02030094 CITY OF CUPERTINO
. BUILDING DIVISION pERMIT �CONTRACTOR-7INFORMATI
•.r.
BUILDINGADDRESS: PERMIT NO.
20080 RODRIGUES AVE # 10A WALDRON CONSTRUCTION COMPANY 02030094
OWNER'S NAME: APPLICTIONS BDATE
LAKE 13ILTMORE APARTMENTS P O BOX 598 03/19/ 2002
'; PHONE:
I{' (408) 377-8186 SANITARY NO.. CONTROL NO.
ARCHITECTIENGWEER BUBDWG PERMIT INFO
< BLDG ELECT PLUMB MECH
m Z LICENSED CONTRACTOR'S DECLARATION Job Description
5 z�n C I hereby affirm Nan at Ilicensed under provisions of Chapter 9(commenci0SCr1p
ng
mtw is in full force and effect.with Section 7")ofDivision 3ofthe Business and Professions Code.and mylicenx REMODEL-KITCHEN,BATHS,NEW WALL ASC UNITr
:;[ S�06 LicenmCma fic.0 r� N
.5 LEOVERINGS & WASHER/DRYER,
3 Dem Connector as
0 ' ARCHITECT'S DECLARATION
g i -^.I understand my plans shall be used as public records BA nv 4. 2002
as L
oOrl
3-0 0 Licensed Professional L
-M n 0! .- OWNER-BUILDER DECLARATION .-
I hereby affirm that I am exempt from the Contraclnr's License Law for rhe'
E:z followingmason.(Seetion7031.5.BusinessendProfessionsCade:Anycity.r y LDIIVCA
4oq o which requires a permit to consmact.alter,improve,demolish,or repair any s
63� -
Prior o its issuance,also rtquiresthe applican,for inch permit to fide a signed statement- _ -
o ibt hon IicSined pwsuant m the IISSmrovisions of Ne Contractor,License Low(Chapter 9 _ A 'i 4'{(-,` Valuation
Gomm 11nl gwith Section of Division 3 ofthe Business pm Prprrsatons Code) , , , .$q,Ft,Floor Area:
t F -
or Nat he tl exempt therefrom eiq Ne basis for the a11egW exempnoe Any violationAnna i
section
303 LS by any opphc in for apermn subjects the applicant to a civil Pendsfill I
:of not more Nen fivehundeddollars(5500). y APN Number <.. - Occupancy P Y EYPe
CI I,as owner of the property.or my employees with wages as their sole compensation, I W FOUNDATION
-
will do me and the SWnure is not immmded or offered for sale(Sec:700a,
Business and Profa.ions Code:The Connector,Liceme Law does not apply to an 10 2 - PIERS Required Inspections'•'' 1'
owner of property Who builds or improves thereon,and who does such work himsalf
or through his own employees.provided that such improvements sae not intended or 103 - UFER
afferW for salc IChowwer,the building or improvement is sold within one year of -"' '- - ' ---"--- — r - - -- - ---- - - — - ---- ---
104 --- --- - ... .
ompletion,the owner-builder will baud Ne burden of n Nat he did not Wild or ''� A� ' ' � - '
c rovi
improve for purpose of sale.). P g - i
_ .___ ANCHOR BOLTS
I,
_ .
,aeet me project
properSam Business
Practing.1 Caden.eic Comment,'.
_._- - SEWER" & WA ER.-_......._ __.....- --
105 _ T
106...- T i ,, .:�..,.,.
c n m the project(Sec,]Oa an Business and Profiting who
Code)The Convenor's
andLic.whcotoesnoorapplysuch
m iownerth property, pmenjathereon, 202 - UNDERFLOOR PLUMBING
Cntracor,LceseeLaw.- projecu with a.mnvacmr(O licensed parsuantmthe '203""-"'UNDERFLOOR'-MECHANICAL.-....
_ ❑la axe «.'.'' 86 PcmrNisrtaon 204 - UNDERFLOOR FRAME''''
n^te' 3�— 205 - UNDERFLOOR INSULATION
WORRER'SCOMPENSATIONDECURATION 301 - ROUGH PLUMBING
I hereby affirm under Penalty of arjuryone Of the following declarations: 302 - TUB & OR SHOWER
^� ❑ 1 have End will maintain a Certificate of Consent iu self-insure for worker's 303 - ROUGH MECHANICAL
Compensation, a provided for by Section 37M of the Labor Code, for the
perfarmence of the work roe which this Permit i,issued. . _ 3 0 4 - ROUGH ELECTRICAL
❑I have and will maintain;Worker's Compensation insurance,as required by Section 305 - FRAME
37W of he Labor Cade.for the performance of the work for which this Permit i, 3 0 6 - HOEDOWNS
ivud.My Workers Compensation Insvence carrier and Policy number_m,
307: � INSULATION'
r
Cemer ' Policy Na: '
CERTIFICATION OF EXEMPI3oNFROMWORI(ERS'i •308 ' -' SHEETROCK" -
_...COMPENSATION,INSURANCE' ,., - _
hi dionomdnetbnamlctdHNS 3"0"9' -=' EXTERIOR`-LATH'-- _.._..._-- __.
