00080115 r.WNIiR'S
F CUPI RT1N0rvc ot4lslorvPERMIT CONTRACTOR INFORMATION:
OkESS: F1'ERMITNIJ.ME: APPLICATION SUB Di
1.0099 °S BLANEY '1D' WALDRON CONSTRUCTIO COMPANY00080115' .
J, - SANITARY NO. CONTROL NO,
LANE BII_TMORE APARTMENTS '. 73 HERBERT LANE 08/1.672000 .
1- ARCHI rECT/F.NCINEEH: _ BUILDER]PERMIT INFO
•�U `. ,BLDG HLIiCT PLIIMB ,'Mr;CH
h= (408)377-818E _ i� " '.r=
z yI
Job DCSCFI Z LICENSED CONTRACI OR'S DI CI ARAl ION "
0z I fares,,ffn rIimi I' 1 p ICI'lt 9(, ring I110n
p:Jr c•� with Section 7ahp of Division 3 of the Bu aand Pridellilnev Collet andmyli,onl,
is n fill farce and effeur
r�y ce 6 Liccnw Cuts -
a�3 ynate cnwraemr - -
ARCHITLCT S DECLARATION
t ,g 1 ❑ d M u
Toy plan,shall sed Timor,
pub!c cors - r
<s I RMDL, NEW KITCH, - NEW•.BATHRMS, NEW. WSHR
- NEW WALL A/C, •'NEId FLOOR CCIVERINGS; NEW
- UN NFR IIl11LDFk DFCLARAr10N
1 h by f1 Ih ,I mpt f Ih C I t L , 1 ,w for are
_ _
t3<
n e.1=n wn en myn,re,a Barron,i ann,wet.aper.' ,Flint,danm„n,.,r repatr am,wewre'
3} Bol ,: 1. q Ih IVr tf ape n I g J:I,mcut .
,1:n1 Ip It Ery Fl Ill C I' 1I 1 G (Ch Y
r .r nn g l s 7nonJ t.D. ) 1l a IP y ' p A� FloorAren' •Valuahon}
roll proer do b, f m uaee e, m n, ,u � -
ofS t 763L5 by nY appbcam fora perm, bj rine apllc IItpen.lty
Dein, ma I nnrJ<aJnn:ms5an •APN Number- OCcuparicy Type
❑I. nh n xnr or n,y emmm ur ges a,ml .ade emnpensmm. V 1 1 •
will J m k d Ih t t m'm d d r R red f I (Sec.7W _
pFl,torn Required Inspections $37785
wine Ip p ty,th n Il ',p sIh 'nl h J h rk has $37785
�II D {�� -
nrm through ry. employees.pro,'ded mm h p einem_ ,intended, L IId�
oHemd for sato If,however,the b, Id ng or itnpmvemcm is sold wic one year of
„nmaiotL d,a owuer.mdlder will wwe the nulden ofFlro,mg mat WdiJno,naldor 36903008. 00 .
in,provc lar purpscaGulc.). - '
L of live fill, I .- ly I i' g withl J tat ,n. t '
ou,l the p i 't Is 704 B : 1 I-1 :. ,C r:)The(....... . - 1.01 —: FOUNDATION
-
-cn,o La, dms not apply to an owner of p,,,,u,who Wild,or improve.,thereon. ,,y '
ane Iran for ch and en,with a contractor(s)licensed p e n,to the 1 rUL� — PIERS
' Cc L
❑ an rN� MYN Ifsri cr mien, , 103UFER'
Date 8^ 1Z n —_ 104 REBAR
snrloN m.u.nRAr1°" _ 105' —', ANCHOR BOLTS -
Inercbrafllm,under penahyofperjury'one ofthe following declamlons'1J 1.0E — SEWER R WATER
1 nave trod Hual
will o" n a Cerliflum nl Cm,n,w In all'-Insall for Worker's ..�' -
Crai...run, a, provided for by Section 37W of the 1a1mr Code. far the .',_02 — UNDERFLOOR ,
perronnanee tone work for wnien this prol i.issued. PLUMBING'203 _'—_•UNDERFLOOR MECHANICAL , `
ElIhull atm win untinain Wohol',Cmnpndmdon lnrmronee.Io roloined by Sic ^e0'4 UNDERFLOOR FRAME
37W of the Labor Code,for,he perfamtnnc,of ine work for which this peau,is
issued.My Worker'sCompen,anonIn,urancecarier.andPolicyareallare: 205. — IINDERFI_OOR INSULATION
Carie,: Policy No - 301 — ROUGH' PLUMBING
CERTIFICATION OF EXEMPTION I ROM WORKERS' GG
COMPENSATION INSURANCE 4302 — TUB & OR SHOWER
This,action teen!not be retai lased it pe hundred dollar 3,1113?
