03040001 CITY OF CUPERTINO `k`'-°�`°`" `'"�' �i° '"�`'�b '�
BUILDING DIVISION PERMIT CONTI2A.Ci'QR TN"T��•"A'" V1 TAfiTONN
BUILDING ADDRESS: PERMIT NO.
10169 S BLANEY AVE # 4G WALDRON CONSTRUCTION COMPANY
03040001
s OWNER' NA E: PERMITISSUEDATE
5LA{�CE BILTMORE APARTMENTS P O BOX 598 04/07/2003
E: SANITARY NO. CONTROL NO.
(408) 377-8186
ARCHITECr/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
yoD LICENSED CON7RACIOR'S DECLARATION Job Description
I hereby sill=that 1 em licensed under provisions of Chapter 9(commencing P
^� wbb Sxtion7")of Division 3 of the Businearend Professions Coda.wd my license is
Nfull ense us see.w reeena eaar INTERIOR RENOVATION-KITCHEN & BATHRMS REMODEL,
Re Daft
Date Comredltar
ARCHITECTS DECLARATION WAHER/DRYER, WALL A/C, FL. OVERING
1 underYend my phos atoll be used u ublic ramda Pi
Qa G p
3�� Licensed Professional M 4R`r �®
OWNER-BUILDER DECLARATION ��
I hereby affirm that 1 am exempt from the Contraoar's License Law for the O 4 L x)003
0 0 following mason.(Section 7031.3,SWAM end Profcrsions Code:Any city or county
$_ which requires•North to construct.site,improve,demolish.or repair any structure
prior to its lAsuenx.aisurequires the applicant for such Permit to rile a signed Moment
G that he 1.licensed pursuant in the pre,hdresof the ConBacun's License law(Clu'ler 9 Sq.Ft. Floor Area DUILD�'aluation
$ (commencing with Section 7000)nf Division]nithe Business and Profaldons Csm IN
Code)
.. But he Is exempt theurmm And the hub far the alleged esonptiom Any violation of
Saxton 7131.5 by any applicant for a Permit mbjeeu the applicant to•600 penalty of - APN Number Type
not marc Nan live hundred dollars($300),
_ ❑I,uownx of the pmperty.ar my empla)su with x+gxu Netr sole rnmpenution,
-:I69n-i002 no
wllldo the work•end thesvuctum is not intended orofAed for sale(Sm.7044.Businals Required Inspections
and Professions Code:The Contractors Lmense Law docs not apply to an owner of q P
property who builds or(mprove themon,and who dcasxh warkhimselfor through his 101 - FOUNDATION
own employees,provided Nn such improvements are not In¢nded cr offered for sale.If.
however,Ne building or Improvement issold within one year of completlon.the owner- 102 — PIERS
Wilder will have Ne burden of proving that he did not Mid ser Improve for purpose of
103 - UFER
Asia.).
as owner of the property,am exclusively contracting with licenud con excmn to 104 - REBAR
n met the penjod(See.7144,Business and Professions Code:)The Contractors Li. 105 - ANCHOR BOLTS
ceme Law deal not apply in an owner of property who builds or improve Neeson.and,
who mnvacts for such projects wish a comnnot(U licensed punuam to Be Contractors 106 — SEWER & WATER
License Le
lame apderhii S a& jf for ,recon 202 - UNDERFLOOR PLUMBING
Owner �WDam .",P' y�3
203 - UNDERFLOOR MECHANICAL
rVp09 RYK[BRS COMPENSATION DECLARATION 204 - UNDERFLOOR FRAME
I hereby affLm under penally of perjury oro of Be following detlanlions: 205 - UNDERFLOOR -INSULATION
have Ad will maintaln a Cenlficamof Consent to self-Insure for Workers Comrv:n- 301 — ROUGH PLUMBING
on,As provided for by Section 3700 of dm labra Code.far the PC,(....of the
We*for whichthis permit is issued. 302 — TUB & OR SHOWER
❑1 have and will maintain Worker's Compensation Insunna.An required by Section 303 — ROUGH MECHANICAL
3700 of she labor Cede,for the aformince of the wort for which this Permit is issued. 304 — ROUGH ELECTRICAL
My Workers Compensation luummc carrier and Policy number au:
Cartier: Policy No.: 305 - FRAME
CERDFICATE OF EXEMPTION FROM WORKERS' 306 — HOLDOWNS
COMPENSATION INSURANCE
('ITh section need not hecompleted from,remit is forom hundred du0ats(gf00) 307 — INSULATION
mlaa) 308 - SHEETROCK
L eenify Nat In me perfn ensu of N, ark for which this Permit is issued,l shall not 309 - EXTERIOR LATH
employ any Ncrmn lnuncran d�mA':)�esubJxtm the Workcn'ComNeMO..
