02030090 CITY OF CUPERTINO 'fib=Latta Ni m'a r.Srt£x'm-::';r.a's Vl`V-'ala2,*r+lt,'
BUILDING DIVISION p��ygT -ONTRAETOR INTORNIATION
Aikris a:drfiaezue
BUILDING ADDRESS: PERMIT NO.
, a00�tP RODRIGUES AVE # 6H WALDRON CONSTRUCTION COIvPANY 02030090
OWNER'S NAME: APPLICA ON SU DATE
LAKE BILTMORE APARTMENTS P 0 BOX 598 0319/2002
PHONE: (408) 377-8186 SANITARY NO. CONTROL NO.
❑ ARCHITECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
.8 Z~
Z LICENSED CONTRACTOR'Sp DECLARATION Job Description
IhercbyammmatIs.uceneBustreunder provieiomofnCode an(cod
ense INTER. RENOVATION INCL KTCHN REMDL BATH
rut with Section 7 tmd e f effect. on 3 of the Business end Professions Code,and my license s r
0�a Licensis in e Class and effete. Lid . NEW WASHER/DRYER, NEW WALL A/C, NEW FLOOR
SLLContractor
c. Dam ARCHITECr'SDECLARATION COVERING FONA ..E®
I understand my plans shall be used as public mcards
No Licensed Professional MAY 0 3 2002
OWNER-BUILDER DECLARATION
1 hereby aform that I am exempt from he Contractor's License Law for the
t F< following reason.(Section 7031.5.Business and Professions Code:Any city or county
P F ce which ob,mes a permit to construct,alar,improve,demolish,or repair any structure
oda m_ �.Pont to its issuance,also req no file arigned.mmment. - JILDING— --- -- - -(commencing with Section Divisson 3 oftheBusinesandPolawmas Cattle)
r ,, .,.^,, Sq.tFt.,,FloorArea. ,,. 1� „ ,_ $34�'810ation
pP Penm .. ....
ns of
pursu Pr
e e )a ('<sr and Professions Codc) {.. _
or that he is exempt therefrom an the basis for the subjects
ed a pliant to Any l penalty
s'.of Section]031.5 iv mud appr[o ll fora permit subjects he applicant m a civil penalty-
"ofnot mare man five nanaaa dollars(Ssoo). 3 6 M13i NyBTb`U O Occupancy Type
C]1,as owner of the property,or my employees with wages as their compensation.
will do the work,and the structure is not intended or offered for sale(Scc:7044,
`Business and Professions Code:The Commctor's License Low does not apply to an 2 03 - UNDERFL0OfflirMHjQti CsAL
owner of properly Who builds or improves thereon,and who does such work himself 3 01 - ROUGH PLUMBING
or through his own employe Provided tat h improvements t intended or
bfh,md for sate If,ho ever thebudding -p mens Sold--thn on=yar of - -' _. -. - ___ . - _ .......... ...._._.__. ....
completion he owner-builder will have he burden of proving that he did not build or 303 - ROUGH MECHANICAL ': .
fo p m xenfxal=) 304 - ROUGH ELECTRICAL
. es owme fhe p(Sac.704t.Business
Busin exclusivelyfecontracting thbcensal,Crachmrsm ..505. .-...FINAI�....EliECTRI C�IIL_... t
OS ut be project fe lyto4 owner end Professions code)Theves themon, 507 - FINAL PLUMBING '
ttnu Law does not apply to an owner of property who builds or improves thereon "
and who contracts for each projects with,a contmaons)licensed pursuant.to.the - -- "50 8 FINAL-"MECHANICAL -
Commodore License Law. ..
01amexer�mder a[. �@a�eforhiereaxom 514 - FINAL PUBLIC WORKS
_ - Owner C- Date _
_ WORKER'S COMPENSATION DECLARATION
1 hereby aRirm under penalty of perjury one of the fallowing declarations:
*% p I have and will maintain a Cenificare M Consent to self-iname for Worker's
r. Compensation, as provided for by Section 3700 of he Labor Code, for the
performance of the work for which this permit is isaucd.
C I have and will mainceirt Worker's Compemation Insurance,as required by Section
3700 of he Labor Cade,for he performance of the'work'for which this permit is
issued My Workers Campcnssdon Insurance carrier and Policy number are:
Corm'r I .. .,°Policy No. . . t.... - , t';' .., . .. .. _. _- ..