tslool nr le,,.) enal)i,for onhu_ - — ROUGH MECHANICAL
= ' , 304' — ROUGH ELECTRICAL
shall nitc a'ly Vh tl pcf fII kI which ll' p 't i„ueI f
F r =re y f accurate.uIBI I, m wnrL r 305 FRAME
Comi,ron ,on Laws of California Dam - - 306 — ' HOLDOWNS
AMI 1 t
NOTICE rOrtneum AYF Workers
ft king'hisCnl flier nPl on you should 307 — INSULATION,
Q 'z' (anhw th bj n the Rork p.C ,pe vion provisions ofthe Labor Code you Trust plrw'im,u asp a,or tti his permt still he diuned men k`d' I. ,1 31718 — 'Sf•IEF_TROCN, .
4 CONSTRUCTION LENDING AGENCY "
a > Thereby,rantdid them is ac,m,trnrd Ruling agency for theNottoonce 309 — EXTERIOR LATH
oT,nT,*,NaLr•wnian ml, mdthi„uee cseu.30 .cit.c.l 310. TNTERIOR'LATH
L•Q ]-ender',Addy .'t .r - r
Z) y Lenaer.Aadre„ I - 311 — SCRATCH COAT
Ur�_/O Immry ro;nlnt,e read Illi,nppliu,litn iron Sln�le llattW:md,e innomt"i°'II 313 -• ROOF NAIL_
W F correct.I agret m cmnply will III lily and county adinarro,and'.smm laws relining ,
V theatrve-ng contionedomperlyfad nbyamhmirerepreunmtiresol,hiscirymemertryn, 501 — FINAL .ELECTRICAL ENERGY
I W the uboi met eJ properly f inspection pu p '
E. A. IW) y'
Z'� � ttile, floe y dkeel' I .' IeCiy fC p lgn't
Uliabilif:Jdg nI costsJepe es whoyn n),way rectragainst said „- - 502 — 'FINAL
' PI_IJMBI'616 ENERGY
City iconsequence of p.
APPLICANT UNDERSTANDSAND WILL COMPLY WITH ALL NON-POINT 503- -
SOURCE REGULATIONS. Issued by:
CHRNICLENERa
,
f-L V
Naturae of AppGenndConfmctor - Dote - Re-roofs 505 — FI'.NAL ELECTRICAL .
HAZARDOUS MA'I'ERIAIS DISCLOSIJRII, ' I -
W1lmeappheomurlmureWadirt,e'copentramor handleharrdeas ratuniel- 'Type of Roof S06 — GAS ' TEST
as definer by the Cupertino Municipal Code,Cramer 9.12,and the Heath and Safety
CWT,See Hot 2ss3xm" . 507 — FINAL` PLUMBING l
•m ❑N All roofs shall este o - `
Will n applicant future building 64U�p 9�Rq�AL aPlELP1R18PLr�iLal being insthlled.
pas ghy p t . q �I, I device, 'hien If a roof is,inst' iI170 1 bt'eq'{y1{�y pinspection, I agree to,remove
niltn; J u. W,n t. ❑I ,ed hy,th P'YAn'Airp a11Iy M' 'g mol u- � 1_,Wt4oC
07., - ❑N all new malei'ialr. qr,m ef.tygrlA p�lO,c� ltdg5�lands and will comply with -
alI non-point soh 3111 tl I a
I ad heba 1 ial,re,lareae(lkti;u,Clo,111,6.95.1 he 51.4 —;FINAL ,PUBLIC ' WORKS`”
Culiforf II 11 k5afelyC I S I' ,25505,25511 unJ 2553) 1 hman❑thin
!the bu lJ g : Ecu Ely ha umnam try lit'- y pn.btl'ty1 Deify llc
capon I V t t h h oust W ,p I an f Cn hcme of '
01
Signature of Applicant Date ', 7
ow�erm motred,gem Dale. _ All roof coverings to be Class`B or better'
• • OFFICE
EADDRESS
RTINO � - �" •�, �°t' t ?'^T`" ^ - -
SION pN RD-.� CONT ACTOR INFORM ''tioN uy
- PERMI'I'NO. -
APPLICATION SUIIDATE
Jig
- . .. ,... .A. T. O. . _ I :N '. .. _ ... r.. .r. ._ .. ... .
