02050031 CITY OF CUPERTINO
BUILDINGpIVISION PERM& CONTRACTOR INFORMAON:
BUILDING ADDRESS: PERMR NO.
10129 S BLANEY # 16F WALDRON CONSTRUCTION COM ANY 02050031
OWNER'S AME: APPLIC TION S B DATE
LAK BILTMORE APARTMENTS P O BOX 598 05,07y2002
PHONE:
(408) 377-8186 SANITARY NO. CONTROL NO.
p 2 ARCHITECT/ENGINEER:
O❑O❑ BllILDING PERMIT INFO
W ra BLDG ELECT PLUMB , MECH
u u u
5 m Z LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affmn that I am licensed under provisions OfChaptcr Caux9(cam Mcin
'„_°y wish 5 tionJ000)ofOivision3oftheBusinessadProfessiouCode,admyliccne INTERIOR RENOVAVATIOI�
yE ;xinFall fare,andeeat. Lic.e KITCHEN/BATHS REMODEL, NEW WASHER/DRYER &
w 6 Licemc Clan
a i)rn:OWU Datc ARCHITECTS DECLARATIONa^ \ �r,,A •�I''�';'L A/C/FLOOR
g 1 understand my plans shall be un p
sed ublic records U\1 e
' 2p02
t-O O Licensed Profesatonal
'6 OWNER-BUILDER DECLARATION 1
iI hereby AM—that I am exempt from the Comroctor'a License Law for duel
g following reason.(Section]831.5.Business and Professions Code:Any city or county
N F o which requires a permit to construct.alter,improve,demolish,or repair my swcturc G
i3� priorm its issuance,also requircxthe applicom forsmh permitmBleasigned sm,ement its �,•�
that he isliecnsed pursuant to the provisions of the Conuanori License Law(Chapmr 9� a� S Ft..Floor Area,,.(commencing with Section 70W)of Division 3 of the Business and Professions Code) . q. $346WWation
or that he is exempt therefrom and the basis for the alleged exemption.Any violation t -
-of Section]031.5 by any aDPlicmt for a pcmdt subjccu Ne applicmuo a civil penalty
of not mom than five hundreddollars(s5W). 369'CP dx�3 b�0 Occupancy Type
01,u owner or the progeny,ru my employees wire wages as their r a compensation,
Bus do the work,and the odeTstructure is not;landed en offersd for sale(Sec.]Baa, 101 — FOUNDAT
owner o and Pro solar,
case:The cm there;.icenseAM w law a«s raw apply tam hired Inspections
owner of property Who loilex or;vides t ,hereon,std who docs inch wink himself 10 2 - PIERS
of through his own employehowever,t building
that such;eme nt is said
are not intended or
oRcred for sale.IL however,the building or Improvement Prov n sold within one year of 103 - UFER
completion,the owner-Wuhder will have the burden of proving that he did not build or -
improve mrparpoaatsnl<.). 104 - REBAR
n owner of the property,am exclusively contracting with licensed contractors to 105 — ANCHOR' BOLTS
n von the project(Sec.7044,Business and Professions Cade:)no Contractor's
License Law does not apply to an owner of properly who Wilds or improves thereon, 106 — SEWER & WATER
.and who contracts for such projects with a commercials)licensed pursuant to the 2 0 2 - .UNDERFLOOR PLUMBING
Commuters License Law. .
❑lam exempt tier Se ,B A P C fonhis reason 203 - UNDERFLOOR MECHANICAL
owl DinaD�. 204 - UNDERFLOOR FRAME
t OMPENSATIONDECLARgT10N 205 - UNDERFLOOR INSULtATION
Ihereby affirm under Penalty ofperjuryamonh following declamations: 301 - ROUGH PLUMBING
Q I have and will Amounts a Cadficam of Consent to Alf-insure for Wimker's 3 02 — TUB & OR SHOWER .
