02050061 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BT 1
818
3MMDRIGUES AVE # 6F WALDRON CONSTRUCTION COMMT 02050061
V�Xkt'%ILTMORE APARTMENTS P 0 BOX 598 APilScgrONsyg2DgTE2
^A PHONE: U / U 7 U V
(408) 377-8186 SANITARY NO, CONTROL—NO.
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E0❑ ARCIII______BUILDING PERMITINFO
ae m
y i BLDG ELECT PLUMB MECH
5 n= LICENSED CONTRACTOR'S DECLARATION I p CIOn
j2,: Inerthyaffirm,hml^mlicensed under provisionsofCsCde9(mmmcncing INTERIOR RENOVAVAYTff#
with Sectio^]11(101 affect, nn3of the dusincss and Professions Code,anJ myliceme
?.a iaiefull seClOseana<R<o KITCHEN/BATHS REM O �, NEW WASHER/DRYER &
O i License Class Lir.p
iau.� °"` c° °r WALL A/C/FLOOR
p An, hall ARCHITECT'S DECLARATION
5 I understand my plans shill be used m public records
f�
v Lnenxd fmfessaonalagglax
, OWNER-BUILDER DECLARATION ✓U� 2
-
w I hereby affirm that 1 am exempt form the Comractor's License Law for the 00
(_'Z< following reason.(Sectinn 7031.5,Business and Pmfessi°ns Cole:Any city or county �� 2
E ❑
which hvres a perm n ❑-r
prove,demolish.Or repair any gtrucmm
c. Pan Is req theapplicatorf°much permmfl 'g edstatement
tmh
'
is Incensed paresum milhe owidmagof the C°mmemi e Law(Ch pmr9 -- -
(co r be g oup,thio 71rx and D son J oWhc Busme s a d P fe s Code) ( ( 5 , 7' SLI. Ft.,Floor Area/ s , 4 6�falhatlon
or Ihat he rt exempt thcrefmm and ahc basis for the alleged exemption.Any violation "" '' .t I * l v f `
of Section 7031,5 by any applicant for a Famt.mbjectsane applicant i...wil agni Y
.Of no(room than eve hundred dollars(SSW). 369�BIQ•Q�IbpfO .. .., . . Occupancy Type
❑1,as owner of the pmpeny,m my employees with wager as ahelr sole compemmioo,
will'do the work,and the swnure isnot inrended or offered for are(Sec.7044; _
`Budnessond Professions Code:The Commercial's License Law does no,apply to an fired Inspections
caner or prepeny Who builds or improves thereon.and who dons such work himself 102 - PIERS
a,Illindsgh h' employe provided that 'h m t. t tended or
'oRcicd f ale If,noxi the building or imlProwennern is gold" th -one y<ar of - 103" -- -iJFgR--
Completion. ner-bu Id r all have the nuNen of prov ng that he d d not build or
imp cfopTosef.ale) 104 — REBAR •
ne olorep pent exclusivelync lig ith1Gamed collimators to 105' - ANCHOR--BOLTS '
ch .um th project
of et(Sec 7044Business e P affect de 7 coThe Contreemr•a 10 6 - SEWER & WATER "
Lice L does not apply t t r of p 1 6 p builds or mpmses thereon •I
_end who.controls fors h projects with a. morn i licensor puasuant m.the_ . . - ._._2 02- .- . UNDERFLOOR.- PLUMBING. . .. .•.
Comra<tots l cense la
El am ex in Inde Saii B&PCr°rthiarytsom 203 — UNDERFLOOR. MECHANICAL
DateS 1-D 2 2 04 — UNDERFLOOR FRAME
' .igyavr -PENSATIONDECLARATION 205 — UNDERFLOOR INSULATION
I hereby affirm under penally of pejury.one of the following limitations: 301 - ROUGH PLUMBING
❑ 1 nave and will maintainf cemEcme of consent toadf.mmra far workers 302 - TUB & OR SHOWER
Compensation, as provided for by Section 3700 of the Labor Code, for ,he
Proom,anaeortnew°rkm,which'hispemitisissued. 303 — ROUGH MECHANICAL
❑1 have acid will m^ir iii Workers CompensmionInsurance,as required by Section 3 04 — ROUGH ELECTRICAL
3700 of he Labor Cut for the performance of oe'wak'(or which this permit is 3 05 - FRAME
10ERTIFI cope t n f. rune a s Policy robe
Came MyW ke CCATION OFF%Facyry ,. •. - 306 - _HOEDOWNS
.MPTIONFRQMWORKERS' t 30'7!'= ,,INSUL'AT,I0N', , , •'
_'COMPENSATION INSURANCE `
_ _308.--- ' SHEETROCK_----
(SIW)(TL saui n eW not bFcampleted tithe permits for one handled dollars 309' ' - 'EXTERIOR LATH t- - �.
