02030092 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT ,C,ONTRACTOR INFORMATI - .
BUR.DINGADDRESS: PERMIT NO.
20010 RODRIGUES AVE # SE WALDRON CONSTRUCTION COM ANY 02030092
OWNER'S NAME: APPWC9TIONS BDATE
LAKE BILTMORE APARTMENTS P 0 BOX 598 03/ 19/2002
PHONE:
(408) 377-8186 SANITARY N0. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT WFO
<Pl BLDO ELECT PLUMB MECH
h 6 y L7 r_3 C".I I_-._1
LICENSED CONTRACTOR'S DECLARATION
Viz:- Ihereby aRrar,hat l am licensed under provisions of Chapter 9 Timor,nclog - Job Description
„2 wiNSecdorceandofDivision3o heBaamexand Pmfexmnscoee.and myhcm. INT.RENNOV. INCL. KTCH REMODL, BATH (S) RM
s.m ismfu cl.s. deffat NEW WASHER DRYE
13 y' < Date coax Contractor / 1 � i,TsW$L C, NEW FLOOR
u.fO Dale Comncmr
.u O 1 ARCHITECTS DECLARATION
S o....7333 I understand my plans shall be used as public words
o Lu. ranmd Pmfaxional . MAY 1 4 2002
R OWNER-BUILDER DECLARATION
1 hereby.firm Thai I em exempt from the Connor's License Law for the,
following reason.(Section 7031.5,Business and Profelaians Code:Any city or county B 1,I�D��
D which requires a permit to constrict alter,improve,demolish,or repair any swcone �/
3$ "Prior m its issuance,aim requires The applicant for such permit to fik max
is. amen,signed menT _ _ --
(commencing
he is licensed pursuant m The provisions Of OF Cimmucmri License Law(Chapter 9 5', ct ,Floor Area
(commencing with Second 7000) f Division 3 of the Business and Professions Code) 1`, 'i; q F,,•. - v Valuation
or Thal he is era tali thelefmm vrrNN the basis for OF alleged eemption.Any violation 1 t 1 1 '
'k o<Section703L5 6y any vpplicen1 for T pmmt subjeeu The applicant m e civil penalty
or not mom than five hundred donan($500). APN Number .. Occupancy Type
Q 1,as owner of The poolast or my employees with wages as Their sole compensation,
will do the work;end the sWcwrc is nod intended or offered for all(Sec:7044,-
" 'Business md'Professmas Code:'2e Contractors License law clever;nm apply at an 102 - PIERS Required Inspections
owner of pot Who Wilds or improves thereon.and who does such work himself 103 - UFER
_or Ihrou h his awn employee,provided then such improvements an not intended or
"offered F r i0e.If,however,Ilie building or improvement ii sold within Tec year of" 10 4 - REBAR
completion,the owner-Wilder will have the burden of proving that he D;d not build or
�^P�'c for PuryoseoflaleJ.
Y 105 - ANCHOR BOLTS
:_ ._. .. y�as owner of Na" pan.soneaclaximl ennctin 106"" = SEWER' & 'WATER
v1 .he p(Sae Y Y ions Co ce)Th Concerts to
ns Taw Penson,(See.7(141,BusinessendertywhobCode:)TheCommcdon, 202 _ UNDERFLOOR PLUMBING
License Law does not apply m mi owner of property who M1ulice seimproves thereon,
.
and who.comma for such Nojass with a contractor(s)licensed pursuant to The, 2 0 3- - UNDERFLOOR MECHANICAL-
El - - - ------
' ' Contra7o6lJccnse l�W. _
Isma=e{pl sneer a. B di P C for this reason 204 - UNDERFLOORS FRAME'''•
- owner oRlcE ENSATION3c1.A Data a Z_ 205 - UNDERFLOOR INSULATION
Ihereby ommrunder Penalty or 301 - ROUGH PLUMBING
perjary sine ohne following aal,n6on:: 302 - TUB & OR SHOWER
❑m have and will maintain a Cmuricam of Consent m mlr-inium far Workers 303 - ROUGH MECHANICAL
panmdon. a provide, for by Sation 37M of the labor Cade, for the
Panic..orine work far whim this permit is issued. 304 - ROUGH ELECTRICAL
❑I have and will maintain Worker's Compensation Insurance,as iequiad by Section 305 - FRAME
3700 or the labor Code,far the pedb imurca of The work for Well Ws permit is 3 0 6 - HOEDOWNS
ismcd.My Workers Campensesion lmomnec artier and Policy number ort:
_ �. .,
C
Policy No.; - 307 , - .'INSULATION' .. - .. .. .
CERTIFlCAT/ON OF INSURANCE
EXEMPTION FROMW_RURS'1 !3(]'8 - SHEETROCK .
. .