LawsarCalifomi .Da ��� - �/(J _ 310 - INTERIOR LATH
NOTICE
OTI 311 - SCRATCH COAT
NOTICEbj AP CANT:IC ellermakingthis vild..or the
Ube,lCadyouahooJ
become hmoo m the workers Compensation provisions of Ne labor vub cyou must 313 - ROOF NAIL
'JD forthwith moody with such STRUCnsar this NDINshall be NY ranted. 501 — FINAL ELECTRICAL ENERGY
CONSTRUCnONLENDINGAGENCY 502 - FINAL PLUMBING ENERGY
(.n.+ 1 thereby kforwich thi Ne Neulsamutm.30 lending agcrxy forthc Performance of
a�
the workmrwnicnthis pennitisiAsaa(sa.3097,Civ.c.) 503 - FINAL MECHANICAL ENERGY
u)La Lender's Name 504 - FINAL BUILDING ENERGY .
=z Lender's Address _
U O I unify that 1 have read this application and mom that On above Information Is 505 - FINAL ELECTRICAL
(rr F cancel.l ague to comply with all city and county ordinances and sum laws minting to 6 - GAS TES T
C)V building coeswsan,and hereby authosim representatives or this city m entry upon the
(ta above-mentions property for fesmetion purposes. O"— F
L PLUMB NG0 (We)agree to save,indemnify and keep bamlcAs Ne City of Cupertino against AL
y Iiamillllta.JYdgmCrN,eenh MdCipenSCf whish may In any Way axNC agelaat Hld City Of the
Of
da
U APPin LICANT UNDERSTANDStAND WILL COMPLY WITH ALL NOrmit N-POINT Issued by: 5 Date
SOURCE REGULATIONS. Re-roofs 514 INAL PUBLIC WORKS
Signature of AppliculAZARDO Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Applicant orfuture Wilding occupantmore ar handle Health and
u dells by the Cupertino Municipal Code.Chapter 9.12.and the Huish and Safety
code,Section35533(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
Will the applicant or future building occupant use equipment car devises which If a roof is installed without first obtaining an inspection,I agree to remove
It W.umua air contaminants As defined by On Bay Arca Air Quality Management all new materials for inspection.
tsict7 /
❑Yea �y
I have rtW the Warden materials requirements under Chapter 6.95 of the Califor.
niaHulN&Safely Code.Sado¢25505,35533 and35534.1 undcamnd thrtif dm tuilding
deal not cu I hew a manor Nat it is my responsibility m notil occupant M the
red hatW tdaipr!YlssuaneeofaCertificate 7/G7 Signature of Applicant Date
uL/JI(Kn1L l
Owner or authorised agent Dam All roof coverings to be Class "B"or better
"Y -
S CITY OF CUPERTINO bei a"
S' CUCITY
TYOF O PERMIT APPLICATION FORM o
7APN# Date:
Z7-03
En , ss:: Phone#:
E BILTMd,e>; ArGfi�2TM»17S (off rJ9/v-5300
Contractor: License#:
910kpRopl &ij5TEAmoA lix 77037
Contact: Phone #:
CM5 W E2 jp sir MaiJa6er- (iso �i� -5308
Applicant/Contractor: Fax#:
LMCE LoRt; AQAOT-Mn --1 Gsb r�/6- 537
-13ufiling Permit Info:
Bld Elect C Plumb Mech
Job Description: u i3Oa Ke+aJA�� 101WAbi oDetf?D KIrWEwI Au ) keW WA-14MIDWrizi
Residential: MuLn_ FAMIL Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
1000 SF.
Architect/Engineer: Valuation:
kAYMum)o STAU&M SINCLMe RSS "/ 660
Type of Construction: Occupancy Group:
RI
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BNEWMULTI New Multi-family Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
Ah BNUCOMMNI New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
Z(S
l of 3 z3
73a
MCITY OF CUPERTINO
C'TM°F PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BNUMULTI' New Multi-family Res PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
I BPERMFEE Bldg Permit Fees BUILDING
3 BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
I BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
I BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
I BPTRAP Kitchen Trap PLUMBING
I BPVENT Alt of Drain & Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
I BREMAIRHAN A/C Units <= 10,000 efm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
9 BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
8 BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT I Repair/Alter Heating MECHANICAL,
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
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CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
uanti Fee ID Fee Description Fee Group
Z BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
1 BSEISMICRE Seismic Fee Res BUILDING
BSF&2FAM Single & 2 Family BUILDING
BSFNA Single Family New Add BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Tem2orary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Tem Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
I PPERMITFEE Plumbing Permit Issue PLUMBING
• PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
13130ILER5 Boiler> 1.75 M Btu MECHANICAL
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