CERTIFICAnONOFEXEMPTIONPROMWORKIttS .. <�
COMPENSATIONINSURANCE - _- _ __ _-. ....... .. ....... .
Mis'section need not be completed if the permit is for one hundred dollars
(5100)or lesv)
shall Dat emply any person m any m ,.
[certifylthat m e cin any ma n the work for which this ct mut a issued,I
ander so as m become subject to the Workers'
Compensation Laws of California.Dale'
Applicant
NOTICE TOAPPLICANT:be Workers If.after Compensation
this Certificate of Labor Con.de,youshouldmust "
4come subject y the such pr Compensation provisions of the Labor Code,you must
0 forthwith comply with such provisions or this permit shall be accrued revoked.
I
r� CONSTRUCTION LENDING AGENCY
I hereby aRrm that then is a-construction lending agency for the performance
of he work for which his permit is issued(Sec.3097,Civ.CJ
p, Gl Lcnder's Name ... ...... ...: .. �..... .:.._ ... _.. -.. _.
�.z Leader's Address'...
L.) .I certify that I have rend this application and state that the above information is
W h eeect.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby entrance representatives of this city to enter upon
t
>y [T] the above-mentioned propeindemnify and kephdrmdbs.
.�yy,ps es,jagreeto,costindemnifyand keephamyinthe City ofcroa,aai against
F V1' liabilities,judgments,costs and expenses which may in any way ec[me against said
C.) City in conte Ice of a granting of this permit - C y,
APPLICAN 'D ANDS AND WILL COMPLY WIT L NON-POINT U C
SOURCE G _u 9 Issued by: Date 3�
Signature of Applic.roConmacon, .. . . .Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE `
Will he applicant r future building Occupant store or handle hmardous material Type of Roof - -
as defined by the Cup moo urmip , od Chapter 9.12,and he Health sod Safety
Code,Sect on 25532(.)
All roofs shall be,inspected prior to,adry roofing material being installed.. .
Will he applicant or future building occupant use equipment or devices which If a roof is installed without fust obtaining an inspection,I agree to remove
em ithaxaedousaircmoaminantxand edbyhe Bay Area Air Quality Managemcm
Doorml? all new materials for inspection., Applicant understands and will comply with
'k °Ve$ all non-point source regulations.,.,
I have read the hand ons materials mquirementx under Chapter 6.95 of the
California Health&Safety Coda Sections 25505;25533 and 25534.1 understand hat
ifiheb,,Idingdo of cuneOrly heves I t,hat it is my:responsibility to notifyhe
mdcuppnt of he e ¢which most C met poo to issuance of a Cenificate of
Occupancy.
rcG��a 3-a0 � Signature_ofApplicant Date
Owner or authorized agent,' ' Dom All roof coverings to be Class "B" or better .
... '. . ... - OFFICE
VAR-19-02 16:40 fR0MFFR4ETHEUS REAOWATE GROUP 650-586-5.T4 T-046 P.02/04 F-258
_ is 9 O 2-0 3 10 �J
CITY OF CUPERTINO
BUILD NG PERMIT APPLICATION FORM
Building Address:
Owoer's Na Phone No:
� � v�Dee` Pararrn».trs 6Sa -rf(6 -5�fp
Contra for License No: &`16 3 Z
(�P��n�or� C�us�2l�cnvrJ Inc. 4
Contact: CI-}�1 Phone No:
l5 W��R (05-0 - e5Y(o
Archite /Engineer S A License No:
�pY,Mrceo STAQXRL I NC W uL
Applicant/Contractor:
Building Permit Jnfo: (circle 4,ne)
Bldg> �E►e.a Plum, ecd )
OD eserifprV��qn: lKTEg:al: fSNuJArlua lNC1.l,L lrcHS Remapec, BA,i�H( qR,)
f6;W (,UflSIi JDeren NGS WA-(.f� A/C NG''W -rwtzCoVE2WG .
Residential: t4g-l- 17krnt Commercial:
Sq. Ft. Floor Area: 1 000 DS/Sq. Ft..
