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CITY OF CUPERTINO
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BUILDING DIVISION PE&T
}CONTRACTOR IN,'FO 'GOON
BUILP10G1A TSESSLANEY AVE # 3D
WALDRON CONSTRUCTION COMP21&y4ITNT2110001
GWFEAKREBILTMORE APARTMENTS
P 0 BOX 598
APPLICATIjNjSls"/lrf 2002
/ /
DONE:
-.(408)377-8186
SANITARY NO. CONTROL NO.
ARCHITELT(ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I7 affirm )ofDihnlamlftheBuicensed nder ng
Division S the Business Professions Code,
onsCare,andpmmenseis
license
withSectiontue
REMODEL-KITCHEIPI;ftYR9 �dALL A/C UNIT,FLOOR
of ssandProfessns
end and my is
nd "Bet
mmneClass dellen.
AND
WASHER�DRYER. i
License Class Lich
�n
Dam Con
DECI,
ARCIIITF.CTSDECLARATION
astll �"il
1 undcntand my plain he re
shall used as public cords
xaj
t
Ii
JAN p^
Liwomed Professional
OWNER -BUILDER DECLARATION
A+ 200'
I hereby affirm that I am exempt from the Contractors License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city of county
which requires a permit to construct, alter, improve, demolish, or repair any swcture
BUIL.nihin S34660
prior to its issuance, also requires The, applicant for such permit to flea signed statement
Ihat W is licensed pursuant 10 the previsions of the Contractors License Law (Chaper9
Sq. Ft. Floor Area Valuation
(commencing wi in Section 7") of Division 3 of the Business and Profusions Cold)or
36903008.00
Nat he is exempt thcm(rom and the basis for fee alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of
nolmon than five hundred dollars ($500).
ApN Number
Occupancy Type
101
- FOUNDATION-
1, as owner of the property, or my employed with wages u fairsok compensation,
will do Nend e work, the suucmre is not intended proffered forme (Sec. 7014, Basinds
and Profesaions Code: The Contrxons Licenm Law dad not apply in an owner of
103
- UFER Required Inspections
property who builds or improvd thereon, and who does such work himself or through his
ownemployeen, provided that such improvements art not intended oroRerad for sale. If,
104
— RE',BAR
however. the building or improvement is sold within one year of completion, the owner,
W ilder will have the burden of proving that be dm not build or improve for purpose of
105
- ANCHOR BOLTS
Sete')'
106
- SEWER & WATER
I, as owner or the property, am exclusively contracting with licensed surmounts to
202
- UNDERFLOOR PLUMBING
co swat the project (Sec. 7044, Business and Pnfessiod Code:) The Conme oes Li-
censeLawdoesnotapplytoanownerof property who Wilds or improvesthemon.and
203
- UNDERFLOOR MECHANICAL
who contracts fo such reorient with a eontncmr(s) licensed Intentionto ds Contentions
Licensela
204
- UNDERFLOOR FRAME
❑lame de e. B & P C for this resson
205
- UNDERFLOOR INSULATION
°once Dent '3-0a-
301
- ROUGH PLUMBING
�T WK OpPENSAT10N DECLARAT! 0N
302
- TUB & OR SHOWER
1 hereby affirm under Penalty of perjury one of she following declarations:
303
- ROUGH MECHANICAL
1 have end will maintain Section 37 0 of tht, Labor
uomuphichthisFrrySccssued,0of the l�Wr Cede, for the Performance of the
Codto e, lure for Wmkera Camce of th-
304
- ROUGH ELECTRICAL
work mrwmenNiapem,aialaaaed. �
305
5
- FRAME
FRAMEHOLDO
❑ 1 have and win maintain Worker's Compensation Inspnna, m required by section
306
- NS
of rhes far which Nupcemit if issued.
ComCnsatiortWurance canner and Policy
My Workers Compensation Insurance artier end Policy numhcr are:
My
3O7
— INSULATION
Carrier: PoliryNo.: r_
308
- SHEETROCK I
CERTIFICATE OF EXEMPTION FROM WORKERT
COMPENSATION INSURANCEii
309
— EXTERIOR LATH
section need not be completed ifthe permit is!mune hundred dollais($100)
310
- INTERIOR LA1 H
r leM.(This
I ceniry that in the for is lhall
311
- SCRATCH COAT
a , oce the work which Nis Permit issued. I net
employ any parson in ans'jq "rssbAcCp;s g- Ne Worken'Compedetion
313
- ROOF NAIL
Lawaorcanfomia. Dw� /1
501
- FINAL ELECTRICAL ENERGY
Applie
502
- FINAL PLUMBING ENERGY
NOTI APPLICA . LaftermaktngthisCcniricncofExcmption,youshould
Wco ulau"thcWorker's Compensation Provisions 0('he Labor Code. you must
roMwith comply with such Provisions or this permit shall W deemed minified,
503
- FINAL MECHANICAL ENERGY
504
- FINAL BUILDING ENERGY
CONSTRUCTION LENDING AGENCY
I hereby aMr. that Or.iso comtrunion lending agenry for the pa,ronmurecof
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
505
506
507
- FINAL ELECTRICAL
- GAS TEST
- FINAL PLUMBING
I,enderaAddmss
I cenify that I have read this application and state that the above information is
508
- FINAL MECHANI CAL
corrttL I agree to comply with all city and county ordinances and state laws relating to
building concoction, and hereby audience representatives of this city to enter upon the
5
FINAL GRADE
above-mentioned property (or inspectionpurposes.