(This mcdonrmeano0ibe<ompleteadthepemsil; roronehanareamll --.._ `.. .... .309--:-- EXTERIOR- LATH. -.__ .... .. ..- .
($1000orle.s.) °n 310 - INTERIOR LATH
comfy that in Ne peformace of @e work ror whion rnix k< ,ix a..6.. I 311 - SCRATCH. COAT
shall not employ any person in any manner so as to become subject,o the Worked 313 - ROOF NAIL
Compensation Laws of California.Dam
Applicant . _' 501 - FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT If,after making this Ceri6cam of Exemption,you should
z binxi object to the WorkersCoolpensalionprovisions ofthe Labor Code,you must 502 - FINAL PLUMBING ENERGY
0 C, fonhwith comply with such provisions or Nis permit shall be darned revoked.
Z -" 503 - FINAL
CONSTRUCTION ENERGY
CONSTRUCTIONLENDING'AGENCY 504 - FINAL BUILDING ENERGY
1 hereby atirm That a msw
eT Nem inmion lending agency for Ne pen'omunce
,_1 ofthework forwhiithis permit isissued(So,.3o97,cv.C.) 505 - FINAL ELECTRICAL
Lender's Name
Up LamdersAddmos• 506 - GAS TEST
1 Finally that I have read dhis application and at.a That The above information is 507 - FINAL PLUMBING
w F cmeet.I egret TO comply with all city and county ordinances and stem laws relating 508 - FINAL MECHANICAL
V to building construction, ¢
ction,and hereby ronzepmsematives of Nis city to enter upon
W the abnva•mmdoned Tampere,for mxpaTionPurposes., - 509 - FINAL GRADE
As (We)Tyree to save,indemnify and keep harmless the City of Cupertino against
V1' liabilities.juagmenu,rosy and opener which may in any way accrue aglow,laid 510 - FINAL P ING
U "!a city in ANTIenc fNe gaming of Nis pertniT. "
APPLICANT IT
E STA D Y WTLLCOh1P ALL N-POINT 514 N WORKS
souRCE REc VE IT
Issued by: Date
Signature of ApphcandCommem, Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the aPPlicanl or future building acvpanl smwe or handle hamo our material Type of Roof
as defined by the Cupcnino Municipal Code.Chapter 9.12 and Ne Health and Safety -
code,Section 15532(0? _ ,
❑rex All roofs shall be ins ected rior to,an r _fin
Will Thea licenTnfumrc 'n PP Y _ g material being installed. _
pp building If a roof is installed without fust obtaining an inspection, I agree'to remove
emit harallous en ronmminana as defind by the Bay Arta Air QFuity Management
Dim n' all new materials for inspection. Applicant understands and will comply with
'+ ❑yes' all non-point source regulations.
1 have mad the haxudous materials requirements under Chapter 6.95 sof the
California Health&Safety Code,Semitic;25505;n533 and 15534.1 understand that
ifthebuildingdom notcutrently have a mom,Nn it is my responsibility to notify The
-
omipant of Ne quinmenm which as,be met prior a issuance of a Ca Ment,of
Oecupaney.
Signature of Applicant Date
Owner or auNonzed
in, Date All roof coverings to be Class"B"or better'
`t OFFICE -
NAR-19-02 10:40 FRCM4ROMETHE0 REAL ESTATE GROUP 650-596-5574 T-046 P.02/04 F-258
CITY OF CUPERTINO
BUILD .NG PERMIT APPLICATION FORM
Building Address:
Poo I� lC3ugS U SO
Owner's Na%M,&P-6 Phone No:
2e PR2T'M1✓iti� 6�z -5�((o -S309)
Contra for
( License No:
rc ��l b 3
Z+
Contact: 04P-iS WOAD Phone No: a�
Archite /Engineer Liceuse No:
M'X! oo Smal3ere- S INOLAitL NzcNls
Applicant/Contract— br:
Building Permit Info: (circle vne)
Bldg �E1c-,a Plumbech )
jooveserxp ri n: 1KTM6?- I'SNuJArTua INCLuot n2ti� RernaDE� g��(M�
N W iL AStIB OegVK-, t-& 1 WALL, FIC NEW �LOde.CGVE2CA_1G .
Residential: 1UT_ Fpcntl L�,/ Commercial:
Sq. Ft. Floor Area: S/Sq. Ft.