APN ti (Must provide); 36 __D > - O G b Valuation #-2 L� I (,�, O
Type of Construction: Occupancy Group:
Qty. N Fee ID Pee Descripdon Fee Group
Applicable
• I IBTEMPP9-R-M Temporary.Bldg Permit BUILDING
BCONST _ Construction Tax BUILDING
BENERGY Ener BUILDING
13ENERG ADD ffn—e yAcIdMUzj BUILDING
BOVER IME inspection Overtime BUILDING
EPERMFEE _ 1310 Permit Fees BUILDING
BMITIGAT HoUSinq Miti anon Fee BUILDING
BPLANCHKIan Check Fee BUILDING
BPLANCKADD _ Plan Check Add Mufti BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BREINSPECT Reinspection Fee EUTLD ING
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic IBUILDING
BSEISMICRE Seismic Fee Res BUILDING
ESPECIAL Special Inspection IBUILDING
BSWIM Swimming Pool IBUILDING
ZADDCHG . Address Change IBUILDING
ion
F;ZS:
UPERTINO -
DIVISION PERMIT CONTRACTOR INFORMATION: -
PERMIT N0.
ODRIGUES AVE # 6H WALDRON CONSTRUCTION CO PANY 02030090
LAKE BILTMORE APARTMENTS P 0 BOX 598 AP03 IONSUpDATE
03/19/2002
ION&
(408) 377-8186 SANITARY NO. CONTROL NO.
(Err O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
U BLDG ELECT PLUMB MECH
I:.J
'Ni Z LICENSED CONTRACTOR'S DECLARATION Job Description
w[_
5 Z v- I hereby affirm thin 1 am licensed under provisions of Chapter 9(commencing
wioh5ection]UW)ofDivisionlof,heBusinessondPm -hw1Cade.mdmylZma INTER. RENOVATION, INCL KTCHN REMDL, BATH
x y� fcis in full force and effect.
-ow6 Date Clan p NEW WASHER/DRYER, NEW WALL A/C, NEW FLOOR
S3 c i- Date Cnnuucom
.u p r' ARCHITECT'S DECLARATION COVERING
g I understand my plans shall be,used es public mvmda
Licensed Prnfessiowl
IYi OWNER-BUILDER DECLARATION
I hereby off that 1 am exempt from the Contractor's License Law for the
?< following reason.(Seelint]0315.Business and Professions Code:Any city or county
I O which requires a permit m cnnoran.cher,improve,demolish,or repairany somemm
ureal ig Prior 10 itsissuance.also requires the applicant for such pemm to file asgned statementnot[lh�S licensed - -
'ianu llepb .' nsnfomcohl-actorsLmcnseLuw(Chapmr9 y , „ S Ft. FloorArea a
(commencing mSemo 7000) fD sion3oftheBuanessaMprofessonache) a"3•Y.,."a ;ir�q': .r,� :_u'tri:lt.�t`l.1, $346Vgleation
or that he is exempi therefromand,he bass for,he alleged eaempti°n Any viola,on
-of Section 7031.5 by any applicant for a permit sngecu,he applimnt,...ivil Finahy
-
ofn.nunacthan fivelondreddollar,(S5oo). 3613'0 9'0i6�30 „ Occupancy'Iype
CW]1,os owner of me progeny,ser my employeca with wngca-1'bcir sole cnmpemation. ,
W] do the work,and the mm,one'I,not intended or-offemdfor sale'(Sec:70,1,1
'Business and Professions Che:The Contmcmr's License Law docs no,apply,o an 203 - UNDERFLBG it(Mg' {gA'L' :•,;.,
fl fproperty Whobuilds th n d who J h workhm If
o
,hl pl ) 'homed dial,sIimprovements am not intended or 301 - ROUGH PLUMBING
ofre df I if now 'h<bu Id'g - p m f -IJ roto o- Year f' ---__.,_..___ _ .._.__.. _
ropier me .builder win have th burden of proving mat head nmbula 303 — ROUGH�MECHANI -
lmp I pro . '.ale.) _ 304 - ROUGH ELECTRICAL
o nm«tl -505 ='FINAL -ELECTRICAL------
property,
ely o , ung w th tensed conoano ,
nv ct th p Hl ,(Sec ]044 B- s ad Professions Code)The Contractor's l- "'- l .
an
h does a-'
of floopenyaconar n Wilds iatso.me 507 - FINAL PLUMBING ••'S' - ".
projects with, nuacoor(s).hcenscd pu seam m me.
c°lb' contractsLicense La 508- - -FINAL -MECHANICAL _. _--
old a der a&ver 514 - FINAL PUBLIC 'WORKS <<�/
ovinellr Dare
WORKERS COMPENSATION DECLARATION l
1 benBiro u d pc by !pep ry tie of the fallow ng declmmmm, /O
❑ I ha d 'll ro ,' C nificam f C .en, ,o self-nsure for Worker's
Compensation, a provided for by Section 37M of the Labor Code,-for ,he
performance or the worn for which this permit is issued. .
