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CITY UILDF c DrvESIONNDPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS:
10129 S BLANEY AVE # 16J
OWNER'S NAME:
LAKE BILTMORE APARTMENTS
PHONE:
ARCHITF.CT'ENGINEER:
LICENSED CONTRACTOR'S DECLARATION
1 hereby off nn Hiatt In. licensed under provisions of Chapter 9 (commencing
with Spends 7000) of Division 3 f,he Business and Prvfiw fops Code, mull, license
in fail force and effect.
License Class Lic.It
Date Gontmctor
ARCIIITEC'1"S DECLARATION
I understand my plans shall be used as public monis
OWNER -BUILDER DECLARATION
1 hereby atlirm Nal I am exempt from the Contractor's License Law for the
following reason. (Section 70315, Basiness and Professions Code: Any city cur county
which requires a pecour to conem¢t, alter, improve, demolish, or repair any sweo e
priono its issumwe, also requires me applicant for such permium file a signed onement
that he l9 licensed pursum(td thi provisions ofthe Contractor's License Law Ulurpam9
(commencing with Section 7000) of Division 3 of the Brioness and Prpfowiom Code)
or that he is exempt therefrom and the basis for the alleged exemptibn. Any violation
of Section 7031.5 by any applicam for a Pemtitsubjeca fle applicant to a civil penalty
of not more than rive hundred dollars (1500).
❑ 1, as owner of me property, m my employees with wages as their sole compensation,
will do the work, and the SlNctare is not intended or offered for sale (See. 7034,
Business and Pmfessions Code: The Conlracmr's License Law does nal apply m ea
mcaner of property Who builds or improves donem. and who does such work himself
though his own employeesprovided that such improvements are not intended m
offered for sale. If, however, the building or improvement is sold within one year of
completion, the ownba
er-Bder will have the burden of proving that he did not build or
improve for parpnse of saleJ.
vas owner of the propend a, exclusively ro railing with licensed contmetorato
also mt the project (Sec. 7044, Bminesx and Professions Code:) The Contractor's
Ureme Law does not apply to an owner of properzy who builds or improves thereon,
and who contracts for Such projects with a connactorts) licenud pursuant to me
a.
for this reason
1 herehy afar under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Cenificile of Consent to self -insure for Workers
Compensation, as provided for by Section 3700 of the labor Code, for the
performance of the work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as tequircd by Section
37M of the Labor Code, for the performance of the work for which this permit is
issued. My Worker's Compensation Insurance carrier and Policy numter ore:
Carrie": Policy No.:
CERTIFICATION OF EXEMPTION FROM WORKERS'
_
COMPENSATION INSURANCE
(This section need rat be completed if the permit is for one hundred dollars
(at0o)ar less.)
I beatify mat in the performance of Ibe work for which this permit is is sues. I
Shan not employ any person in any manner s, as to become sabjecl to the Workers'
Compensation Laws nl California. Date
Applicant
NOTICE TO APPLICANT. If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you most
forthwith comply with such provisions or this permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that mere is is co.,theima lending agency In, the performance
efuto work for which this permit is issued(Sec MO. Cie. C.)
Lender's Name
Lender's Address
1 certify Ihal 1 have read this application and sate had the above information is
roarer, I agree In comply with all city and empty ordinances and nate laws relating
to building communion, and hereby duthorize representatives ofthis city to enter upon
the above-mentioned property for mspectinn purposes.
(Wel agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, jeFlgmer , costs and expenses which may is any way accrue against said
HAZARDOUS MATERIALS DISCLOSURE
Will the applicam or fiumara building occupant sere or handle hasaNnas roerial
as defined by the CuPnflam Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
Will the applicant or furore building occmpam use egaipmenl or devices which
,all hozardoas air conaminoms as defined by the Bay Arca Air Quality Management
Di,andO
❑ Yes ❑ No
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code. Sections 25505, 25533 and 25534. 1 understand HS,
Hose building dnqq not currently have a tenant, that it is my resparsihility Io notify the
wupr t�the�f2quirememltwhich must be met prior to issuance of i Cer{Ificme of
WALDRON CONSTRUCTION
IIL«:1�:�_ 1�1.�1�iI1Fl�i71
(408)377-8186
ERMIT NO.
ANY 01100016
PPLICATION SUB DATE.
10/02/2001
ANITARY NO. CON FROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I I —I r i I I
Job Description
INTERIOR RENOVATION.
(REMODELED KITCHEN & BATH, NEW WASHER/DRY
WALL FLOOR COVERING.)
��/. LeED
NOV 2 8 2001
bq. rte.rtaenol pg3 d� )' YC?N.�: $34
ity
101 - FOUNDAT]IOpired Inspections
102 - _PIERS
103 - UFER
104 - REBAR
105 - ANCHOR BOLTS
106 - SEWER & WATER
202 UNDERFLOOR PLUMBING
203 - UNDERFLOOR' MECHANICAL
204 - UNDERFLOOR FRAME
205 - UNDERFLOOR INSULATION
301 - ROUGH PLUMBING
302 - TUB & OR SHOWER
303 - ROUGH MECHANICAL
304 - ROUGH ELECTRICAL
305 - FRAME
In 306. ,,s .HOLDOWNS .,,,1., ,
307 -INSULATION '� `
308,1- SHEETROCK '
309 - EXTERIOR LATH
310 - INTERIOR LATH
311 - SCRATCH'COAT
313 - ROOF NAIL
501 - FINAL ELECTRICAL ENERGY
502 - FINAL PLUMBING ENERGY
503 - FINAL MECHANICAL ENERGY.
504 - FINAL BUILDING ENERGY
505 - FINAL ELECTRICAL
506 - GAS - TEST
507 - FINAL PLUMBING
508 - FINAL MECHANICAL
509 - FINAL G
Issued0(` 1NNG
4 �--N g ^ TS^�, Date
Reproofs/ U
Type of Roof T _12D
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection. Applicant understands and will comply with
all non -point source regulations. . .
Signature of Applicant Date
All roof coverings to be Class "B" or better
OFFICE