1000 . SF
APN # (Must pruvid0): -3� l —.0 j 068 VHl4at10A 2L�I D
Type of Construction: Occupancy Group:
- ►21
�I
Acable jt Fee ID Fee Description Fee Group
• I BTEMPPERM Temporary Bldg Permit BUILDING
BCONS�TA - Construction Tax BUILDING
BENERGY Ener y BUILDING
II I IIII
BENERG ADD Ener Add Multi BUILDING
ROVER IM— Inspection Overtime BUILDING
BPERMFEE _ Bldg Permit Fees BUILDING
SMITIGAT Housin Mitigation Fee BUILDING�
BPLANCHK Plan Check Fee BUILDING
BPLANCKADp Plan Chack Add Multi BUILDING
SPLANCKREP Plan Check Re eat Fee BUILDING
' BREINSPECT_ Reinspection Fee BUILDING
BSCBLVD Scb Specific Plan BUILDING
`I BSEISMICOM Seismic Commercial IBUILDING
1 SSE1SMICRE Seismic Fee Res BUILDING
B PECIAL Special inspection BUILDING
BSWIM Swimming Pool BUILDING
i ZADDCHG w ddress hange BUILDING
D
CITY OF CUPERTINO
n otic DIVISIONCONTRACTOR INFORMATION
Bo ;
PERMIT
BUILDING ADDRESS: - �.., PERMIT NO.
20010 RODRIGUES AVE # 5E WALDRON CONSTRUCTION COM ANY 02030092
OWNER'S NAME: APPLICgTION gyB DATE
-imLAKE BILTMORE APARTMENTS P 0 BOX 598 03/ 19/2002
{ HONE:. _ SANITARY NO. CONTROL NO.
` - (408) 377-8186
O O ARCHITECTIENGINEER: BUILDING PERMIT INFO
eu
1 . .. , BLDG ELECT PLUMB MECH
r1 .. . I__1 I...-] I- 1
G Z '.'
8?i + ' LICENSED CONTRACTOR'S DECLARATION lob Desch hon
i y F, tw d',I with
affnn than 1 am licensed under provisiens of Cnapter9(commencing p
. , ithSeerbr7000)ofDivision 3ofbeBusinexxandPrnressfon,Code,and myEcanse INT.RENNOV. INCL. KTCH REMODL, BATH (S) RM
S
s,tasS is innarseana.rreph ' NEW WASHER/DRYER NEW WALL A/C, NEW FLOOR
. u d LicenseCIClaw Lic.# '" r
c V: Data Confirm.,
3 u.o'vl-s ARCIIITECT'S DECLARATION
e3 N 1 ande,mand mY Plans shall be usedpublic pe,mrd,
u d
L eJ Pf pinnal
0
o. -
OWNER BUILDER DECLARATION
w-
on� I hereby affirm that 1 an,tonamm for- tl e fe n t L for me'
C Z__Q toll g (Section. n]Oa LS s
B .'n n a Profession,.. Code:
Any or counry
hM1r9 aP rmu , r M1 Pm d M1moaned,any
n y , ,
.�
-pirsor lith, t l apI requiresn Permit signed t ,
not mtp ishfnheContractors Lis .. . .. -.. _...,._._
L (Chapter 9 I ,Sq.Pt. Floor Area , . ''t is r V n
(c m g,with Section)0001 of Division 3 f,h B 'n aJPOf.. n CodJ (. ` n, ,.. t "^. a.. 'C ,, i. J.. ,, Ipll'I D
r lith v exempt therervnu,d the basis for thealleged ptpn Any v latah " iAgniling BUIL
LL..
oois ,om ethanrehwEddoliar,(assp00%tsubluLcmeaPPb<anttoaavupenalty APNNumber. 'Occupancy Type
❑1 s e fin propeny:rmy emploiecs with wages as tier vol.conpen.mno,, - FOUNTIMTTON "
will do the- -k and the xwchare is nm intended o offered-for'sale(Sec;7BR,
Bas ss:adtl Profess o is Cm. The Cammnim s I.lime Law dues ,at apply to an 102 - PIERS Required Inspections
- . -owner°rpmpenyWho builds orlmpro,esthereon,and who does such work himself 103 - UFER
o r_b nn wne ply p dad,ht n. p_ t. t' t as
yy .... ....... ..._ - ._..._-.. _......_.... ...-.. .__.
orf a'fo .ale If however,I the building t_. that
-within- rte °f -
'a inlet me n la "nn e n burden rp proving ane to le 104 - REBAR I
iI fnpp fI ) 105 - ANCHOR BOLTS
_.
tin property, 1. (nothing lll' n J compact.,to _.106 - - SEWER & WATER .. . ..., r. ."... . .
hr t to project(Sec.7044.Business and Protax,amis Cm )The Champion's 2 02 - UNDERFLOOR PLUMBING
Licence Law does
no apply to an owne ro
of pperly who builds improves the..
d ,ncontracts-r n projects with a<untm<m s).li«ism pn ram m the_ .._._. _ --2 0 3- UNDERFLOOR MECHANICAL' -
-. C of tis Lcense lA ..