s (We) egret to save, indemnify and keep harmless the City of Cupcnino against
1O
FIN G
liabintiis, judgments, costs and xpenseswhichmayinany way acerae against said City
5
F N LI WORKS I
inconsequenceofthegrintin fthispermit.
APPLICANT UNDER...yyy.y$$.��rwwww��a�a��aa3L S AND WIL COMPLY WITH ALL NON -POINT
Issued by:
Date 1
SOURCE REGULATIpNS/��
Re -roofs
Type of Roof
. / _ —��
Signawre of Applicar Dam
H
HAZARDOARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
u defined by NCe
e Cupertino Municipal Coda Chapter 9.17, and the Health and Safety
Code, Section 25532(a)?Ycso
All roofs shall be
inspected prior to any roofing material being installed.
the applicant or future Wilding occupant use equipment or devices which
[f a roof is installed
without first obtaining an inspection, I agree to remove
kWill
ih
t rmdous air contaminants as derby the Bay Area Air Quality Management
all new materials
for inspection.
triear?
❑ Ycs
Iheve read he haxardrms mamrial5 mquinmenu under Chapter 6.95 of thu Califon-
t
nia Health&Safes Code, Sections 75505.]5533 and 25534.1 understand thu ifdtct Wilding
t
n
dins nor cu have a tenant, Nat it is my responsibility to notify the recupilm of the
real ah mast npriormissuanceof. Ccnifia¢oracupan t
� Signature of Applicant Date
� «' �(
e
All roof coverings t be Class "B" or better
Owner or auNnmeJ agent Date
C
CITY OF CUPERTINO
RIJTLDING PERMIT APPLICATION FORM
Building Address: vp o; bD
I l�� 0
Temporary Bldg Permit
Owner's Nam:
LAKEeILTM02E PPARTM
Phone No:
GSD
S`16-5'300
Contractor:
g. CousmQ Tiot4 nlc .
License No:
Energy
Contact s wEAtIEK I I'"zcr PGKL.
Phone No: LGp
Syb-530$
Architect/EngineerLicense
S uem SwcLA14 CS S
No:
Inspection Overtime
Applicant/Contractor:
<MO" APAerMc-ntrs
BPERMFEE
Bldg Permit Fees
Building Permitlnfo: (circle one)
BMITIGAT
Housing Mitigation Fee
Bldg Ele Plumb
Mech
JtfDescription: 11`fTCR. m FZ4NVVA rlo4 11,3
RBM6De4-C-0 W
Ba i l
1j8W WA6gt:fae.lpeYea. , NEW w&w-Ale-, NEW Ftme CouERIfJG
BUILDING
Residential: MWN-FAMILY
Commercial:
BUILDING
Sq. Ft. Floor Area:
$/Sq. Ft.:
BUILDING
1000 S1=
Scb Specific Plan
BUILDING
APN # (Must provide):
Nol-03-DO 4f
Valuation
o
Type of Construction:
Occupancy Group:
R I
*ty. if Fee ID
Aoalicable
Fee Description
Fee Group
BTEMPPERM
Temporary Bldg Permit
BUILDING
BCONSTAX
Construction Tax
BUILDING
BENERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BOVERTIME
Inspection Overtime
BUILDING
BPERMFEE
Bldg Permit Fees
BUILDING
BMITIGAT
Housing Mitigation Fee
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
I BPLANCKADD
Plan Check Add Multi
BUILDING
BPLANCKREP
Plan Check Repeat Fee
BUILDING
BREINSPECT
Reinspection Fee
BUILDING
BSCBLVD
Scb Specific Plan
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
ESPECIAL
Special Inspection
BUILDING
BSWIM
Swimming Pool
BUILDING
ZADDCHG
Address Change
BUILDING
ZoZ73
77.3.1