02060200 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BObD6916DrsDRIGUES # lOHWALDRON CONSTRUCTION COMP �(MITI�o2060200
tg " !LTMORE 'APARTMENTS P 0 BOX 598 APPLICA6'9" T2002
PHONE:
(408) 377-8186 SANITARY NO CONTROL NO
Z ARCIUTECTENGINEER
BUILDING PERMIT INFO
HY - BLDG ELECT' PLUMB MECH
',Sin i LICENSED CONTRACTOR'S DECLARATION �ynnyg
_o rebrarr mntlamBan.Keunae,pro,'ismnsnrcnapter9tcommencog INTER.RENOVATION/R�MBf EED KITCHEN AND BA
,e
,n F_ul with Sutiun7(IOlp of Divislon3af the Business true Pntlesionx CnJe.nne my llcotse
z7 in Bud for.and effect. NEW WASHER/DRYER, NEW WALL A/C, NEW FLOOR
a License Class Li,.a
O a Data Contrenor
G ARCHITECT'S DECLARATION
y 1 understand my plum shall be used as Public remN.
r
1 d c L¢enud Prom,innxl
=a that I dam exempt
m the CoATION
1 hereby affirm that 1 am exempt from the ellimm, is License Law for the
C < whiching reuam.(geetloI 703I S.Bua t e. and ...de io demolish.
code'.Any tan or county
YFG rwr q p tit toe t t II 'np ed f.hn p 51 ire
,mT Be Phi he is o 1 reg the luo t f h pen 1 f fined w I m (� - .. _
that he Ic nseap _ an)mtlxp " rat Contractorsucev (Chapter 9 S Ft.,Floor Area.,., 6Valuation
34.
( mmcnc ng w th S ct an 70(NB f D' 3 Rbc B n .and Prof m Cadc) Y � 'r ry"' q' 'I a �'l^a
tl Lit he ase pt theref d th hes s I the Ile6 a etoml tl n.Any v oLt an ' 3 6 9 0J Oro 8 O b
-nf Sect nn 7031.5 sty any appl cant for n perms subjav,the applicant m.civil penalty
.or not more manBvenanareaammrslss(IOI.
APN Number Occupancy Type
❑Laxnwnerermeprope,ty.urmrentPlayeesw,nwagexasmebsalecomPensaeon, 101 - FOUNDATION
willdu,ilm weak,and the stmcture is not intended or offered for sale(Sec.7044,
Badness ane Professions Code:The Cnmmnor i License Law a«.not apply m an - Required Inspections
awn<rof progeny Who builtls or impmves herton.and who d«zsuch work himself 103 - UFER
or thruugh his own employees.p,.,,d.d that such improvements are not intended or
.urre d for sulc.e,boweve,, he building or ormuncmem,s sold wimia one yea,or 104 - REBAR - . .. --.. ... ... ........-
impr vaon;me owner-ntdldm will have he Women er prows that nc Die Dat beim ar
improve m,pntpoxe oame.)_ 105 - ANCHOR BOLTS
t 106 - - SEWER &:-WATER
1 1 s owner of the pmpenY I 'ely t act g with liccnud conmaaurs to "' - --- - --
ohe'prolcat(Scc 7044 B d Professions Cum ) me Contractors 2 02 - UNDERFLOOR PLUMBING
License Law does not apply to an owner of property who builds or improves theater, .'. "
I' .and who contracts for-such projects w,h a commctor(s)licensed pursuant to me . 203...-- UNDERFLOOR.. MECHANICAL. . .. ....-
Contractors License law.
Yd ❑lamexempp ad" ec ,B&PCforthfsreason 204 - UNDERFLOOR-'FRAME..
Owner '' C= am' D'atc" -7_3 e� 205 - UNDERFLOOR INSULATION
' N'ORKER'SCOAIPENSATIONDECLARATION 301 - ROUGH PLUMBING
Iherebyafrrmunacrpynmtyo(perjuo�eofm,folm»'mgeeclareuons: 302 TUB & OR SHOWER
❑ 1 nave and udl maintain a Ceniaeam of Consent to self-insure Jar Workers 3 03 ROUGH MECHANICAL
.a J iomrnasuceo he work for
for by Permit naB or me Lanor code, for m` 304 - ROUGH ELECTRICAL ,
rn,ensice n, as work for which this nm issued.
