02010034 CITY OF,CUPERTINO. "
-''• BUILDING DIVISION r CONTRACTOR INFORMATION:
PERMIT. ...:'
NUILti1NG ADDNFSS: . t+. PERMIT NO.
X 20030' RODRIGUES AVE # 7B '�WA'LDRON:'CONSTRUCTION COMPANY "• 02010034
s ' OWNER'S NAo,'' - APPLICATIONSUB Dsm
LAKE 'BILTMORE' AFAR TMENTS " P O -BOX 598 01/08/20020
N.L
1/08/2002ONEr SANITARY NO CONTROL NO.
r.! (408) 377-8186 '
`a O O ARCHITECT/ENGINEGR:.;; , BUILDING PERMIT INFO
t. I. BLDG ELECT PLUMB MECII
u
Z 8?� +d' '•' i LICENSED CONTRACTOR'S DECLARATION Job Description
O y: 1 bercby niton Ivan 1 am Ilcemed under pmvuinnv of Ch,pmr 9 ammncncins
po, wimSecrnanaxnnruinixina,lnrmeBnxmexxmmPmfcx.annxCode.amdnarCrena INTERIOR RENO . & BATH. NEW W
7 Befall Class amA eliat. ��
� class en DRYER NEW WAL OOR COVERING.
X o Dmf - .I Contractor' ' '
w 3 u l" ARCIIITECr'S DECLARATION
l5 0 S •- '1'tandewmnJ,i,,Phael fiml he need as public rcconla MAR 0 3 2001
r
Oo Licensed professional' -
ca OWIFER-BUILDER DECLARATION
'ast anon that 1 1..Bfrom the Commnnr's License Law for me .i .
C=a BUILDING
following mrcla(Section 7031.5.Businessimp improve.
de o li h.or Any city orcounry
which requires a permit to cnnslmcL cher,improve,demolish,m rtPan any xtruaurc r
3G
Fiat
beisliamracgaLwrtla thee lhovisioso fors Conditionals
nditi miuoicense w(Chmmcm
Icomili.Been.it pSec lathe ane the Business Lieen�Lawlchnmery S F[. Floor Area,. a ostial
(eoll.,he mBwithSatiofin;id1id teFoodnor do.Businesend ion.Firafic,
Cale) ++qua".T's'� 5'r A'' l)bs •I," � .a I" `
or that he ii 31.5 b tany.,Ii and Inc hair for the ctfloo p icarioh.Any violation
-of mat oom than by any hundred
dvm for a Iermil mbjam Ile,pplicam to v civil penalty -
nfnamnrcthan'fivq hunslmd Jollms(SSmI. � r � ',j� � 71b .. r Occupancy Type
❑1 , fth pmllo my employees with wro,con, L pe non
101: FEARISA
will d the work.and the structure t, to J drf d f (S 7044
BtsnssauJP f..t c 1 Th e t qt . c I d t pplytovo 102 - PIERS equiredlnspections
of properly,Who ht Ids orI,natures thcrcon' n who d oes a ch work h n,selr ... - -.
orrK y11' wnea,ily .posid6d,hia—li re,porvi,leastarat mended or 103 . - LIFER . . .. ... ..
officted'f I If,ho dhe h ilmng or hattrulcouclin is.old w(h't o,e yc tr of
iontplmimt.ane own6r.nonner will now:Ihchmdeaarprrng mat tic did,I hold m 104 — REBAR
mprove An It apo.e ofxmc.)' - - _ 105 - ANCHOR BOLTS
q,�I t o fd pop ty I : 1r t 136 'n,licensed contractors 106 - SEWER & WATER ..
n d 1 11 project tS .]IWd B d I or.. Carle)Tito Connaclor s ,. ..
