02100036 CITY OF CUPERTINO '�
BUILDING DIVISION PERMIT CONTRACTORRRRINFORMATION:y
Bun. 1 ,A ESELANEY AVE # 17C WALDRON CONSTRUCTION COMP lTN(02100036
WNIpAK17r;:BILTMORE APARTMENTS P 0 BOX 598 APPLICATIQ'"94'il/2002
ION2: (408) 377-8186 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
r
LICENSED CONTRACTOR'S DECLARATION
e
K V F 1 hereby affirm that I am licensed under Provisions of Chapter Y lmmmcncing O
isuhSection7000)ofDivision3ofineBusinessandPromasioneCWe.andmyliccn is REMODEL-KITCH �A��R ,`IdALL A/C UNIT, FLOOR
<o� in and mar and errtt'L AND WASHER/DRYER.
ZOO? License Class Lic.p
o� o Date SDECL �B�1lRlL��®
ARCHITECTS DECLARATION
y< 1 understand my plans shall W used as public records
X3 a.
=LLQg LiccnreJPndccainnal DEC
4y}
OWNER-BUILDER 0 9 2002
s w<Z I hereby aflirm that I am exempt from the Contractor's License Law lar the L L
to
ce
o O fnfiecM.g reason.(Section 7031.5,Business and Pmfesxions Gide:Any city or county
m mi $3 4 6 6 0
n e which requires a permit it) re
construct,alter.improve,demolish,or repair any structu
norto iLi issuance also acquires the ap pliemil fnr.mch permillnlileasignedsWlemenl
I-za that he is licensed pursuant to the provisions of the Contractor:sLicense Law(Chapter 9 tea Valuation
(commencing with Section 70017 of Division 3 of the Business and Professions CWe o
a 3$
that he is exempt therefrom and the basis for the alleged esrmption.Any violation of 36903008 . 00
Section 7031.5 by any applicant for a Perrin subjects the applicant to a civil Penally of APN Number Occupancy
not mom than five hundred dollars($500). 101 — FOUNDATION Pane y Type
Q 1,as owner of the property,or my employees with wages as their sole competuation.
will do the work.and the structure is not intended or offered for sale(Sec.7034,Business
and Professions Code:The Contractors License Law does not apply to an owner of10 3 - UFER Required Inspections
Property who builds or impotent thereon,and who does such work himselfor through his
sewn employees.provided that such improvements;are not intended or offered for sale.It. 104 — REBAR
however,rhe building or improvement is sold within one year of completion.Ne owner- 1OS — ANCHOR BOLTS
builder will have the burden of proving that W did not Wild or improve for purpose of
Salo) 106 — SEWER & WATER
as I
of Ne property,am exdosively contracting with licensed coneracmrs to 202 — UNDERFLOOR PLUMBING
ods roc,the project(Sec.7 Y .Business and Professions Code:)The Contractor'a Li-
cense Use does not apply manowner ofproperty who Wilds orapprover,human,and. 203 - UNDERFLOOR MECHANICAL
whoLiccncnmctsfi Petjiccawithacantractor(s)licensedFuncammUeConuacar's 204 - UNDERFLOOR FRAME
D1amrc und- ell: ,B&PCf thmason 205 — UNDERFLOOR INSULATION
worn DareM to 301 — ROUGH PLUMBING
6 COMPENSATION DECLARA
302 — TUB & OR SHOWER
Thereby storm ander penalty of perjury one of the following dcdamtions 303 — ROUGH MECHANICAL
Ion seand wmmamtamacenmcateofCansemmeltinscm Tor workciacampcm 304 — ROUGH ELECTRICAL
sau'ro,as provided for by Section 3700 of the tabor Code,for the p,iformance of the
work lit,which this permit is issued. 305 — FRAME,
"are
and will maintain Worker's Compensation Insurance,as required by Section 306 - HOLDOWNS
1719)nl Ne Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number ate: 307 — INSULATION
Carrie' Policy Na: 308 — SHEETROCK
CERTIFICATECOMPENSATION IINSURAANEON FROM ORKERS' 309 — EXTERIOR LATH
Miscreant incident becompleted i(the permit isfmonc hundred Jollars($100) 310 — INTERIOR LATH
le"') 311 — SCRATCH COAT
I worry,Our in the pcIfeepance of the work for which Itis permit is issued.1 shag not 3 13 — ROOF NAIL
employ any peruse in any manner so as to become subject the Workers'Compensation
Laws of California.DateApplicant 501 — FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT.I1,after making'his Cinilicam of Exemption,you should 502 - FINAL PLUMBING ENERGY
become subject to the Worker's Compcosa'ion provisions of the Labor Code,you mus'
Z f 503 — FINAL MECHANICAL ENERGY
forthwith lh i
with compy with such provision or this pemth shall W deemed.naked.
z � CONSTRUTIONLENDINGAGENCY 504 — FINAL BUILDING ENERGY
F Ihereby affirm that them isacommuctim.lending agency forthe penormanceof 505 — FINAL ELECTRICAL
Ri > the work lot which this 11.11isi.old(Sce.31n7,civ.C.) 506 - GAS TEST
f17 Q Under',Name
"Dz ander'sAadma 507 — FINAL PLUMBING
U O I certify that 1 have read this ifirth Ilion and sum Nur the above mimmation is 508 — FINAL MECHANI CAL
Hcorrect.l agree to comply with all city and county ordinances and state laws relating to
O U building construction,and hereby authorize represenm'ivesolt is city to enter up^nthe S FINAL GRADE
F 1 aMw-mentioned property for inspection purposes.
(We)agree to save,militantly FIN P ANN mntly and keep harmless the City of Cupertino against G
173 liabilities,judgntcnLs,assts and expenses which may in any way accmc against said City 5 F N LI WORKS
U in consequence 01 the granting of this permit.
^� APPLICANT ERSTANDS AN'D WILL COMPLY WITH ALL N N-Pp INT Issued by: Date
SOURCE G AST AI— /.1 -�/ A P� OZn
//JJ.•�n//ta^^.• f/il/ l /V si Re-roofs
Signature o pprcanUCnntracmr Dare
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant or tumor Wilding uccupam.shar e,handle hvardom material
as defined by the Cupertino Municipal CWC.Chapter 9.12,and Ne Hcallh and Safely
allml.Gide.Scnion 255320)l )<it All roofs shall be inspected prior to any roofing material being installed.
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Will the applicant or future building occupant equipment If a roof is installed without first obtaining an inspection, I agree to remove
Pp s pant ase a tai t of Minas which f3 P b'
�miJous air contaminants as JClincJ by the Bay Arca Air Quality Management all new materials for inspection.
District?
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1 hast read be havardnusmaa:rials mquiacmenu under Chapter 6.95 of Ne Califnry
nia HcaIN&Safety C'xk,Sttdnns355115.25533snd 25514.1 unJucswnJ Na if the building
Nes net cu d all a tenant.Nal it is my a Wnsihili'y m carry'Ir,ccuPam t1 domquimme s hmel ,^1st ,facerdEcaleafDecap Signature of Applicant Date
Owner or amhod,cd agent Da,e All roof coverings to be Class "B" or better