02050030 CITYBUILDING
cuPESION CONTRACTOR INFORMATION:; '
.. HUILDING DIVISION PERMIT
BUILDING ADDRESS:
10169 ' S BLANEY # 4F WALDRON CONSTRUCTION COMPANYMIT D 02050030
OWNER'S NAME: wPPLICgTIONS yR DATE
;LAKE
BE LT
APARTMENTS P 0 BOX 598 05/ 07/2002
-c PHONE:
(408) 377-8186 SANITARY NO. CONTROL NO.
C ce Z ARCHITECDENGINEER:
O BUILDING PERMIT INFO
u i BLpG ELECT PLUMB MECH
_-1
botc
LICENSED CONTRACTOR'S DECLARATION
:ml- 1tion7 ))Ofon thm lam licensof The
Bonder p and
Piofsof Cnepror. id mmecense Job TIO Description
xort , is in fallhueandCfDIVI51on3aforeBusinessandProfessionsCoae.endmylicense INTERIOR RENOVAVATION
E,6 sin full force and eRea.
:oa. Daenseaaaa L;o,n KITCHEN/BATHS REMODEL, NEW WASHER/DRYER &
I u.a. Dore ARCHITECT'S DECLARAno, WALL A/C/FLOOR
a-4 1 understand ter rlan:snail be nsw a:pnbue manor:
i .00 Ltccnxcd Professional �B��p �Ift1
' as Oat I am BUILDER DECLARATION
1 hereby a1Erm that 1 1 exempt from the Contractor's ha License Low for the
tS?r following rwsom(Section)0315,Business and Profe.emoli Cute:Any city nr aunty A I 2 4 2002
CFO pooch requires a permit tobonswn,alma imprr su demolish,or repair any strunure ..
i3m
that
els1. pair q ' the know ralof for Countch rtmttriesignedChapter9
math 'licensedputi ort map Division
me Contmcmr. a nee La (Chapter9
of
_(Immunicarcungwlh5et m.a rD"ann3 hebild.aae ar r. scale) i '� ,, z, FIoo4Area ( u'LD' �Lation
or tin rh is xempt m -fm ad the basis for the ell2ged earemPu n Any violation �' I t` 's t''•' '- P") + 1+-t
of Section 7031.5 by any applicant for a pemut subjects the applicant to a civil Penalty
1 Of not more than Eve hundred do] (s5w). 3 6 Yd1b'bkFP b - Occupancy Type
❑I,as owner of line pmpeny,or my employees with wages as their sole compemmion,
will do the work,and the'stmcm a isnot intended or offered far sale(Sec.7(A4,
Busmesc and Professions Code:The Contractor's License Law does not apply to an 1 U 1 - FOUNDAT RZ3#ired Inspections I
Owne
t of property Who builds or ingttovea thereon,and who Goes such work mmsolf 10 2 - PIERS
or thmugh his own employees,provided that such improvements arc not intended or -
offered for sale.If,however,&a building or improvement is sold%ithin end year of _. 10 3 - UFER ... .. . .. . . . . .. . .. . . ... ....
completion,the owaembodder will have Ne burden of proving that he did not build or ,-
impowerorpurpmenr.ala.) 104 — REBAR
Las owner ooh - -- . _,_. _ -... 105 =—ANCHOR BOLTS
proMny,am exausivelycoProfeisi with ---- --�
.t O truce Law ods no(s<a,1oad Bu.e"f and Professions code:)Tp<ve,nt encom 10 6 - SEWER & WATER
License Law moos oat apply to on owner of property luno builds or improves thereon, .