• License LawJ«xtot,pplyInanowncr'trpmmB
prolardywhohard,orm .ovcaean, 202 - UNDERFLOOR PLUMING
and who count s for such pmjects with v contractors)licensed premium b,the -
cnmmmof.to aw. 203 UNDERFLOOR MECHANICAL
❑lam ere p;t ides. :. &Perna mi._rcasn" 204 - UNDERFLOOR FRAME
/002 205 - UNDERFLOOR INSULATION
W RKER: 'OMPENSA'DON DCLA .TION
inercn rfimtanadfenap r rtne,rmkwinsa«lara11aa.: 301 - ROUGH PLUMBING
a " `ia n`n' 302 - TUB & OR SHOWER
3 1 have roil will notinmio'i'Cenifi<me of Consent to self-inxum for Worker's —
compenxa)Iop„a., provided for by Section lam of tl,e Labor Cam. lin he 303 ROUGH MECHANICAL
performance or meworkrmwnimmr,permB,isixx.cd., : 304 - ROUGH ELECTRICAL
ClIFar l dl :fin Wdkc,s C p I h +tq ' lby,Section 305 FRAME
31m of theI ih Ct is t 11 p6 f' c f thek f which his perm t is , t
sto II.My WorkcirsCuaipscnxaticm Insurance and'I lcyntn am. 306 HOLDOWNS
cline "'t. fat +' rol yN '"` 30r7 •{INSUT.�ATION�, � 't• ,
( I I Cllil'IPICATIONOI CXI;MPIIONIIIOMWOIt KIIt} q, ('if '
!};r,' i ,COMPLNs.voN INSURANCE a i1 .,, `3-0 8 • - SHEETROCK
309'•'-• EXTERIOR LATH'
itI,' (Diassectmh need a tot be coapdcwd-i frhe peunit�is for one handmd dollars
almLdn6xr),,. r 310 INTERIOR LATH _
1 cenify that in the per , e of[lk for which this pe a i..issued I -- 311 - SCRATCH COAT
'shalt not ernMoy',ay person'm any maaaer.so as to become subject to the Worker. 3.13 ROOF NAIL
Compensation laws of Cnluomia.Date -• .. -'. '••...' - .
Apnlirare I " • .. •'501 FINAL ELECTRICAL ENERGY -
NOTICE TC APPLICANT:IL,Rer making els Ccaificam nr Emm,Iinn,you should
zb«mesanjcctto the Worker's Ceapentaiaam
j, vidim,oftheLan<ncwm
e.youaxt 502 - FINAL PLUMBING ENERGY
0 O fo llwith comply with such provisions or this permit shall be dmmcd evoked.
Z . . 503 - FINAL MECHANICAL ENERGY . .
v CONSTRUCTION LENDING AGENCY '
F g ” a Ynimbyalrmammmemisiconstr�tcronlandingagency for the ficdamanom 504 - FINAL BUILDING ENERGY
WannewoNme Ficnmispermitisi...ea(Se6.lm]:Civ.C.) 505 - FINAL ELECTRICAL '
a, Q Leader's Name
p y. Leadcr',Addres, 506 - GAS TEST
U O lccrtifyIla;ii,avcrc:,it his and be thoseiaBnm:dionix � 507 - FINAL PLUMBING
tL.F coimci.dasrcetonmtflywithallcityandconmyindinnncesandmatelawsreluing 508 - FINAL MECHANICAL
O.0 tom II g, t .tin II 0,y III p : I Ivcn Illi ' t, ,,musr upon
,y W then II 1 tyr :p 509 - FINAL GRADE
Fy a (W)agreet J fy [keep ln In.11 City f6 nest s'°nxt
Btnd lell1 dg_ gip,, t and ,wr,cs which on,,in my y ,gamm'sand 510 - F NA P NG
U Gdy tcon:egt me fthegnoulan,ufth loctinit,
AI'IIICAN rUNUEllS I, Ds ANO WIII COMIII'.WI.1'I I AIX NON POINI Issued b�14 r N 0"' Date
SOORCE REGULATIONS. -
Sil Iv fAp11 c,uUC Otr s Date Re-roofs .`.\\
I. HAZARDOUS MATERIAI 5 DISCLOSURE
n
-Will he ppIctt mr Farm buldns is Ihandle bm.w1mr,mma1 _Typeof Roof I . /
i def ed by t C pct' Municipal Code.Chapter 9 12,and II Health d Sultry
, • , ,.
Code Sat 255321 )P, ,en ; '/
t , tore. i pNo All roofs shall lie inspected-prior to any roofing material being installed.
'"j'Willthenpkrc-ata:roaarcbaildiagM,cuj„atokax,,ipt6�ntnor okvic�dwm*Zn If a roof is installed without first obtaining an inspection; I agree to remove
Or hm
uiarddus air cmwnunas as deGncd by the Bay Area agem
a Air Quality Manent
i.nicl4 .,• ;. • , all new materials for inspection. Applicant understands and will comply with
t
to gv6x ' ,,I .y ;ons , , all non-point source regulations.
0'7 'I 1 -'u'dIdo,bit,imlimsri t y rano under Ciminero 695 of'me LCsIiN;o 11'6,111,'&Safety Codd Section:25505,2551.,and 25534.1 undermmd Ihot
hebuildingdoes ti,ilcurrcmlyhavenicnanl.that it ix my rc,porv,lonlityrontify the
enpum ofthe ei,uacmei,ts,wniebni n be Metprior m announce oC a Co tiEcme ofeip""`r• Signature of Applicant Date
_ All roofcovcrmgs to be Class"6"orbcttcr
�,rw; wn uuthon icA tigcnl .,t„t Un¢
...I ` OFFICE
ITB,nAINGDIVISION PERM
PERMIT NO.