'O I have and will'muianim WmoiPs CimmeinaGani]it....act.us required by Seen.. 305 - FRAME
370C)of the Labor Cade,for the performance of he w.,k for which his perm,is 3 06 - HOLDOWNS
d.My Worker Compe r Ins mnce carnal and Policy number are . 307 -INSULATION
_. .....
C ;.,:t `1 bey Nn " " i,: f 308 a!SHEETROGK
't• - CERTIFICATION OF EXEMPTIONFROM WORKERS _ ,
COMPENSATION INSURANCE" t .._.._-3.0.9._,__,--EXTERIOR-..LATH_.._....___.__-__...._.__._._..'__
- .. _.. \
SU (Thi,,anis„eeenm becompmmrrfinel><rmirsforonehunartaaollar, 310' - INTERIOR LATH, .: '._I�.�...t•,'-t
SUR)eness.l
311 - SCRATCH.,COAT_..
•' I c-nr( man the -I,issued,I _ ..
r perp e urine kr nentbspe t 313 - ROOF NAIL. •
'hall not employ y person y manner so a t becomesubject t the Workers' . '= - t' ,
CompensationL sofC.rm .Date' 501 - FINAL ELECTRICAL ENERGY
Appllam
NOTICE TO APPLICANT:If.Co silion ten acme the
Exempt you should 502 FINAL PLUMBING ENERGY' - -- '-
z hecdoe.ubjen min Workers C� pen anion pro' ns of the LaW Cod you mus ”
O forthwith ply ithsump nsorthispe 'uhallbedeems revoked, 503 - FINAL MECHANICAL ENERGY
z �
4 I ' CONVIRUCTIONIbDINAGENC
NGY - 504' - FINAL. BUILDING' ENERGY -
y, In byamm matth Stonlenatngasene>r me per m 505 - FINAL ELECTRICAL - '
ke
� r f the work for which thii pe,m t is issued(Sec.3897,C'v.C.) - '
y0 UndersName..: :f..._ .-506 -- GAS TEST . . . -
a rl"nif that iohh -
�.z Lend 507 - FINAL PLUMBING"
O y w ee.11 ppl tco d state that the d state
f s re on is
�+' t.., cmrea I co t construction, with R city std county nt es and t t I refining 508 - FINAL MECHANICAL ( _
V thebuilding cont Lion do by ve rc representatives t t m
as ly] the neve m dp panda P t pum ' Y oP°" 509 - FINAL GRADE
rP: (We)agree msile,,nndexpynsad keep aswhihmayinanyit,o(Cure
dirm.,ain't 510 - FINAL PLANNING
fn liabil,trca,judgments,costs and expenses which may o any way,accrue against said
City in consequenceofthegainingofallperrm.L .. 514 F NA WORKS
APPLICANTU."ERST NDS AND WILL COMPLY WITH ALC NON-POIN7
SOURCE Rect vr�1 •' 7-3-fl7 Issued by: Date
Stgnamre of w
AppwanIlConcta " •• Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Willthe4plcantor future bedding occupint armor handle huardous material Type of Roof..
is defined by the Cupertino Municipal Cod Chapter 912 d the Health and Safety - ^`- "" .
Code.Set 25512001 k� �.,, s•y „„ I
Oyes 7qN ,' •, c s„
' !!� " All.roofs shall be inspected_prior to any roofing_material being.installed.-,
W ll,l ppltc t rf t laId'ngs,cc p t q , nt devices which If a roof is installed'without first obtaining an inspection, I agree to remove
n,Ierad elf i ni nne t d Riled byth BayA Ai Quality Management g p g
District' / all new materials for inspection Applicant understands and will comply with
r ❑y x D M10 all non-point source regulations;,, _
�-� Ph ead,the hazy dfyass'm"ater als requirements under Chapter 6.95 of the
call frimia lieu]h&SafetyCode,Sectons 25505;25533 and 25534.]under and that
if the building dao not currently have a tenant,mat it is my responsibility to notify the
ocsvpant of the method...r prdds(/w�hiimb must be met prior to issu/same of Carldreac of
Z, Signature of Applicant Date
er or outho,...o.em •. Dam All roof coverings to be Class "B"or better
y
OFFICE . ..