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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