RtNGADDRESS
° o
20010 RODRIGUES AVE # 7B WALDRON 'CONSTRUCTION ANY 02010034
APPLICATION SUB DATE
OWNER'SNAME .'rl .. OZ/OS/2002
LAKE `BILTMORE APARTMENTS P 0 BOX 598
SANITARY NO, CONTROLNO.
PHONE: (408) 377-8186
BUILDING PERMIT INFO
ARCHffECf/ENGINEER:, BLDG ELECT PLUMB MECH
t8t—H LICENSED CONTRACT'OR'S DECLARATION Sob Description
QZ�g�g T hereby affirm that l am licensed under provisions of Cbup:er 9(commenoin6 INTERIOR RENOVAITON KITCHEN & BATH. NEW W
F=CW with Sotion]000)oFDiv",anJ of rhe Busin<ss and Pmressinns Cade.and my license
qq 77 is infullforeeandeRecL Lie N DRYER, NEW WALL A/C, NEW FLOOR COVERING.
p6p�0 61
LDietense Class Contactor'
bj 3 w H ARCHITECT'S DECLARATION
tS 0 g 1 undersmnd my plana shall he used art public m o rds
Y
ides c O Licensed Professional
- OWNER-BUILDER DECLARATION
to 1 hem no nC had
1 nm exempt from be Co.joint 'e License Law for the
C M following reamer(Samson]031.5,Business and ve,de io li Code:Any rty or county _
ce which:equinaapermit mcarnet,cher,improve,de int firepair anyswdurc
p'or to iter Isamnce,also inquires the applicant forsuch pe,minn fie a signal daamms natlOn
Bad he is licensed pnnuantm fha final an,of the Cast, he sLicenu Law(Cheprer9 Sq.Ft. Fjb
rea,
(c romancing with Section 7000) rDwrvmn3of:he Bu' ass nd Pmrusmns Code) s s r that he Is exempt therefrom ane the bass for the aftil aI him.Any v olatimofSecan]031.5 byrny.pplveptforapermt subjects tit applicant to a civil penalty - Occupancy Type
real mme thanfyc hmidrcd d0llSSIS I. 0).
❑1,as owner of the property,or my employees will,wages-:heir sola marl ensstion,
will do me work,and the stantere is not!included o,offend far sato(Sea.7044, equired Inspections
Business and Prof.-hams,Code:The Contractor's License Law does not apply to m 102 — PIERS
owner of property win builds or improves thereon,and who does such work himself
or through his own 103 - UFER employees,provided that such improvements are non intended or
offered Rolando.If,however,the building or improvement of Prov n sold within one year of -
compldiolJhe of.however,rthe l have g on i provement is Sold
within
not build or 104 REBAR
improve for purpose arson.). 105 — ANCHOR BOLTS
QI,ps owner of the property.am exclusively contacting with licensed matmcaa to 106 — SEWER & WATER
construct the project(Sec.7044,Business and Rorendons Code:)The Conarecmrs '
License Law does not apply to an owner or Property who Whods or join mvex therem, 202 - UNDERFLOOR PLUMBING . ,
mad who controls for such projects with a comrnctor(s) licensed pursuant to Oa 'Z O3 — UNDERFLOOR MECHANICAL
f Contractor's Lic m w.
❑1 am axe p, de &Pc far this reason 2 04 — UNDERFLOOR FRAME
�)0a 205 — UNDERFLOOR INSULATION
Owner, WORKER OMPENSATIOND CLA ATION
301 — ROUGH PLUMBING
Ihereby aM.under MralkyofPerjury one lurthe following declarations: 302 — TUB & OR SHOWER
�! ❑ I haveand will maintain'a Compete,err Consent to self-insure for Worker's -
Compe-tin..as provided for by Section 00 an 37of the Labor Cade, for the 303 ROUGH MECHANICAL
perform aneeofhewnrk,forwmehmix,.,tisallmd. 304 — ROUGH ELECTRICAL
❑1 have and will maintain Worker's Compeecstion'1-mance,tri required by Section 305 — FRAME
37M of the Labor Code,for the Performance of the work for which this permit is -
issceatMy Workers Cmrismshtion Insorma runic,a ad'Pofcy climb.Nail: 306 — HOLDOWNS
'caRte�:. .raf<yrvo.: 307 INSULATION - ..
