01100017 CITY OF CUPERTINO ,
BUILDING w VISION PERMIT CONTRACTOR INFORMATION:' `
BUILDING ADDRESS: PERMIT NO.
20020 RODRIGUES AVE # 6K WALDRON CONSTRUCTION COM ANY 01100017
OWNER'S NAME: APPLICATION SUB DATE
LAKE 13ILTMORE APARTMENTS 73 HERBERT LANE 10/02/2001
MIPHONE: (408) 377-8186 SANITARY NO. CONTROL NO.
aO O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
m I BLDG ELECT PLUMB MECH
a y '
5 m Z LICENSED CONTRACTOR'S DECLARATION. Job Description
5 Z—❑ I hereby affirm that I am licensed under provisions of Chapter (commencing ..�,.
•,.MCm with Semion]000)arDivision3oficBiomass and PafessionsCode.andmylicense INTERIOR RENOVATION.
S m 5 is in full force and effect. (REMODEL KITCHENBATH NEW WASHER DRYER
License Class Lip.It & r WASHER/
DRYER
- SDECLA WALL A/C, FL. COVERING. )
ARCHITECT'S DECLARATION
oI I understand my plans shall be used ars public records F U N A L E®
N
OO Licensed Professional
OWNER-BUILDERptfrom he CwrrION
W � • I hereby of<rm that 11. exempt from the Contractor's License Law for the NOV 2 8 2001
H '
following .(e i ]031 5 Business d Professions CW e y an county
❑ whichrequiresne, n to,what t Ir , tap demolish.dIo rep any structure,
m m .Flr tat ewe Iso regwrcm ppli Ifr hperm nolle sg dttemenn - -'. ._ ._ ._............. .....
thioh .I' sNp n map' t L' La cas C erg
S Ft Flo r Area > Dation
nn c t
(c ending wnh5 ton](100)of Div on3of Ne eosineaand Professions Code) �,�� ra aq•�1 IY. Q < l _ t $346��
of that Section
is 31.5 b tang a,m-and the basis for the alleged a plicanod.Any violation "' ' ' "
of not me]03P.5 v any applicant for o 500). subjects me applicant to a civil penalty
or not mare man rap hundred sonar,(ssw). 3 6 Occupancy Type
D U.,owner of the progeny,or my employees with wages.their sole compensmion. `
Will do the work,ana'ts,swcmre is nor intended or offered for sale(Sao 7014,
BusinessandProfessions Code:The Character's License Law does no,apply to an 101 - FOUNDAT IlG*ired Inspections '
owner of property Who builds or improves thereon,and who does such work himself 10 2_ – PIERS
or th gh has o mpl yea provided that s h improvements r Intended o
-.off df le Irn ih b ld g p t Ie Nfna 'y f -._.. 103 UFER
i
completion,th a h ilt will have thehuman fproving that he did tb ld
impp rp f I ) 104 – REBAR
m f
eaownet orthepopeny,am eacrosveiyconnacangwmnce:)no ontractsto '-' 1.05 ANCHOR"-BOLTS
License the present(app,]oa4,Busower of dna Pay who
code:)The cantapmra 10 6 - SEWER & WATER
License Law does not apply m an owner of property who builds of improves thereon, C ' '
..ams who oma, for such prose,¢with.a contacmds)licenud pursuant to me .. 202 --- UNDERFLOOR PLUMBING-
Cnnneaar c xLaw
,.
Dlame m Sp ''' PB P forthismasom 203 – UNDERFLOOR 'MECHANICAL
ow ��eat 0 204 – UNDERFLOOR FRAME
LR'SCOMPENSATIONDECLAd G DECLARATION 205 - UNDERFLOOR INSULATION
Inercby arra,under penalty of Re III aneof she It deplamnaes: 301 — ROUGH PLUMBING
D 1 nave and will maintain'a Cenifiame of cancer,or self-imsna far Wrrkers 302 - TUB & OR SHOWER
Cion,msanon, as provided for by Section 37(H) of the Lobar Code, for tris
performance of the work,for which.tms Permit s issped.. 303 – ROUGH MECHANICAL
D I have and wi i maintain Worker's Compensation iq:efance as regmred by Section 304 – ROUGH ELECTRICAL
3700V he Labor Code,for theparr tarmare of me work for which anis perrah is 305 - FRAME
C d My Worker's iC pe t I ancyd Pol be ..,,
r_.
