEfi 1 WA5t 2 DR�t� t►tEu� WALL. Ad C.I lJow fL401t
Residents : _ Ly Commercial:
Sq. Ft. Floor Area: DDD S. $/Sq. Ft.:Iftam d
APN # (Must provide): /q- 03 60
8 Valuatio 7 L6D
Type of Construction: Occupancy Group: R
Qty. if Fee /D Fee Description Fee Group
Applicable
BTEMPPERM Temporary Bldg Permit BUILDING
BCONSTAX Construction Tax BUILDING
BENERGY Energy BUILDING
1 BENERGYADD Energy Add Multi BUILDING
BOVERTIME Inspection Overtime BUILDING
✓ BPERMFEE Bldg Permit Fees BUILDING
BMITIGAT Housing Mitigation Fee BUILDING
BPLANCHK Plan Check Fee BUILDING
I 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
IP5.1 .'7 O