02060201 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,CONTRACTOR'INFORMATION::
TYYYM"Pi{bDRIGUES # 8B WALDRON CONSTRUCTION COMP MIT1&2060201
t_X.�,'IA12ILTMORE APARTMENTS P 0 BOX 598 APPLICA" 002
' PHON[:r'.;' j ., (408) 377-8186 SANITARY NO. `CONTROL NO.
O s i ARCHITEC(/ENGINEER: BUILDING PERMIT INFO
O,O BLDG ELECT PLUMB MECH
a i F= 1 1 L7-.j L.1
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'Z LICENSED CONTRACI OR'S DECLARATION
I hereby affirm that I am uclued i nder prinkmas of Cnapler 9(commencing INTER.RENOVAT I00IP2M616�2IED KITCHEN AND BA
a
facmmno0erDmi>mm3.nheBuamesaandPr„ressinnsenae.andmyuame
11in '. NEW WASHER/DRYER, NEW WALL A/C, NEW FLOOR
fyfC C ': tars rune andeffect,
K ¢ License Clan Lie4
]O y:U D at Co.,....nr
3 a v ARCHITECT'S DECLARATION
1 understand my plans shall he used.as public records
il'i E
i i p C
Licensed Professional ”
'OWNER-BUILDER , Cl
ON
in Stanley,affirm mat I and exempt Ga.]halnm
a - 'Law Por the
following.....(S 70415 B .l .. JP focasCeAd,,,c may
whichdinner1a ah,clort.topsoil,tlI oropall,
-
soccom. $34660
w pmierta it e I q m.lh m,plicanl . h ,.it to file @ d ltemem,
thado Blended urunumauffise possimoofthc I Licars,L (Chapwr9S Ff:.Floor Area - Valuation
,-' a rs ms I 7000) 1D' : 3 nn Baa e qde r '' n,Coa� l C ''x '36903008'.`00 �j...`t,v.- 's
o bad 1 clump,th rcfiom and Ihe b ss for the oNgIdd 4dmjll.n.Any v,olal on
of Section 7031.5 by any applicant for a Fermi t subjects the epplieent to a c....penally
ontl am than five hundred dollars(s51w) APN Number Occupancy Type
°I;as owner of me properly.or my employees nam wagesas that, .In cemprowiti ¢ 101 — FOUNDATION
- will do its,work,end the'ntrucmrc is not inanded or offered'for auto(Sec:7044, 10 2 —
,Business and Professions Code:The Contractor's License Law does not apply to an Required Inspections
r of properly H'ho builds or topic,es Ihue.n,and who does such work himself 103 — UFER
ortl gM1 h'e,has a emply In d d th t...htap l t' t d or
' tr a for add.v however,Ili bidding- ' p n . ,la In i " ane year or .104 - REBAR - ._.... ,.-. �.. - ...... ... ._. .. .. .
completed;the e b Id I I have the burden f phoung that he as notbuild or. 105 — ANCHOR BOLTS
1 .1 ta ro f t p m: f l )
_ . 1,06 .-. SEWER. & .WATER .
a n - f th P e]) d
pxus dY c nt ac(g Ili l 'ed contractors to
eaama the project(sec 7044 Basta ss and Professions code')Th.Contractor 2 02 — UNDERFLOOR PLUMBING ,`:p
License Law does at apply to an net of fmpen)who builds m mpm,es mere.., — UNDE
and who contracts for such project.with.a combecter(s).license.pursuant to"the .. .. ..2103- -_.__ - .RFLOOR-._...MECHANICAL_ .... . . .._.._ r __.... ... .......
c ' traLicense La 204 — UNDERFLOOR,,;:RAME . :
❑1 a7�' ''/Bcat /J` Pcrortmsreason, 205 — UNDERFLOOR INSULATION
_3-0ia,A WORKERSCOMPEM1SATIONDECLARAT]ON I/ 301 — ROUGH PLUMBING
O�4kSIn
I hereby offrm under penahy of pejury one of the following declar.dil 302 — TUB & OR SHOWER
'°'i have and will'innintain'a aniecme ofICoaseot 10 self-insure for Wmker's 303 — ROUGH MECHANICAL
Compensation:.aa,,m,idld for.ny Section 3700 or the Labor Code, for me 304 — ROUGH ELECTRICAL .