Compemation, n provided for by Section 3]00 of the labor Code, for the
petfi na um onhe waA far which this petm;t is imam. 3 0 3 - ROUGH MECHANICAL
01 have and will mainuin worker's Compensation Insurance,as required by Section 304 - ROUGH ELECTRICAL
37M of the labor Cox,far the pnfarmince or he work Por which this peemit is 3 0 5 — FRAME
issued.My Worker's Compensation Insurame canter end Policy number are:
Carrier: Policy No.: ” 306 - HOLDOWNS '
CERTIFICATION OF EXEMPTION FROMWORK RS', '307 - ' INSULATION' '
COMPENSATION INSURANCE .308 SHEETROGK-
l i section need not be completed if the permit is for one hundred dollars
($1(113)A,
ar Rax.) 309 - EXTERIOR LATH ' '
I cmify mat m the performance of
wmk for which this Peroat is issued.1 310 — INTERIOR LATH -
shall not e.play any person in any manner su as to become subject to the Work<n' 311 - SCRATCH>COAT
Compensation onLvwsorcaliraroia.Date 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT.If,alto reeking flits C<roReate of Eaempdom you should 501 - FINAL ELECTRICAL ENERGY
z become subject to the Workers Compensation provisions of the labor Cada you must
Q 0 forthwith comply with such provisions oe this permit shall be deemed revoked.
502 - FINAL PLUMBING ENERGY
a.Z."rn CONSTRUCrIONLENDINGAGENCY 503 - FINAL MECHANICAL ENERGY
.,? I hereby Affirm that mere is a consmction lending agency for the performance
of the work far which this perm,is issued(Scc.3097,Civ.C.) 504 - FINAL BUILDING ENERGY
W Q Lender's Name
Pa' 12 Lme<rxAderexx 505 - FINAL ELECTRICAL
U 12 I certify that I have read this application end scorn thallic above information is 506 — GAS TEST
GL Fconch.I agree to comply with all city and county ordinances and state laws miming 507 - FINAL PLUMBING
U to building construction.and hereby aumoriceminesematives of this city to enter upon
W theabova-mmlinuAdPropertyformspecaampurposes 508 - FINAL MECHANICAL
a
(We)agece unitive,indemnify and keep hum ass the City of Cuprome against 509 — FINAL G E
h liabilities,judgments,cents and expenses which may in any way accrue agaimt said
V ► City in consequence of the gearing of this perath.
APPLICANT U.�' ERS�lryt,xNOS AND nTLL COMPLY NgTH ALL NON-POINT Issued 510 N NG �J
SOURCE REGGLATLl1,Yys. b3r1 Date
LL x-9-0_
Stgni ture.of Appbcam/Conmer« 'Dam
Z==
HAZARDOUS MATERIALS DISCLOSURE Re-Ioofs
Will the applicant m limn building weupant store or hurtle haurdws mated d Type Of ROOF
as defined by me Cottonton Municipal Code Chapter 9.12.and the Health and Safety - -
Code Section 25532(.1 ''�Yl'
❑Yes I LJ�o -
// `` All roofs shall be.inspected prior to any.roofing material being installed.
Will the air emiat r t re Wti in «<ap.n,axe<gaipme t or devices which If a roof is installed without firs[obtaining an inspection;I agree to remove
emit heaardous nn comaminants u defined by the Bay Amo Air Quality Management
Distinct] ss,,// all new materials for inspection. Applicant understands and will comply with
' ❑vas 91. - . .
/ all non-point source regulations.
I have Health
the hmCode. materials 505.2 533 A under Chapter 6.95 of me
if did Im i Health s.Sefcur Cade,Sections ant.that
it
and xpensi 1 int to notify
that
if cU building dm not currently have a tenant,Net it is my ruponsibili,y to notify me
o«upam o!mer rtmenm which must be me,pdono issuance of a Cenificam of '
aeawney.
