02060204 ' CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTR'ACTOR INFORM'ATIONi
6T16TNt1I9DRgssBLANEY AVE # 9I WALDRON CONSTRUCTION COMP MITnO60204
AMA"SILTMORE APARTMENTS P 0 BOX 598 APPLICAUle/IJ28A/122002
PHONP.:,,' (408) 377-8186 SANITARY NO. CONt'ROL NO.
O zQ ARC HITECP/ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
1_I GJ L._.I
5 w Z LICENSED CONTRACTOR'S D17CLARATION
1herebyaflUmmatlamlicensed underprnvisninsorCharter9mmnminning INTER.RENOVATIOIIPpI�L596I E'= KITCHEN AND BA
_bw wilds'ItfencPlin'efoi.isirn3rnnaBasim<ssamdrrcr<sirmerde.andmyuee"Se NEW WASHER/DRYER, NEW WALL A/C, NEW FLOOR
,ez-< tLI cnae Mask � Lic,a
o O.y.V .Doc Camrnemr
1'.3 a,o -ARCHITECT'S DF.CLARAI ION
E 0 `I understand my plans snail nm used ns puhlm records -
i i p C Lice.need Prrleseional
'u,o.�y b di O\At I canBUILDER m loo CtAT10N ,
1 M1e ason. ce tom 1 am exempt,7070 loo Conua Co License Luw finco the
:w M ',hielfirl—f red re a so n.Ilumn"I ]031Ser,alleasond Arofesaolih.or1 Any city ItmUlty -
z€�
'wbh q - P 'n t f 1, 'inp cdml'.I r p' Y.wcure $34660 _
370 ,pn t . 9 a i'pl- r h purmil 1.filecar .... . _ .. . ...-..
'In f 1 edp a t 1.the p ` :drue
afire Chianti' n. Law( ,pt 9 Sg[j -Ft,,Ploor Area3 , t Valuation
'.(ro Ingn
. h Sec on]tpo) for,: n
3 B 'n aProfession,
cel t 36903008 .'00 "
or that be,s exempi,hereto mind the h s s fnnhe alleged excmpYun.Any.tole.rn -
1'ofS i ]oiLS by yppl' mfrupe l:ubj e.c the aDPbcnnuonc vii penalty
rr 't m m 1 n d a d u .as0rp. APN Number Occupancy Type
111,ati'ou,ncronhe PenY.or my employees wen wages as their sole compensation, 101 - FOUNDATION
will do9he work;Dna the ore The is Dat intend Lie offered for sale(Sec:]1144.
ram.of and Profession,cd,o The License Law ares nr,apply m on Required Inspections'
qw ilpnywl n 'le. �- p .m a n d n kl,imseu 103 — UFER
>urn gl'l e ply p admt an r ,, et. l uncured or .... 104 — REBAR
{'nff 'd f 1 If,however,.he building or imp,memenl Id will one leer of
'c
n'dldi i,'heow,erbulderwllnavetheburdenofpro.igtM1thedidnotbuildor 105 — ANCHOR BOLTS -
,i of prp r. l ). .. 106 _-..SEWER & .WATER....
_ .
PP Yen Br,ia ly frc ,iwto I' serfe Contract.,
ontrct
as <' foe n 202 - UNDERFLOOR PLUMBING
crnmmu,he pmjecf fSec ]044,Basin d Profess'on. CrdeJ The Cnnwcfors
License Law does not apply to an owner of property who builds or improves thereon,
and who cast for.such propels with a eomramo,(,)licensed parson,m me ?O3_ — UNDERFLOOR MECHANICAL _
' .0 1 , 204 License Law ._. .- _UNDERFLOOR .RRAMS _ ..
" �❑1 mp ae�P � - ,B&F' for this reason
- ,
owner IGU - -Date - -�Do1 .. 205 - UNDERFLOOR INSULATION
,[: •' WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING
In by auraltndcr.penm,yofP i.ry a,,cf the following e laratmm 302 - TUB & OR SHOWER
I i[7 1 lose end "iii maims n u Ceaif 1 f Consent mns'clf' re for workers 3 03 — ROUGH MECHANICAL
vl� ,co Pcn , n •prc.aed far by S . 3700 of m Ln Code for the 304 — ROUGH ELECTRICAL
perrermaneenflnewarkmrw9dahIII,pemiDisissued,. 305 - FRAME
J
i❑I h d sill mu i Wok C pe f bn uronc recoiled by S cion
f ,3700 'f d Labor Code.forrt the D f t work r which this ansru is 3 06 - HOLDOWNS
.is' ❑ MyWorkers,C mp ,. ,on Insurance ndP Icy number are: 307 — ,INSULATION„
Carrier; r l e :r '',Policy No.: 308 ; a,SHEETROGK 'y,.