'performance of the work for which Ibis permit is issued.'
f 305 — FRAME
Eli37W awborC I nwolier sCorporationofhe rad qulrea by ,mit is 306 — HOLDOWNS
3700 Pili labor Cad;for[lie performance of Ihe work for which this permit is
,isad.,My Worker's Compensation Insu ' rand Pol cy number ere: 3 0 7 INSULATION_.......... ..:.. .
..
Policy Nm:
CERTIFICATION OF
EXEMPTION FROM WORKER S f30 . f Y SHEETROCK'+k' .I,
v,. COMPENSATION INSURANCE,
".;._. ._ .30.9.... .._EXTERIOR,-LATH;,,._.._._..
.. ern::e6don need not be acompleted if the permit is for one hundred dollar: 310'`-- INTERIOR LATH ioo)prleaa.) „ 311 — SCRATCH COAT
lt Icn't,that at Ihp 'f nnance fthewkf -'h hthis Permit'i"s edI _.: ::. 3.�.3...- ROOF NAIL`.' ._ _ . .- ".:. -•-._. ...
"span not employ any cement in any'ma nes so as to become subject to the worker' 501 — FINAL ELECTRICAL• ENERGY"
Compensation laws of Califdrniu.Dae "
APPlicenl
(NOTICE TO APPLICANT If, Bn
cnnkng hisCrifirthe ofException.you should 502 — FINAL_ ..._PLUMBING ENERGY -- -
Zbecame-subjecttothe Walker',C ,pen I precision,efuld Labor Code, on must
503 — FINAL MECHANICAL ENERGY
Z O font ih mplY with h p ''.'ons. this permit shall b deemed revoked
�'� i - CONSTRUCTION LENDING AGENCY '."' '
" 504 _ FINAL BUILDING -ENERGY ;f :
a � I h 'h)affirm mat th 'a con.tuln lending agencyfr the performance 505 — FINAL ELECTRICAL
w:. c) 506' — GAS —TEST
.0 Led a Na P u .. . .. .. .. -
of th oAf h lith e t nu d(Se 1091
-Z a Aaa 507 - FINAL PLUMBING
U-O. jnry.mlln dlh' pVl I na �t'�nttn e "nfnm,amenia 508 — FINAL MECHANICAL
fse=F, co ti greet c ply to 11 ity a tl ty dada d t to laws relating
�:r, fob Id ng ttmsbud dhercny talo rz p .e tativei ftm'clq menoccupied 509 — FINAL GRADE
W the bo t oned p p ny fn "napeu on carpo'
�y.I.p:(. (We7 agree in a e ' d- dy and kc phannless ilio Cny f Cupertino A'gaina 510 — FINAL PLANNING
Fn fn li burs j dg nus t dna expenses h¢h may n any ay ecc "against said 514 — F NA P WORKS
V ,Z Cty roq ace ,the gra t g'of th r " ""
�"B APPLICANT U11Nyy'��tER. A DS AM1�WILL C011pLY,'W7THALLNOM1-hO1NT°I, ri
soulxc8 REcyyaTr;r.'��U. 3_09 Issued by: Date
5 n tare ofA``I¢anVConuhcmr' '� Dae
g PF".,HAZARDOUS MATERIALS DISCLOSURE Reroofs
o - " Wil th applicgm mfm eh'Id ng tics pa tsmremhandle HavaN us I Y
and Safely mmfety Type.of Roof. -_-..... ... .. .. . ... _. -:c:
. P
a m H hh All roofs,sbal_1 be inspacted nor to any roofing material be
th5 i2pe) M I CW C 2.37 m
being,installed.
P PP
Will In t,c l n f l h Id g p t eq p n m u devices limn If a roof is installed-without first obtaining an inspection;I'agree to:remove
of al he db)Ih Hai QuatyMnag mens
'emlhazara al P g understands and will comply with
Dat ct all new materials for inspection. Applicant undo
r _ ..t ° I all non-point source re ulahons:�.;.,_
c i have read he hatat mater 1. y umai under Chapter 6.95 of the
California Health&Safety Code:Soldiers 25505,25533 and 25534.I understand that
ifthe building does not currently have a anent,that it is my responsibility to notify the
" me,
%
cam of th q em is. hic�h�mr t b m t p m f 6 Cenlrmate or
Y WWVLL / -3-a, Signature of Applicant Date
O ermauthorizedagent'. .. / Dae All roof coverings to be Class "B" or better -
t
._..I. ...... . ..... .. _.... . .. . ..
OFFICE .,