�' r3 '"�Policy Na. 306 : $OliDOWNS _
CERTIFICATION OF EXEMPTION FROMWORKERS s 4 �}. i''3'07 l-, -INSULATION-il I s�" '
' coMPENSA'lION wgUnwrvcE I`... .� ..__...... .....3.0.8'-i-,`....SHEETROCK..-.. ...... __._
ITh s section need not be completed if thpermit is rer n danara
n ndred 3 0 9 – EXTERIOR LATH
L,
(8100) ) -
3.10.,._ , INTERIOR' LATH _
I opt mai ar perf. f r ark far eco nth Pont't o Workers'
I
ash II not employ any p wn in any man r become subject m the.Workers 311 – SCRATCHCOAT
Compensation Lows f`Cai fomia7 Date "'"
:.Applant ;.: ., 313 - --.ROOF..NAIL ... �._. ,..._.... ...---....... . . .
NOTICE TO APPLICANT If,after mek ion Certificate
fE Labor
ode should 501 – FINAL ELECTRICAL"ENERGY
P provisions
aim beta b th W kcrpsC mssusd(S permit 309] Ciagency
C)Yabo caa� y ,_ _ 502 FINAL PLUMBING_..ENERGY ..
Z forthwith complywith such ov mons s o this hell bed d to mined. mu
is
I CONSTRUCTION LENDEVOAGENCY 503 – FINAL MECHANICAL ENERGY '
of the work
for
affirm ch Jhmcee�,t ap st m tall a e c r th rmance 504 _ – FINAL BUILDING ENERGY;
+a.Q Lea Name -.
Lea Address' : 505 – FINAL ELECTRICAL,
U'0L�. _ , 1Icertifythat Ih d dals application ad late tbut the alinfo.matoa's 506 - GAS, TEST
amreci l agree b Comply With sll.dryad county rdlwnc a a Iawsrelanng 507 – FINAL PLUMBING
..O U to building causwction,aidhemtiyandminareprcsenwtivesofdoxp ymenterare. 508 - FINAL MECHANICAL
rW the above-mentioned pmpeny for inspection purposes
W liabilities,(we)u� erto ns t d a ify entl k p h Ipss the C tY f C apaeitor,against
pease Which may in any way me against said 5 0 9 – FINAL GRA
- City a Donee of th t ng of m pe n 51 N NG
APP IC U PERS IDS AND WILLCOMPLY WITH ALL ON 01
In
so RCI �.'n Issued Date
�" rpo yApplin HAZA–R—D�OUS MATERIALS DISCLOSURE Data' Re-roofs
I aeenmlb�ecl"ntof maiinrpbuilldinnipal grampChapterm9ii a��Health Rosenbaum, ri l " Type of Roof. ' ( Cl
Cod DYn25532P)es, 11 No 11 R.1' rf Safety - ..Al s.'.I. .v
I roofs,shall be inspected poor to-any roofing material being installed. ,.. .. .,
Will theapplicant future build, g upantsuse equipment- devices which If a roof is installed without first obtaining.an inspection;I agree'to remove
em t hishandmiS air contaminants s defined by the Bay Aria Air Quality Management
Di tot '.; . „ all new materials for inspection., Applicant understands and will comply with _
DY s ..I ❑No all non-p oint source-regulations. '
I. x
I ha a read the Intonations materialq tremens under Chapter 695 of me
Cal Tom a Health&Safety Cod Sections 25505 25533 and 25534 1 understand that
'ftht bind does not currently have tens,that t ,my hasquarsibifir,r oify the -
p e q /}h-h must hem rpno ris a'fitC trharo of '
�A/ / Signature of Applicant Date
ow mornoa agemt D.e All roof coverings to be Class "B" or better
OFFICE -