ChKI Hn CATION OF EKEMPTION FROM WORKERS'; 308 SHE,ETROCK
COMPENSATION INSURANCE
r',!
max section need not be complmin
cd he permit is for one hundred dollars - 309 - EXTERIOR LATH
IS100)nr less.), 310 INTERIOR LATH
1 certify that in the performance of the work for which this permit is issued,( — 311 — SCRATCH COAT
'shalt not employ any person in any manor so as to become subject to me Workers' 313 — ROOF NAIL
Compensation Laws of California Date
Applicant ' 501 — FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT:If,after making fbix Cenifcane of Exemption,you should
Z becamesubjecttotheWorkcr'sCnmpcnsmionpmvisim,oftheLaborCale,youmusl 502 — FINAL PLUMBING ENERGY
rnnhwithcomplywimxuchprovism-arinispemitxhallbedeemedcooked. 503 — FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
a rty Ihereby aRrmmntthere isacammuctionlending agency for the Performance
w 504 _ FINAL BUILDING ENERGY
W of the work for which this permit 505 FINAL ELECTRICAL
y p ender'.Name
Lanaarsnearexx. . 506 — GAS TEST
U � .
O Icmifythan,Ihavereadhis application and state nhal the oboveinfma ianis 507 FINAL PLUMBING
ran E. correct.I agree to comply with all city and county codgmncas and xmm laws renting 508 - FINAL MECHANICAL
Q U to building cmn,inich:nod M1ereby nmhore.reprnsemmives of this city no enrol upon
the abm
ove- eantinned property for inspection purp-e,. 509 — FINAL GRADE
h y; (Wa)agreetosave,adatnmfyand keep lwrmless the ctyofcupoll inoagainst 510 - F NA P NG
r.t Vi liabilities,judgments,mos and expenses which may in any way scenic against said
U City in consequence of the griming of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b;4, N RKS Date
SOURCE REGULATIONS. '`
Sig nammaf ApphmmiCMtmdar Dans Re-roofs / / CJ
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Jell the appape,t at future buildings.Cimp st9xer handle Heath and
yp
-defined Section
@e Cupertino Municipal Code.Chapmr 9.12,and me Health and Softly
Chile,S yes 25532(a)? '
'❑vas ❑Nm - ', All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or Enure huildi..gcmpmt uvc equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
crolhazadea,air contaminants-defined by the Bay Arco Air Quality Management
Disaiet, all new materials for inspection. Applicant understands and will comply with
f oven El No all non-point source regulations.
' have rtad the hazardous mdcrials requinemmhss under Chapter 6.95 of the
Cal itramiHmlm&Safety Ccdc;Sections 25505,25533 and 25534.1 undersand that
if the building Jos not cunemly have a tenant,that it is my responsibility to notify the
occupant or the requiremeh{s which must be met prior m isxnance of o Cenifcane of
... occupancy. Signature of Applicant Dale
owns,cur aumoriaea nsem ' Date All roof coverings to be Class sB"or better
OFFICE
CITY OF CUPERTINO O�� I O,O�
BUILDING PERMIT APPLICATION FORM
Building Address: 20630 l ES E. 4— 7�3
Owner's Name: Qe- � Phone N
Cont act r: License o:
o �ONsrnurno�► nic.
Cont a t: PRD�[T t'sR Phone N .`SZ5'!6- 5 8
Architect/Engineer License No:
SIM 9-nwbEK uG Mk.
Appligant/Co trac or:
Ir E >�PAttl'Mtf3
0ElecBuilding Permit Info: (circle one)
Idg
Plu Mech
Job Descri tion: I p� VA'1101.1 IuC rJG R��MDOe1 EO Kl C3A'r>`I
W-W WA r R f Orz4r Ntrw w Mr, Prow fLaoa. e4uml&Ze
Residents Commercial:
Sq. Ft. Floor Area: DD $/Sq. Ft.:
D s. ,
APN # (Must provide): q� 03 608 Valuatio%slow
66 D
ype of Construction: Occupancy Group:
Qty. if Fee /D Fee Description Fee Group
Applicable
BTEMPPERM Temporary Bldg Permit BUILDING
BCONSTAX Construction Tax BUILDING
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BOVERTIME Inspection Overtime BUILDING
BPERMFEE Bldg Permit Fees BUILDING
BMITIGAT Housing Mitigation Fee BUILDING
BPLANCHK Plan Check Fee BUILDING
I BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BREINSPECT Reinspection Fee BUILDING
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
ESPECIAL Special Inspection BUILDING
Allh BSWIM Swimming Pool BUILDING
ZADDCHG Address Change BUILDING