.. - 4 �ii,'06CGfLC Signature of Applicant Date
5 H--D�
-. Owner oreumonudegcm _
Data All roof coverings to be Class `B"or better
OFFICE
CITY OF CUPERTINO ' -
I1HILDING DIVISION PERMIT 'CONTRACTOILINFORMATION; ,
BUILDING ADDRESS: - PERMIT NO.
.10129. 5 BLANEY # 16F WALDRON CONSTRUCTION COMPANY 02050031
�'1B WNER'S NAME APPLIC TION S DATE
LAKE 'BILTMORE APARTMENTS P 0 BOX 598 05707y2002
PHONE: (408) 377-8186 SANITARY NO. CONTROL N0.
❑z 2 ARCHITECTIENGINEER: BUILDING PERMIT INFO
E 0 0 BLDG ELECT PLUMB. MEER
de
LoB"i t "LICENSED CONTRACTORS DECLARATION
Z N 0 1 h 1, firm,h,I 1 ed d p ns of Chapter 9(commencing lOb Description
?yF� with Section I000)atDivi on3oftheBusinessandProfessionsCode,andmylicense INTERIOR RENOVAVATION
�E is License Class lass darca<,. KITCHEN/BATHS REMODEL, NEW WASHER/DRYER &
C Lireme Gass Lic.# -
Date ' Continent, WALL A/C/FLOOR
7 3 u y , ARCHITECT'S DECLARATION
•1 understand my plans shall he used as public rewMs
}
e O O Liranmd Professional.'
' OWNER-BUILDER DECLARATION
'1 hereby affind the,I am empt from the Counselor's License Law for me JUL 2 4 2002
I-.z a fallowing reason.(section 7031.5,exBusiness and Professions Cody.Any city or county
F,
n,FD wn h 9 permit t t It p d I'M1 p- dstructure
ista�.F� . . .. . . ...... ..... .._.
333 ato is vendmilptursunnimme . nn Command's L La (Chapter 9 Sq.Ft. Floor Area D1 6�At}Iation
ofmuSerum Icomenng with Sec7000)of Dvi" 3 fm Basin,,,e MProfessionsCode) k. , f, A:-- .l-' AM
or that he is eaempi rhmfirom'and the has far the alleged ekempuo,Any violation `
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of not more man five hundred dollars($e00) 3 6 g�pY(� liM Occupancy Type
❑I,as ow nor of the properly,fir my employees with wages a, her,sale compcnsamr, '
will'do the work,and the structure isnot intended or offered for sale(Sec.7044,
Business and Professions Cade.The Cmmmpmr's License Law does not apply to an 101 - FOUNDAT RWIred Inspections'
owner of properly Who builds or improves,he...a.and who does such work himself 102 - PIERS
or through his own employees,p d d that such improvements are no,intended or
offered for amt B Immemn the t iding thommodent is sold within ane year or . -. . . 103 = UFER
a6deple,dinme ov,no-braildr,Aid h edid burden he did a.,b Id or
on"pose for p p f l ), 104 - REBAR
.. s ..s its -P P nY . toe IYcounting n licensed van r m. .. _.. -10 5 — ANCHOR- -BOLTS
4tthpoiject(s 7044 e .siness aaP f '...C.dc:)The c ,rat 's 106 SEWER & WATER
Lice se Lax does no,apply to an owner f property ho builda orbuildimprove,thereon
.and who earn rans forsuch pro)ec,s w'm. comments)tire...d parament to the _ . ..... '2.08 _ .UNDERFLOOR PLUMBING - • - - -- - --- -
. Cot t 1¢cote La � '
111mosachipt dais s B&PeBerlin,..,.a 203 - UNDERFLOOR MECHANICAL
5 q 01 204 - UNDERFLOOR FRAME
it t?fw GMPENSAT1ONDECLARATION 205 - UNDERFLOOR INSULATION
n<req-arfi,m ae penwty asp 1 D ane tone loll g a I atmos: 3 01 - ROUGH PLUMBING
14302 - TUB & OR SHOWER
❑ I ha a and will m m Cevific, f C nventm self insure for Worker's
e°tape,aaani iewokmawn��nninisSection
,ism, me Labor Code, for m` 303 — ROUGH MECHANICAL
performance° ,amrd
❑1 have
ana'wiu mah"m1;Workers Compemillim Insurance,as regiii:ed by sec,mn 3 04 - ROUGH ELECTRICAL
37W of be Labor Cade,forme Pnrroimanne of me work for which this perms,is 3 05 — FRAME
sx a My W k a C pe et I sur ,ilei and Pol cy tbar era:
306 " HOLDOWNS •-...
