02110001CITY OF CUPERTINO
BUILDING Dtv(slory PERMIT
CONTRACTOR INFORMATION:
Bu1L1)I GIA u9)ts$LANEY AVE # 3D
WALDRON
CONSTRUCTION COMP
ITN(02110001
KOEBILTMORE APARTMENTS
P 0 BOX
598
APPLICATIINISVI(91rr/2002
/
PHONE'.
(408)377-8186
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm matt am hecnsed ander Proveyonsof Chap., 9(commcndng
REMODEL -KI TCHEJ "; �eA�tis�O�]ALL A/C UNIT, FLOOR
with Section 701k)of Division 3 of me Business and Prof<aeions Code, and my license is
In full force amleffiro
AND
WASHER/DRYER.
License Class De. N
°are-- �SDEC` —
ARCHITECTS DECLARATION
FINALED
I understand my plans shall W used as public ..,its
-
JAN 0 2 2003
Uncasted Pmfcasom.1
OWNERBUILDERDECLARATION
1 Hereby .(Sero that I exempts me Cessions oo License Law Iia the
1. an Professions Code Any city or county
following reason (Swint 7x31.5, Business
improve. dnmorsn, avaaam3
4 6 6 0
which requires a pnmlh to ctlnstrua, alter, improve. or mpah any
poor tons issuance, also requires me applicant for such permit to file a signed statement
BUI
WE Area Valuation
that he is licensed pursuant to the provisions of me Contractor's License Law(ChapterY
q.
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
36903008.00
That he IS exempt therefrom and me basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7)31.5 by any applicant for a Permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
101
- FOUNDATION
❑ I, as owner of me property. or my employees with wages as their sole compensation,
DIERS
Required Inspections
will do he work, and the structure is not intended or offered for sale (Sec. 70d4, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
10 3
— UFER
property who builds or improves thereon, and who doesswh work himself orthmugh his
own employees, provided that such improvements arenot intended or offered for sale. If,
104
— REBAR
however, the building or improvement is sold within one year of completion, Be owner-
105
— ANCHOR BOLTS
builder will have the burden of proving that he did not build or improve for purpose of
Y
106
- SEWER & WATER
1, as owner of the property, am exclusively contracting with licensed contractors to
202
- UNDERFLOOR PLUMBING
construct the project (See 71,4E Business and Profusions Code:) The Contractors Li -
cease Law does not apply to an owner ofpropertywho Wilds orimpmvestherenn,and
203
— UNDERFLOOR MECHANICAL
who contracts for such projects with a contractor(s) licensee pursuant to the Contractor's
204
— UNDERFLOOR FRAME
License L
plame dr,�S� c. .B&PCfmtm5rcamm
205
— UNDERFLOOR INSULATION
or Date &3 D3
301
302
— ROUGH PLUMBING
— TUB & OR SHOWER
ODECLARATION
A/ KFY_40PYPENSATIN
KWde
I homer-e�b�y�aR/Lrmunderr Penaltyofperjury one of me following declarations:
303
— ROUGH MECHANICAL
❑Inaveand cool mamminacnnieeam of consenunselt-Insure mrworter's dampen-
304
— ROUGH ELECTRICAL
station. as provided for by Section 37W of me Labor Cade. for the Performance of the
work f which this Perron is issued.
3 05
- FRAME
D I have and will maintain Worker's Compensation Insurance, as required by Section
306
— HOLDOWNS
37N) of the La Wr Code. for the performance of me work for which this permit is issued.
My Workers Compensation Insurance caner and Policy number aro:
3 07
— INSULATION
wrier: Policy No.:
308
— SHEETROCK
CERTIFICATE OF EXEMPTION FROM WORKERS'
309
- EXTERIOR LATH
COMPENSATION INSURANCE
o'bis.seclion need notWcompleted HIM permitisrorore hundred dollare,410p
310
— INTERIOR LATH
"Gess.)
311
— SCRATCH COAT
I certify thin m the pc ace the work far which this pcormt is oyand, I Shan not
313
— ROOF NAIL
ploy any Nomons an oas ua Emmc WnErs Compensation
mr
iawsofcahfomat
501
— FINAL ELECTRICAL ENERGY
NOTIC APPLICA Lahr making mis Ccniltc fir Esmm�enn. rnu shoam
502
— FINAL PLUMBING ENERGY
coo onjetlumeWmkc,xCamPhaalionprovisionsonne noraac.yonmust
503
- FINAL MECHANICAL ENERGY
aathweh comply with such a-ioni s ,,his permit snap W deemed revoked.
504
- FINAL BUILDING ENERGY
CONSTRUCTION LENDING AGENCY
I hereby affirm that there isaconsuacdon lending agency iorthe pvoomance of
505
— FINAL ELECTRICAL
mework for which this permit istumd (Sec .3W7.Cn.C.1
Under's Name
506
507
- GAS TEST
- FINAL PLUMBING
Lender's Address_
I ccmfy but 1 have read his apphcauoo and scow that the slave information is
508
- FINAL ME CHAN I CAL
builcit. I agree to comply with all city ane county ordinances and state laws ediung m
5
FINAL GRADE
ding concoction, and hereby someone representatives of this city to enter upon me
above-mentioned property for inspection Proposes
(We) agree m save, Indemnify and keep harmlem the City of Cupertino againstliabilities,
10
FINWWORKS
r/�,
judgments, casts and xpcnses whiehmayinanywayaccmeagainslsaid City
5
F N
in consequence of the grantin fthis permit.
APPLICANT UNDER SAND WE, L COMPLY WITH ALL NON -POINT
Issued by:
Date
SOURCE REGULATI
Re -roofs
Type of Roof
-UZ
Signature of App1iwnUCmnrat9nr Dam
HAZARDOUS MATERIALS DISCLOSURE
Will me applicant or future budding occupant atom or handle Evurdous material
is defined by the Cupcnino Municipal Code, Chapter 9.12, and the Health and Safely
I, Sectors 25532(a)I
All roofs shall
be inspected prior to any roofing material being installed.
Ely
If a roof is installed
without first obtaining an inspection, I agree to remove
son applicant o la buaahi ant use equipment or devices omen
WillPP g occon
emit hazardous ter contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
Distnci?
❑Ycsn
1 have .it the Int.dem materials requirements under Chapter 6.95 of the Chide, -
all HcalmlkSid, Cwk,Sccuons25N15.25533wd25534.lun&c =dmalifinehuilding
dces no cu77D��Sa y have a tenant that itis my responsibility ,I entry tM a.cupanl of the
requbemn (s1 ehmost a etprinr nerneraecefaCbnmcaworOceupan .
Signature of Applicant Date
II // 3 U
All roof coverings to be Class 'B" or better
Da¢
Owner or authorised agent