02100037 CITY OF CUPER't'INO �,
BUILDING DIVISION PERMIT "'CONT
BuIL118gA019IS13LANEY AVE # 17G WALDRON CONSTRUCTION COMP Y41TN®2100037
W9�AAIQIPEBILTMORE APARTMENTS P 0 BOX 598 APPLICATlT"Y B// vv 4FY2002
1 ( )ONE: 408 377-8186 SANITARY NO. CONTROL NO,
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�sraip� LICENSED CONTRACTOR'S DF.CLARAI'[ON
IRI hereby afford But I am licensed under provisions of Chapter 9(commencing O
with Section 7(XX))of Division 3 of the Business and Professions Code,and my liento is with TCH � S4 a�IALL A/C UNIT, FLOOR
in mu mree and effect. AND WASHER/DRYER.
ZO&� Licenm Class Crain �������
°y'O Date Cumrannr
F�gu� ARCIIITECI'S DECLARATION
rc I understand my plans shall be used as public coerced,
u�°�° DEC 0 9 2002
6
;a Licensed Pndcssional
OWNER-BUILDER DECLARATION
ConTION
1 naso .(firm than 1 1. excmpl form rbc Cssions Code:Liccnsc Law Lo Nc
urki_p° followwhich re muoa ermituSection]03 onstr,Businessand vefessinmh,inAny city orcounty BUILDING 34660
,S� which requires a Permit re ctmstrthe alms improve,for such
demolish,nr repair any structureBUILDING
prior mits issuance,adorequires the applicant for suchrPermit mice s Law(shaptert
�Z<
that he is licensed pursuant In the provisions of the Cuntractnr's License Law(Chapter Sq. Ft. Floor Area Valuation
FaFC (commencing with Section 7000)of Division S of the Business and professions Code)or
that he is exempt themfom and the basis for ft alleged exemption.Any violation of 36903008 . 00
Section 7031.5 by any applicant for is permit subjects the applicant to is civil penalty of APN Number Occupancy Type
ret mom than rive hundred dogan($500). 101 - FOUNDATION
❑I,as owner f the propcny,or my employees with wages as their side compensation,
1192 PiER-
will do Be work,and the smacmm is not intended or offered for We(Sec.7044.Business
and professions Code:The Contractor's License Law does not apply to an owner of 103 - UFER Required Inspections
Property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If. 104 - REBAR
however.the building orimpmomincnt is old within one year of completion.the owner. lOS - ANCHOR BOLTS
buil r will ham the hardener proving that he r id not Wild or Improve fur purpose of
106 - SEWER & WATER
I. s owner of the prepeny,am exclusively contracting with licensed contractors to 202 - UNDERFLOOR PLUMBING
maet the project(Sec.7144,Business and Professions Code:)The Contractor's Li-
vsnscLaw does not apply to an owner ofPearson,who Wilds orimprovrathemnn,and. 203 — UNDERFLOOR MECHANICAL
who end Isf'such projecuwilhaconvamor(s)licenxdpursuanno Ne Cuntracor's
License204 - UNDERFLOOR FRAME
❑ lam se and See Z.1 B&P C fgf Nr reason 205 - UNDERFLOOR INSULATION
wne' f Date/O (2 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby aRrm under penalty of perjury one of the following dcclanlonst 303 — ROUGH MECHANICAL
I have and will maintains CeniOam of Consent to self-imum for Worker's Compere 3O4 - ROUGH ELECTRICAL
1['137.00
tion,M provided for by Section 3]1X1 of the Lehor Code.for the performance of the
rk for which this permit is issued. 305 - FRAME
1 have and will maintain Worker's Compensation Insurance,as required by Section306 - HOEDOWNS
of the LSWr Code,for Ne Performance of rhe work for which Nis permit is issued.y Worker's Compensation Insurance carrier and Policy number ere: 3O7 - INSULATION
rrler Policy No.: 308 - SHEETROCK
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 309 - EXTERIOR LATH
mussection neednot be completed if am Permit is for one hundmodollars(sla) 310 - INTERIOR LATH
"'less') 311 - SCRATCH COAT
I certify Nal in the Performance of Be work for which this permit is issued.I shall not 313 - ROOF NAIL
employ any penum in any manner sn is to become subject to the Worlmna Compensation
Laws of California.Data 501 - FINAL ELECTRICAL ENERGY
Applicant
NOTICE
NOTITO APPLICANT:If,eller making this Cenilicam of Exemption,youshould 502 - FINAL PLUMBING ENERGY
become subject hs the Workers Compensation provisions of the Lalmr Codc,you must 503 - FINAL MECHANICAL ENERGY
OQ forthwith comply with such powisionsorthis permRshalt bedeemed mvnkcd. SO4 — FINAL BUILDING ENERGY
z CONSTRUCTION LENDING AGENCY
[-+ 4+ 1 hereby affirm Oat there is a construction lending agency for the performance of 505 - FINAL ELECTRICAL
IX> Nc work fnr which this permit is issued(Sce.3097,Civ.C) 506 — GAS TEST
m p der'sAame
1 Leader's 507 - FINAL PLUMBING
der's Address
UO leenfythat Ihave read this application and state that the aWw;information is 508 - FINAL MECHANICAL
correct.I agree to comply wi lh all city and county ordinances and slate laws relating hs
0[-' building construction,and hereby auiumerpmerentslim of this city to enter upon the 5 FINAL GRADE
4U] shove-mentioned property for inspection purposes. 10 FIN I G
L>t (We)agree to save,indemnify and keep harmless Ne City of Cupcnino against
„y Ln liabi lilies,just LS,a'its and expeno.which may in any way acerec age inu onto
City 5 N LI WORKS
U 7 in conscyueoc tMgnntingof Nispermit.
r� APPLIC nDE STANDS NO WUL COMPLY WITH ALL N-PINT Issued by: Date
SOUR R NS. /1vs �D��/00 Re-roofs
Signet o APplicanVConvecor w�/ Dore (••-
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building occupant score or handle hazardous materiel
as defined by Be Cupertino Munjgipal Code,Chapter 9.12,and the Health and Safety
Code,Scclinn 25532001 _T'fF(r/tit All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicantmfumre building occupant tax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
rid,hcmrdnus air conNmiwnb as/Ichard by the Bay Area Air Quality Management all new materials for inspection.
District? 're-/y/�`/
C]Yes r
I have mad Nc harnrdous Winners requirements under Chapter 6.95 of the Califs-
a
.is IIt"I"Safety Cjqc,Sections 25505.25533 and 25534,1 understand that if am building
Jma but C Y a@ I,Nal iii Yr Bury to relay the n'c 1t.�
myuiremcn w c ePlnr u c f CcmfcamefOcv Signature of Applicant Date
t0 j� 101-
Owneroraut onacdagcm Date All roof coverings to be Class "B"or better