I CERTIFICATION OF EXEMPT ION FROM,, ORKERS
b '', _COMPENSATIONINSURANCE - ; 309 EXTERIOR "LAT, H _
` (This secdom besd not be completed lone permit is for one hundred dollars 310 — INTERIOR LATH'
Isiool„rless.) 311 — SCRATCH COAT
n 313 ROOF NAIL -
'' Ic fy thin the prf ce of work 1 hp
thsrmit is is uedl 1t
'shall not ply any person say mann r sit as to becomes Meet to the Workers
Compensation, Laws.rclfn ia:Datc -- 501 _ FINAL ELECTRICAL ENERGY
'Appl c nt - _ . .. .
NOTICE TO APPLICANT,Ir Dermal. gtl Certircare tE mpaon,yon snrnld 502 FINAL PLUMBING ENERGY-, .
Od?cdme subject m the Work„Compensatinnpm. inns of.he Labor Cade,yna must 503 — FINAL MECHANICAL ENERGY
forth fh plj wi0 "hp visionso tti.p lit shall bad and revoked.
Haa i 1ne o-
CONSTRUCTIONLENDING AGENCY
504 FINAL BUILDING
ENERGY
NERGY 'an.... ld,reiinl...
Jim edmgng agency rerrrr n�e 505 FINAL ELECTRICAL .
Leine work to, lhich. p ls- sit d(S 309] Cv C)G, Le ae Name 506 GASTEST -
.
..
p z Led Address • 507 — FINAL PLUMBING,
1 cidif, not I blieconaltht ap,lit,iflian adstate that the above informa,ion is 508 — FINAL MECHANICAL
laC(~ corwin.I agree to comply with all city and county ordinances and state las relmm,
Q'O mbuddingcrash...firm,a adherchyauthorimrepresentativesofthis citytoewmaropen 509 — FINAL GRADE
the abmic-men,im ed D,o,,rJy far is podium Puepoxes.
F p,,, Iwe)agree 16indemnifyandYanaha ss'fheCityofCpnimo gains. 510
FINAL PLANNING
h Ba61 t i dg in c a xpense h h may m any y ,again t sold 514 - F NA P WORKS 1
V ,� City n 9 ce f0 yin I gohM1 p t. ..
APPLY DE NDSAND WILLCOMPLY WITH ALL ON-POINT ! ' r
soURCE Rri, by: D
T _ �� Issued
Signature r(ApP lie matContmetin
HAZARDOUS MATERIALS DISCLOSURE /• Dale Re-roofs
)kill m ppa< i f t building
azi ,cell (store rr ameHeimasiSafety
al Type of Roof
d f db he Cop n M el,alC e Chapter 9,12and ae
c ae Section
...
25532(1 " If a roof is ;
oY stalled without first obtaining an inspection',being.insta_rem ..,.
All roofs shall be inspected prior to any roofing,material
,being,
d the I,pial t n rc building occupant l p t p.aces.n en g p ;I'agree to remove
ei .h tl e r n tam n . a'a m e n the B A Av Quality Management
rn, , 9 p understands and will comply with
r r v
❑Ye - N all new materials for inspection. Applicant
J all non-point source regulations.
I.ba a read the lmzardrus mann 1 r hib nm to made,Cha ter 6.95 of the
California lhalth&Surety Code,Sections 25505,25533 and 25534.1 understand that
if building does no,curremly have a¢nant.that it is my......ibil ity to notify the
O c p o yf he cyu remcn t b .prior to issuance f e CeniGcate of
p /l/�
_ Oc _
41W7_3 Signature of Applicant Date
rope:ca g p, - I Dole. All roof coverings to be Class B"or better
- '- ' OFFICE