ARCHITECT/ENOINPER - I'fbNLa - AbkDIII46TF^IWWM
HIDO, ELLC'I PLUMB AtECH
{nuoo a t9 Sr+ LVi c t .., A� ,' TOARRANGE INSPECTION
g m F 9NSPECTIONS„ V " DATE 3 a INSP EC, JOB DESCRIP"PION
CALL 777.3228 MONDAY-FRIDAY 24 HOURS RF,SIDFS_C AI'
v BEFORE REQUIRED INSPECTION.JOB ADDRESS Cl SFDWI KITCHEN REMODEI
zJ J= FOl1NDA1'ION/FIliRS/H.D.S' AND PERMIT 8 ARE NEEDED WHEN PHONING.
t,M UFER GROUND D AUDI'P-ON D PLUSTRUCTURBINGAL L PIPE
gg ❑ )IULTI-UNIT fl Sl'RUCTUR.4L
z a-1,
PAD/SET BACK-CERT
RESIDENTIAL COM11MERCIAL__UTI IER MODIFICATION
sir GARAGE SLABS/PRECUNITE D INTERIOR CI CHIMNEY REPAIR
.._. ._. HA7 IRDOIIS FIRE�.{l,[.;A
a y�P+POUR NO CONCRETE-UNTIL4^ABOVE HASBbEN SIGNED iN • IMPROVEMENT ID SWIMMING POOLS
i r D BATH RE\1�,)DEL/REPAIR D DEMOLITION
UNDERGROUND/SLAB � ❑ YES Iry<s-I undcrwwnJ ihmu Cmsw.\mn[m.camlya rnµaaxL
LL�� ❑ GTF11iR f
PLUMBING ❑ NO In:tml LC.B.O.a -------.._.-,.
ELECTRICAL EWBLJ/�
u a':-DO NOT-POUR'FLOOR'UNTI°'ABOVE HAS BEEN SIGNED,:"" ' EXIS'11NG ROOF COVEMING COBILIAI:
3� ❑ NNEN' DG/ADDITION 17 UHM11(11.ITION
PLUMBING
Numberofexisting covelingr' ❑ TENANT C7. FOODSERVICE
MECHANICAL -- IMPROV CM1IF:NT
ELECTRICAL "ru he reruned To be retained D (l 1'1 WR
FRAMING VENTS
INSULATION
PI ACE N0.3UBFLOOR UNTICAROVE.HAS BEEN SIGNED:j .t". TYPE OF R(/OF COVERING
ROOF SHEA'1"H/DIAPHRAM EXISTING: QROPOSF,U:
PLUMBING D Built-Up Rnof ❑ Built-Up Roof
TUBS&SHOWER PAN D Asphnll Shingles D A.wphal15hinglet
MECHANICAL j ❑ Wood Shakos D Woed Shake,
ELECTRICAL/P001,BOND ❑ WI'od Shingles ❑ W'nrxl 3hinelec
FRAMING/STAIRS/E.EGRESS D Olher(Spceiry) _ D Other(SPecil't)
NSULATION/VENI'ILAHON / �� Pruclde LC.H.O.Itcport No _
„COVERNO WORK INTIL=ABOVE'HAS'BE NSIGNEDMfpr Iltlulhvion Spcus.
EXTERIAL SHEAR/HOLD DOWN' -
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR INSPECTION SPECIAL INSPECTION REQUIRED ❑ D4'fE INSP
EXTERIOR LATH/N'-SCREED
SHOWER LATH '
",NO TAPE ORYEASTER•UNTID'ABOVE'HAS'BEEN SIGNED--deg'`Pi<I
SCRATCH COAT
SEWER/WATER
TEMPORARY APPROVALS
OCCUPANCY
z PLANNING 777-3308
Z,2 GAS TEST
I" GRADE(P.W.777-3354)
FIRE
J Z HANDICAP
U Q ELECTRICAL
OF PLUMBING
rsVj MECHANICAL
ENERGY /
UZ. VISUAL FINAL ONLY - --
BUILDING
;OCCUPANCY OFrBUILDINGISrNOT PFRM717FD �r
kUNTIL BUILDING FINAL IS SIGNED BY BUII IN
KiNSPECTOR._:+',l) r,,; '�'„ ^ ,<`c�#m”"=„z,.. /„',.,' CERTIFICATE OF OCCUPANCY O
PRE-INSPECTION: PLYWOOD IN-PROGRESS
INSP. DATE: INSP. - DATE—L— IN'SI' DATE _
TEAR OFF INSPECTION: BATTENS: FINAL:
INSP. _ DATE INSP- DATE INSP. DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
APPLICANT'S POSTING COPY