310 -_ INTERIOR..LATH
•ll 1 mfy then in cr-perform nc f r look f r neo th perm a o Workers
•I - - - -'--— •-- -
shall t ml, y any,pe. any manners n a m become a n(ect I 'thrworkera 311 - SCRATCH COAT , a
Comp nim I 'of California'pate
Applicant - _ 313 — _ROOF NAIL_ _
NOTICETO APPLICANT If f k saht Cnf t fF rept 'y ushould -' -'" -'-" - - --
Z bee°^ q itnaleW°k c pe t y 'em,nrmeLnncoa,yetitl,dat 501 - FINAL ELECTRICAL ENERGY
z0 O rnnhwlhmmply with such provilicasarthspermt.hall beaeemadrevaked. 502 _ FINAL PLUMBING ENERGY
_ _
:CONSTRUCTION LENDING nccrvcv 503 - FINAL-MECHANICAL ENERGY.-`.
oreRiam this therclaaconad(See lendngagcncy fo the perfomazntt 504 — FINAL BUILDING ENERGY
r�,n•t of the hereby for h¢h the[merma n sued(Sec lending
Cie ea -
y.p Lenee Na _ - 505 — FINAL ELECTRICAL .
_ . .
Lanae Adareaa . . . .. .. . ... .__...,..
o z 506 — GAS TEST
.-O tort.,�1'cenify that'Ihavc read This applicolion and start tbm vhe above informatien is '
F ecdI c et IIy with b ty dcounty,d meas dna reaming 507 — FINAL PLUMBING
O V t building ti to dh for nth 4e ep m tivesofah ctyt ntcrupon 508 — FINAL MECHANICAL
''yy [6 the abo a n1 oiled Prodigally to y and keep
purposes.es
'r•t 0. (Ne) lira ' vecode tifyaak'hih may insury ty fCupeoglingaitnt 509 — FINAL GRADE
tp
liabilities pollinating,cast d menus which may any w y e ogling said
V Z APP - q or megranting Dthis LLpermit ... r NG
APPLfCANyytNt>jRgT?2NOS&pryp WILL COMPLY WITH 510r-Issued el Q! - N Dale "
SOURCC a Ul /1/rCcllgfy'r�•rVxl/ 'S"q-,i
stgna of Ap�hcandCont sur,
1 .i Dole Re-roofs
r HAZARDOUS MATERIALS DISCLOSURE
Will th< ppI can,or future Wilding« Pam m ,handl harsaeoua ormarial Type Of Roof
as defined by theCupertino Municipal Code Chaps 9 12 and the Health d Safety -
Code,S t 25532( ) - '- - - - -
t
El yet, N 31 1fl tart .
r- All roofs shall be ms acted nor to an roofin
�j can m ppI a t �b building n1 P P Y- g.matenal being installed._.__
orifi h J y y Q y w. If a roof is Installed without first obtaining ning an inspection; I agree'.to remove
all non- oto[source regulations
can[ understands and will comply with
p ,equipment t e which
nm t d toed b the e A Air ala Ma gemrn
all new materials for inspection. Applicant,
i h grad she hez dousmaterials regmrements under Chapter 695,of the P
CaliforniaHealth A,Safety Code'Seaions 25505,25533 and 25534,1 understand that
ifthe hvJding(ices noicurrently have a tenant;that it is illy mispersihilitymnmify the
«cuprdm f N 'cquire ants h'h ud t be t Pi!"ami e f C nificme of ! "-
Occupan r .,. -
n Si nature of Applicant
. g _ PP - Date
ownercarbon
m gaeaagpnl Dore. Al] roof coverings to be Class "B" or better
OFFICE
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