::z ,-,` ❑I have ll and wimuin vin Workcda Comp'manon Inidmnce.as required by Section
3700 of the Lmor•Code:for,he performance Of,hc"work'for which this parrot is
- issued,My Worker's Compensation Insurance,carrier and Policy;number are:
_.
r.e d ' •.. F n FPolicy N0,
Cam
" ".CEKTII'ICATION OF EXEMPTIONFROM WORKERS .'i, l�yrI t•k.: r ,fJll, lydTfit e9 :f (n
COMPENSATION INSURANCE'S"'-•'- -"
(This ie t on need mot be cote!Coed if the permit is for one hundred dollar 'I' ( 1, ;-) )
(5100) rlessJ ' '
"'r- 1 cemfy m t'n the p K rmanc f me w'rk f h,h'h perm o -_,.•.—a•..�F. � -�.�: - ::.__" ,�.----.:>.- _
ihull' at employ 'nany.pb any mer ' , 'become s bJ .. !fie Workers •- ll','^ b it - l r n -
Cianknsauon Laws of Cel fdnita.DateAphrot
`
:NOTICE TOAPPLICANTIf hr makingth Cenificam of Cxcmp,on you mould ----- -_._..-. _..... ... . ....
z becor2
m subJ to the W rlo Compen t n p io tons of me Labo Cod y u most
0 forthwith c reply 'm such prorthis Permit shall bed ed ri ked
_. _ .. ... _.. .. ------._-..._. ._... ........_. .__... -.
" l` 'ICONSTRUCTION LENDING AGENCY '
bs I hereby afi' that a co w t n leading agency f the performance ,•„
y heWork f ' hch th t cd(S 309]C¢CI " "
Lchde -Name
;-.)7Z Leaders Acidic
V0 m n I agree ma,1 have re d all city
and
of and ordinances
a°hove laws mini is
tin+.[r tomo 1 agree'.comply ,h II Cty-nd hpoeoro eves and scamI s e,up..
to Wildinge) nt coo ndhrhoifeby ya Pres t'ie'sityof f1his coy, em'upon
4
he ah(W)e� edpoepe ndmafyp dkeephmditih City ofC Penn "gem,
liabilities.judgments.costs and expo u h ch y n any way me g st said
U CIy in o e nce of eg ,ng of mis pe t
51;PL A11 I pFAIIA OS MD WILL COMPLYWIin,I LNON'POIAT"
SOURCE EG Issued by: Date J
�tgnm r of Applicanl/co tracto ,-, "Date Re-roofs
'
HAZARDOUS MATERIAL$DISCLOSURE "'
vrR m xpphc 1 or Boom bu Id ng ovetacal soon 6,luairdici histardstas m mnal Type of Roof '
asher cd byte Cpnn t p d.cl p 912 d'heH Ire dSafty, - t - " ' "' a"='r- - -
Codq`Sea 255321a1- 1 tp-a 1, -'
.. .goes 4 =i N 1t trT L 1 t t.\. :
All roofs shall be inspected.prior to.any,•rooting material being Installed.
•mt W11 the ire future gecaptain seaequipment roe nm If a roof Is installed without first obtaining an inspection I agree to remove
smiclI au contaminants azdjmed by me Bay Arw Am Qu ryManagemem g
I `l' all new materials for inspection Applicant understands and will tom 1 with
oY P,Y.,.
all on-porn[source regu]ations
I have read the.h d' met Holz of immentt under Chapin 695bf the
hat
,finent iY d no,cu n,l h et- notify
th
. he ,haP, m � Y notify me
C i r o Health&Safmy Cod S , 25505 25533 and 25534 l t d
lxc- am fth Y Y ,.Pon blr ,
Dd Gvarr� 3-.
n f ate ser
mem n rn ma t b mm o , ,t amn ser a c�� Signature of Applicant Date
' -
r ogmer In - - -- .
k _ ed^gent time , All roof coverings to be Class "B"or baiter -
- -OFFICE
t.