p permit is for one hundred dollen
($100)mhna.) 310 INTERIOR LATH '
311 SCRATCH COAT -
I certify Nen in the performance Of the wok-for which this permit is issued,1
shell not employ any person in any manner on a to become subject to the Workers' 313 - ROOF NAIL;
Compensation Law.of Celificome Data
,Applicant 501- FINAL.-ELECTRICAL ENERGY..
NOTICE subject
LICANT.If.eWorkrs after Compensation
this CeniOpteef Exemption.you should 502 - FINAL PLUMBING ENERGY
�I become subject,the such pr Compensation p.it as of the Leber Cod00 e,you must
fenhwiN comply with such provisions or this permit Nall h deemed revoked.
z . - - 503 - FINAL.-MECHANICAL ENEPGY- ,
E"", 'rye - 'CONSTRUCf1ONLENDWGAGENCY 504 - FINAL BUILDING ENERGY
' 1 hereby affirm that there is a ronanec0on lending agency for the performance
N RGY
OfNgworkforwhichNspemiit,irissued(See.309zCiv.C.) " 505 - FINAL ELECTRICAL
Genders Name .. . ., .. .... .. ..... .:. . - _.
;Z Lender,Address
506 - GAS TEST . - .
V O cerae I tify Nhoe ted this appfieadon and arm that the above information is 507 - FINAL PLUMBING .
ka Ey correct I agree to comply with eit city and county ordinances and state laws miming 508 - FINAL MECHANICAL
V to Wilding ronstmetion.and hereby authorize representatives of this city to enter upon
>a W me above-mentioned property for inspection purposes. 509 - FINAL GRADE
`Fa 4 (We).9.tO save,mdemoify and keep harmless the City of Cbpenine against
-rA' liabilities,judgments,costs and expenses which may in any way accrue against said 510 - FINAL.P ING
UZ city tie'�' 60�
APPLICANTUn RST/cgg1r�gn$l.i4nNO WILLaCnut. WffH L O -POINT' 514 N WORKS
souRCE RE LA 017q/ 4Z(Ikq� ��� Issued by: Date
Signature of Applxanv/ oWnueccttor "" - .Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE � '
Will the.Ppli.1 a festive building occupant store or handle haudaus material Type of Roof
as defined by Be Caperton Municipal Code,Chapter 9.12,and the Health and Safety
Code.Section 25532AI?, - r m
ova . AI f hll:ti';
1 ,too s s a ems acted riot to.an roofing.material
P. P Y being installed.- .-..... ..
Will the air comet or futurnis balding by die B yAm%use pmentotdMana Management
If a roof is installed without fust obtaining an inspection,I agree-t6 remove
emit b,rudouuir conumimnnadefined by Ne Bey Arte'Air Quality Menagemem g P g
um,brict' all new materials for inspection. Applicant understands and will comply,with
all non-point source regulations:
1 have had Ne Safety
Code, materials requirements under Chapter 6.95 or the
BikCalie Wil ing lth&dos Safety Cade,Sections]5600.25533 and spirsi I ityunderstandtoof that
BikeWildingmgait.,n.ly which .atW,e,prize be Is,. onaiof.COnotify the - - - -
occupedt of requirements which tour be ton prior m Isaumceof•Cerifinm of
Deedpa<..' 3ZSi nature of Applicant Date _
Owner Orauthonzed agent ' Data All roof coverings to be:Class,"B" or better '
OFFICE. .. . .. - ..
IAAR-19-02 1040 FR.CWPROMETHEUS REAL ESTATE GROUP 650-596-5:74 T-046 P 02/04 F-258
CITY OF CUPERTINO
BUILD NG PERMIT APPLICATION FORM
Building Address:
Owner's Na Phone No:
Contra •tar/: , License No:
. WF�LD�-onl CGFJi77LUC-[-(pr.l (hIC. 7�'
Contact: Phone No:
Dueis wEA � &moo _ sy6 - s3o�
Archite /Engineer < License No;
IF �LWOO Stpu 2 INCUkuz �2LF{1 S
Applicant/Contractor r:
BuildingPermitlnfu: (circie .,ne)
Bldgg �Ele.ct ' Plume ecH )
I 63
NDescrin: I�U'(E,�'arc �G-Nu�n-nua IuCLLwI rrctEt�-1 REmcoe�� 6ATNCS REW�d+fC�.,
g;A ppt�i�gq
(t1R5H�/DEIVz, N&IA1 WA-LL, A/C , NE'W f[CdQ- E2WG .