t °lameeptuade B&aCturmisreason' 204 - UNDERFLOORI' FRAME<'
'Owner W, Date .3 Z 1 ' 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 3 O 1 - ROUGH PLUMBING
hnembyalumaneerpenmrourp3 :y,dneonnenl in,ane<laranmns: 302 - TUB & OR SHOWER
kqy��5 ° 1 n e and will,maintain,a CandifichiaL of mono n,to self-insure for Wmker'x 3 03 - ROUGH MECHANICAL
Compensation. as pro d d for by Section 3700 of ,he Labor Code, for the _
Farrcarmnceofthe worknot,which this permit isissued, 304 - ROUGH ELECTRICAL
o I rasa anti will ma ata o Worke?:P Cortiper al do Inst rance,as.aquGea by,Section 30,5 , - FRAME
3]00 of dau Labor Code,for me Performance of ma'work'f°r'wnicn this parmit is 3 06 - HOLDOWNS
issued.My Weaken a C opan m en lisnormacecarria,and Policy amarder are IL
Cartrer I '.,eol<yNu. J�.i, 307; ( ',INSULATION`
ICERTIFICATION(TF.ExEMPTION FROMWORKERs' �. .. sir30'8 _1LsHEETROCK;, - ''
s
COMPENSATION INSURANCE -. _, _--
- _... ._-....3 0 9, . EXTERIOR_LATH _-
(Thisse" 'a ead ran be'co npl led if the permit is for one hundred dollars 31 O - INTERIOR LATH
5I00) 1. ) -
3,11.,:-
" _•iSCRATCH;,COAT
nr ipH nnbecomehn� p' dl
II t PLYor,a �yino as io � tinew krsONCompnstcltData
Applicant 501_-=--FINAL ELECTR
ICAL..
..E._N..ER.
GY
1after ..-... -
NOTICE TO APPLICANT If, ft- akt g this C n f to of Lxemptmin you should
becomeSbJ line WorkersCmpen t Povsao's of the labor Code,yu ust. 502 - FINAL PLUMBING ENERGY
OzC :forthwith, mplywnnsnnproismns.,,his permit,hall he a,resukm 50.3_._-_...FINAL.-MECHANICAL- ENERGY, _
v� —CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY'
I h reby,ffn ,h l d on f coon lending agency for theperformance t
'h:ch „'she is<309] ciy C) 505 FINAL ELECTRICAL '
G,Q. ..Le tl r N ... .. „ ..... _.. _. _.... __...._ . .. .-. ..._... .
D z pa Addres 1 506 GAS TEST r
U'C 1 linty th ilinvented the applicationJnarn thenh boat rtmm 507 - FINAL PLUMBING'
morean I agree to ell ply with an any qa county condition
sand state laws sat a 508 - FINAL MECHANICAL
� U t b Id g nandci do eby auth - p ertatiJe (this city w enter upon
>{rw men ,bnedp Pen,fran"ct purpoes., 509 - FINAL GRADE
(Wq agree m save,indemnify and keep nannless int City of Cupertino 4amat
Gr m 1 b I ii s,judgments costs and expense which may in any y e against said 510 - FINAL PL ING
U Cry dcrnseprenc fin graining of th re, ' 514 N 'lJ '+ WORKS-
'APPLICAtW.UN E 5TA�'DF D WILL COMP ALL�',ryry(N-POINT Issued I7 �DatO
SOURCE REGL A ION811 � 11 pt� Y
Sgnatreuf ApplicanUCon✓✓traactor„ I'•' ,Date Re-COOTS '
W n me app HAZARDOUS MATERIALS DISCLOSURE
Cilia.Sect 255320B?”,can r fu rebuilding oc p t tbrc c handle h Nous material
.:Type Of Roof...
r open n M n cipal Cod Ch pie 9 12 and theHealth and Safety „ _ -
s deduced Section
meC
Will(lie applicant i Rome building occupant use equipment devices which, @ all roof
is instal for without first obtaining
Y Y Quality by 1 -
erials
t s > 1 1
All roofs shall be.spec p ' o any roofing matenal.bemg installed
th b c main , asdenedn the Ba Area aI, Manan em fIf btalmng aninspechon;I'agree`to remove
inspection. Applicant understA,1ands and will com_ ply_with
❑Y a °n -a11 non-poin'tst uC`ce-regulations-. - -
' 1 ha e read 4he haaard us mahims'regmre meas under Chapala,695'.f the
California Heilth&Safely Code.'Stations 25505,25533_and 25534 1 unchostraddat .
ifth
Owner or aumorizgda ant, Y p Y responsibility
Y - _
° , Signature of Applicant Date
oca P tYf th en gm t�be mm n m ,..r i . _.. ._ _.. ... .. ........... _. . .. - ..
e , doenot currently t rant that 6 m tt n ib I t t n t f 'he
of a Cmif d, f
cy �
All roof coverings to be Class B" or�better
_OFFICE-