add who cammms
=xen'� s(orsucjith a a < ransee. tt .ors LiceneLaw 202 — UNDERFLOOR—PLUMBING
Olson
ler eeB�PCfor this reason 203 — UNDERFLOOR"MECHANICAL
°x•'"" 5- - 204 — UNDERFLOOR FRAME
< WOR1hR'SC MPENSATIONDECLARATION. 205 - UNDERFLOOR INSULATION
I nerebyarftrmanderpenehyofperjuty ane Orme mnowingdealamtinna: 301 - ROUGH PLUMBING
❑ I honove,ane will maintain a Ccomedic of Consent to sell-insure for Worker's 302 - 'TUB & OR SHOWER
Cnation ton, as pmvlJed for by section 37W "f the Labor Code, for the
PerfnmtOnce ofthe work for which thisp.I,isleaaed, 303 — ROUGH MECHANICAL
U I lone and win mamddo wartier.Cnmpen,hu n hobos ice,as rest by section 3 04 — ROUGH ELECTRICAL
3700'"(the Labor Code,for the perrnmmuce of the work for which this permit is 3 05 - FRAME
• issued My Worker's Compcnseuon Insurance carter and Policy number we:
306 — HOLDOWNS
Came'
CERTIFICATION OF Policy Nn r
,. ) EXEMPTION FROM WORKERS , t. ' '. ' ,_3 Q.J i '- i'INSU'LATION a,I 'L ':
COMPENSATION INSURANCE Ir
309 _ SHEETROCK.....— —
8.._
'!Th i idne J uu he annplemd f the perm t rs future hundred dollars
(sloo) nesa) EXTERIOR LATH '
-310' INTERIOR- LATH
shall' 1 rtry m t in a<rt nn T m work r which n p�_' t "'. add,l -
coDate
mpenaatt Lowsyof Cal Tom a.ad,hummer as to be,com subject m me Workers 311 - SCRATCH `COAT
NOTCa C _. .. 313 r _ ROOF NAIL
NOTICE TOAPPLICANT If he king th.Cnfcote"fF tpfo you should
Z been WorkersbjctI. he ' C pmoutdoj , fthcLan Cod,you..,I 501 — FINAL ELECTRICAL"ENERGY
zO roan m ply with wchp s1 . Orthspc 't n.nxae ee ked. _ 502 — FINAL PLUMBING ENERG
ti ....
1. t "�cONSTis.coNLEM1'nwGACENCY' 503 - FINAL MECHANICAL ENE GY' '
w '"t 1 rk by firth th t dome s it IS on lending agency for the pertonnenm
?. of the a lura;bra;spemttistasuedlsec.3o99,rv. ., _ 504 — FINAL BUILDING ENERGY'"
y.Q �Lmde Name .. . ,.. -._ ,. .�.. .. - ,
505 FINAL ELECTRICAL
.7'Z LenJe Add est . .. ._ .__. ... _. . ._
U'O 1 centfy mar I has read thin eppl estOn dna sorra mat me above mrnm,adOn is 506 - GAS. TEST .
1. doIagreetOcomplyd heencity dna representatives
nmaives of
ante mwaer upon 507 - FINAL PLUMBING
to building construction:and hereby numorize represemmives of this city to enter upon
y.W me above.memmnep p op ny ter sp atm paryo s.
508 — FINAL MECHANICAL "
�.p„' (Wc)agree to save:indemnify and keep harmless the City or Cdpenino aga;nst
.CO liabilities,judgments,costs and expenses which may in any way accrue against said 509 — FINAL GRA E
V,Z City in consequence of the granting of this permit' "
_ -r APPLICANT "DERSTW51QrN
SOURCERN / NL �POINi NG
Issued 1y3 Date
t. Stgwmre or Appbeant/Conmaemr✓` ^' Date Re-roofs
" HAZARDOUS MATERIALS DISCLOSURE •
Will the applicant or,futum btilJ ng occupant store or handle hazardous material .Type of Roof.
as defined by the Cupemna blurt c pal Cade,Chapter 9.12.and the Health and Safety
Code Section 255321 )^
❑Yes - Jo } - 1 _ r t s e C?• e: :,,:v ,
All roofs shall be,Lnspec[ed,prior to an ,roofing materia] being installed.--...
Will the ireCoptic , r t n Id;ng apt q 'p t de es which
If a roof is installed without firs[obtaining an inspechon,'I agreeao remove
niit he bo a o mm is as d fried by tin B y A Ail cost ly M agement g
n" ' all new materials for inspection Applicant understands and will comply with
1+� 1 have read the huwJ/ins matelots milomments under Chapter 6.95 of the all non-point$011ICe regUlaC10DS.
C-I foram Health&Safety Cade:Sections 25505,75533 and 25531,1 understand that
'i fdpehalcing does not currently have atanam.that it is my responsibilitymno0fy the
0
mupam of the requirements which must be mat prior to issuance of a Cenifirsi of -
txaupOday.
((''ff
Sign atureofAPPlicant
-
Date
OwnernramhnnzcdagCar Due All roof coverings to be Class eB" or better
1 . . ._ ....,. . OFFICE