Residential: u�r >-aN tL Commercial:
Sq. Ft. Floor Area:
16000
$/Sq. Ft.:
APN tF (Must provide): 369 3 oValuation-0 - GB
Type Of Construction: Occupancy Group:
— IZ
Qry. if Fee/D Fee Description Fee Group
Applicable
. BTEMPPERM Tempora Bldg Permit BUILDING
BCONSTAX--- Construction Tax BUILOING
JBIENER—GY Energy BUILDING
BENERGYA D Ener Add Multi BUILDING
ROVER IMS— Inspection Overtime BUILDING
BPERMFEE Bldg Permit Fees BUILDING
BMITIGAT Housing Miti ation Fee BUILDING
BPLANCHK Plan Check Fee BUIL ING
BPl.ANCKADD 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
B PECIAS�L Speciallnspection BUILDING
BSWIM Swimming Pool BUILDING
ZADDCHG Address hange BUILDING
-CITY OF CUPERTINO " - - `
BUILDING DIVISION PERMIT CONTRACTOR'INFORMATION
BUILDING ADDRESS: PERMIT NO.
20080 RODRIGUES AVE # 10A WALDRON CONSTRUCTION COMPANY 02030094
OWNER'S NAME: APPLICATION SUB DATE
LAKE .BILTMORE .APARTMENTS P 0 BOX 598 03/19/2002
! "HONE: - — SANITARY NO. CONTROL NO.
r (408) 377-8186
❑s z ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
Poo BLDG 'ELECT PLUMB MECH
5LICENSED CONTRACTOR'S DECLARATION ,Job Description
5 z_0 4 Thereby affirm that 1 am licensed under provisions of Chapmrii(commencing p
with"Sectionvono)nfDivision 3ortheBusiness and ProfessmmCoaeand mylicense REMODEL—KITCHEN,BATHS,NEW WALL. A/C UNIT,
ismfull mmeand err"''
COVERINGS & WASHER/DRYER.
e�O�� Clamse Clusb Lia.# :
S Date Common,
w h, -
._ ARCHITECT'S DECLARATION
:Eon
}
1 daranmrdray plans snail bcused as PM1I'<marine,
Y@IJ
amo2 Lice dP f al -
- OWNER-BUILDER DECLARATION' I' M�t
—m .Ili ther I tl Cnt"mr 4 L f flue - AY `2002
mid,
�Z_� fall."ng rcu mb.(Section
Sa(5 7031.5,Business d ProfessionsCod Any city or ty � G '
Cx whh 4 saP tine aV t h p- Jem l'.M1 rePany sl tin
o _p t s. c "1 q eh pplicant for such Parma fl 'g d t t e.
3, that h "d p n a no ti e pr ,ons of the Comracto L L (CI pt 9
Sq:Ft Floor Area, b 1.• ,,.,, , Dation
(c , nirmun9 tofirmnmorDbasisoof the Bnslne ridim.An,s Gd) rLY} a X'Fp kr ,z , in„ yl ,
or thin to Is 31.5 be therefrom and the basis for the alleged euiver,t.Any violation Inn
of not moe than v any applicantfar n Permit subjects he applic,m to a-civil pemJry'
!of nnt,nomthanmrvehundred dollars(sSPo). APN Number ,.. ..,., Occupancy Type
°1,as owner ofti,e property,or my'employees with wages as their sole c ni,arr mm,
will do the,work;and the structure is not intended orofferedfor sale(S,C 70U. 10 2 - PIERS Required Ins eetions'r'
Business"and Professions Code The Contractors License Law does not apply tom q p
—car of property Who builds or improves thereom umd who does such work himself
103 - UFER
n tl gi his pl Y provided.. that hm, „" t t'intended
-.o1Y d.f l 'If h th n ildin6 mP ,ement le within - y or .
. _._
c nl r m n ld r will have Inc burden or proving o,m he a,a not build or . — R
improver ( '
p � r i.) 105 — ANCHOR BOLTS
__
s fthepopny i.' ly tag-with licensed cotr-a rcto 106 SEWER �_ WATER
t(lieproduct(S 7044 Business d Professions Cotle)Th Contractor's - 202 UNDERFLOOR PLUMBING
,_r-• .,
License a Law does not apply t n owner of property,who no Ids r proves
th —
and.who contracts for.such majects,wtha.cmentembs)Icensedporsoarm nothe. ._..._-......_'.203 UNDERFLOOR—MECHANICAL'___... _. ....