C�,.i CERTIFICATION OF EXEMPolicPTION FROM WORKERS +.5. .307 : ,•!°INSULATION
. COMPENSATION INSURANCE SHEET-ROCK-
(This sectionneed notb compmid if the permit is for one hundred dollars 309 — EXTERIOR LATH -. ..
..pp I a onLaws fcIrm,a:Dina n hth corm,r,iss d 1 - .. 310 . - .INTERIOR OATH
shall t ploy yva yin nn kfxrtme blct, meWorkers
311 - SCRATCH-'COAT - '
a
Compensation 313. - ROOF NAIL
•-NOTICE TO APPLICANT 4f ft ..king thCenificae of Exemption,you should
z be< a ppeetothe W k Compensation provisions oftheLaborCodryoumus, 501 - FINAL ELECTRICAL-'ENERGY
C) O font th comply with inchphavi,for,or ti parrait hall be Seemed,worked. _ 502 - FINAL PLUMBING ENERGY _
CONSTRUCTION LENDING AGENCY
i' Ina nyaffi,mthatthee saconst cion]codingagencyf me pent; 503 - FINAL MECHANICAL ENERGY
mance
arm oSintwnien ". .en ,t, isned(sn3097,Cip.C) ,I, 504 - FINAL BUILDING ENERGY,
y.q
Leri Nanie - .. . . 505 FINAL 't ELECTRICAL .._.. - .... . ..._..
Led s Add
ta.1.O
506 GAS TEST
1 dartitye t I hav
a readtn ppli , and state that the binformation'$rarre g t ply nt h TYa ac ,y a a t ,moo507 FINAL PLUMBING
L, banconstruction.ano hereby authorizerepresenWt vas trio ac,y to ante upon° mepeteeprpef,for inspection purposes, 508 FINAL MECHANICA
move-
O Jagree tosave;indemnify and keep hamtless
theCty of Cpenin,against
V] 509 - FINAL GRA
U City
t ar E �••� �
liabilities,judgments costs and expenses which may in any ay accrue ainn said [J V
U Z City m q fm g Ing arm permit. 10 N NG
ti APPLICANT U
RHG i i:Rl NDS AND WILL COMPLY WITH ALL NON-POINT
5
Issued b51 Date
Signature dApplica ,C , t . Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE'
Will the name,or future tr'Iding occnpim shot or haeme hazarded,material Type Of Roof : .r.: .. . ...--
as d fn d by the C.,amima Municipal Coca Chat and the Health and Safety
Code Sem on 25532G,1
t°ve All roofs shall be insp acted poor to any roofing material being installed.
�m
Will the future building pat use w p , devices which If a roof is installed without first obtaining an inspection;I agree to'remove
Yd's
t
D r r Costly s men all Don-point source regulations:" P _ stands and will comply with
commandoes e
n qu rented A IFl Mafia - .i p ..p - - .,.
all new materials for inspection. Applicant node
k's-19
p _ ❑Yes °-
' I haveread he hazardous rmsmnals re rm order Cha ter 695 of dre
California Health&Safety Code;Sections 25505,25533 end 25534,1 understand that
if,hebudding does not ammmly have a tenant,that it is my responsibility to notify the
Oc ^ "g �D� s,be met prior t is 'nfs Cenate of
ifc
occupant, f/mel m n�which
/.hiSignature of Applicant Date
P Y
Owner maamm:ea fit Da,a All roof coverings to be Class "B"or better '
,
j
-OFFICE