Contractor's License Law. 1
°I andicrelu or ec B'&Pcfor this eason204 - UNDERFLOOR' FRAMS4
Oamum ` 'Dto 205 — UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION` -- 301 — ROUGH PLUMBING
-I hereby affirm de pench of re or one of the followingaeduratlnns, 302 - TUB & OR SHOWER
❑ 1 have oil will mm'min'a CErtincme"ofcmn.:eni'it,self-Insum for Worker's 3 03 - ROUGH MECHANICAL
Compensation, as provided for by Section 39W of the-Lahr Code, for the '
"r Perfonce Orme w k f " h n this pe m t is issyeg. „ 3 04 — ROUGH ELECTRICAL
rma
❑I ban I adnm t Worker's CrPe t I. i sainum 305 — FRAME" ..
3700 rif"heLdser Code,fit,the purbommice ofh'work for n h this permit is 306 - HOLDOWNS
c-. - issuetl.My Workefs Compensation Insurance carr imr and Pohe number arc: '
30,7 INSULATION`
Cmr E >I i- ^'vpolcyNo 308k{`3SHEETROCK%1
,CERTIFICATION OF EXEMPTION FROM WORKERS,. `-
:.
' COMPENSATION INSURANCE
309; EXTERIOR--LATH - —'
or
/' 1 (Tots sect-on neva nbe corn,let a f the permit is r r me hundred dollars t,i n.,., d
(aloo)orlessl 310- �INTERIOR LATH
a'. _,.=311.. __..SCRATCH:;COAT
s I comfy thatPerfom
•n the idaf th or,
ce wk'fnr which thispe t t is issued;I - .,r;,
sh II not employ my person in any man r as m becamebled to the Workers 313 — ROOF NAI li'"' "'
::. ._ ..po
Coms , Lnws. ,Cal_ ma:nate ",. .50"1—= FINAL ENERGY.....
Compensation -. _e .:'_t_' : :.. .
__ . .._. ... ._.. .. .......___
' —NOTICE TO APPLICANT:If.after makingthcn'f'an,of Exemption.youshould 502 - FINAL PLUMBING tENERGY -'
b me subject to theWoke Compensationprevisionsof theLb Code,you most
Zforth ih mply with such provisions or this permt shall b deemed yoked
_ . _. -.. ....503 .r ._EINAL__MECHANICAL-. ENERGY-
-"!;4
,',,CONSTRUCTION LENDING AGENCY "-' 504 - FINAL BUILDING ENERGY""I"
' I.,k
kfar which
that the e t s const ton lending e6 Y f the performance' _ t.
ohne kr 'nmr' print 'sand(s.-I , ,cmc) _505 FINAL ELECTRICAL
W Q -Lc d r Name - .. -. .. .. - - " - ._. _. . _ ._ --_...._-_
�;z
a Aad 506 — GAS TEST
U-O 507 FINAL PLUMBING
1 n d th t I h d all city
cat e state that d infatuation s
w < b tl g t Imply with nctyatl ty, d e ee l enter Em 508 — FINAL MECHANICAL
0:U tob Id g t i ehereby th z rcpres-f i e of this city to t pan
F.,C6 m b t stoproperty f inspection,bum _ . 509 — FINAL GRADE
{ -00 1W 7 g m s rid pe d k harm) n a City fern ni o hg,am
fry habit judgments, std dog of may.'n any y crve against said 510/'s— FINAL PL ING
U'Z Cny mconsequcn fthe gr or df th p e - 514+ N WORKS
APpLICANTU RST S NDWILLCOMPLYWITH 1: _POINT"" ISSlled11 Date . -3
SOURCE RE LA 0 � ` I Y•
CCC /
§g t fApplica't/C mmeeor - "::. '.Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE C
W,In ,pike tont balding caopst sw trial Typeof ROOF ... .. ...... :. . .:.. -.
a as defined by theCupertino Municipal Cad Chapter 9 12 d theHealth d Safety
Code,Section25532O tt ! mM1fn araM s _ s 's'T a �:tYvt19
TI xr .J,.
°Yes All roofs`s6a11 be mspic' d prior to any roofing.material being installed
"Will the applicanto"r t building p t useequipment ordevme which If a roof is installed+without first obtaining an'inspection}I'agree'to'reniove
oti hadershous air
contaminants es defined by the Bay Arc A Quality M nage ent
t an _- comply wI[h
.' t , ares : ._. � all new materials or inspection. Applicant understands and will: _
all non-point source regulations. .
=lyI ha e read•the haiardous materiels requ mmmts under Chapter 6. of the '
California Health&Safety Code;Sections 25505;25533 and 25534:1 understand that
if thebe ld gd f entlYh-dam l that It responsibility to notify the '_.._... ... _.,,_ ._.._.._ - .... ._. .,_
oc p t f q vera m h¢h mu t be m t prior,.1 f Certificater All roof coverings TO be Cl
O rip
Signature of Apphcant Date
_ _ _ _ :--
ass .
O inehomxed g m Date"
g B or better i
OFFICE -