02070158 ,. ..CITY OF�CUPERTINO 7* -.. . k ,-. n.'. iu;.y
curs owc omston . pET ,'CONTRACTO
a
BUa.DWO ADDRESS. PERMIT NO.
20030 RODRIGUES AVE' 4 '7A WALDRON CONSTRUCTION COMPANY 02070158
OWNER'S NAME: APPLICATION SUB DATE
LAKE`:BILTMORE APARTMENTS P 0 BOX 598 07/25/2002
' - _PHONE:, SANITARY NO, CONTROL NO.
" (408) 377-8186
p rt Z ARCHITECUENGINEER:
p+O O BUILDING PERMIT BIFO
BLDG ELECT PLUMB MECH
`'B' LJ E= O LL
z 6' - ?%,-
I hereby Jfum muEDavOi�ttmd unwdCR S DECLARATION lob Description
Oz provisions of Chapter 9(coat ming P
14 withSaeuon 7000)Of Division of she Business asd Professions Care,and mylicense INTERIORRENOVAVATION'
Is in full(ora and ee«a
Or License eleu Lica KITCHEN/BATHS REMODEL, NEW WASHER/DRYER &
O u Daµ' ' - Contractor
'u53 to- ( _ '•s ARCHITECTS DECLARATION WALL A/C/FLOOR
y
C LL 2 f[' it understoodmy plans shall be fixed as public rtcoNa
" 6 p o •LtcensM Pmfeaaonal SEP 2 6 2002
t, ,, h OWNa'BU exempt
fr DECLARATION
1 hereby vein.Net 1 am exempt from the fessim Co Littnu Lew co Ne
E Z N which
reason.'(Permit
to
90313.Business ani Pre.dem m Code:My city or county
which requite,a pemiia te canstm0.date intfor su demolish,or tams any swerurt
u°ra13C�•-priortniµi,suarce,also rcquirea tite applicant for such pcmutio filaaaigmd sumiaot.
thea ne la liocq>N wnu„1,y yp pmDivmi of Ne the Business
asinandif ere law o's Cod 9 S Ft.-Floor Area
or mar he it a with SaaGplp,n twit' ,o she
3 of e a B Sto,ci and on.Aay t Code) j - ;'F X41; uation
or mar II exempt NmeSem'and far burs for the aIle eE exam " ' •` - `1 '<l o'e!L e,: e .
g gioo.My violadon � �°�'
•, ,of nation 1031.5 hY any applicant dollars
far g petmi,mbj¢µto aPPlican,ro e evil penatry'
of narin«e twn Eve hu.ared aanan(ssW>. 3 6 96'A hTYR <. Occupancy Type
1 ❑1 aiowmrof me property,or my employers with wages u their sole compensation.
'wi,do the'am1V4ad the'sbucture'H am Intended 0r off wd fe,.m rsac.9B41;Builn
'Owner sk'aro Property`
Who b Cada:The Contractors,and w law does m,apply m su 101 - FOUNDAT I$liQuired Inspections •I-
.
Owner of property em builds«improvrs Norton,and who dors such woh himself
or
or through his awn employers.provided Net such improvements em not intended or 102
- PIERS
M,alf Nr sale IF however,the buildinso,imyfovetmni i,7 old within one Yr+r of- ---
103 . .. UFER _... ...
cdmpletion,the owner'builder will have the human of proving that he did not build or
im m «wTouotue.). 104 - REBAR
-.... --------------------:_ .....
—...
Loow«rmr dp property.em rscludvaly amroctingwiih lianaW convecmnm ].05... - ANCHOR—BOLTS-- ,::.::In?t.!'•a".r:';, ---- ....
License
alter Law
oro no(Sec, to a B,..I o and erofevio b Codea The ves tho ms's I;f
- - Lice.¢law does not apply to su owner of property who builds or impravas thereon; 106 - SEWER & WATER "
arta.whocomracmmLAWucb.pmjecµ.wim.a.a.uecmrfsl.Eaemed punuant.m me._..._ .. .. 202__-....UNDERILOOR'.'PLUMBING
Co t ctora Ltanse V ,, -
olmeempun 3« B&PCfwthis eaoa 203 UNDERFLOOR"MBOHAINIICAL
Date 7 '� �' 204 UNDERFLOOR FRAME
/IL1urENSATONDECLARATON
ctJ1 205 - UNDERFLOOR INSULATION
-1 hereby aM.underpbuslry of perjury0jof the following Calandom:
301 - ROUGH PLUMBING
o'i h:v:':uia i„ifenaietam:cnufimic of Cam<nr to,els-insum for worms 302 - TUB & OR SHOWER
Compemation,=as provided far by Section 37W of the Labor code, far the
lxmlw awxahfdw'wwkrarw nmlap nay.iaxwfl , - 303 - ROUGH MECHANICAL
�p shave and'Will'eµiuWn wodu',CompeniNon'insuiv,a,o m4bimd by Section304 - ROUGH ELECTRICAL
- ,3900 of the Labor Code;for the la rfomunce of me'wdh for which do.porous is
�- Y penution Imurina carrier end policy nhmbcr ve:
_ LrivedlM workeracom 305 - FRAME
•Ga,a, 'r, f i '.PahcyNd.' :, ,. _ ._ ..30.6.
- CERTBsICAT10NOFEAEMPTIONFltOMWORKERS j. 307 + -INSULATION' 'r
' COMPENSATION INSURANCE '
µ. 308 ;,_: SHEETROCK..-. _.__. .-..-- ... ... _ _. .. _..
Mrsµ«t En need not be completed if the permit is for one hundred dollen ` J✓ 3' ` .i`=
slW 309 EXTERIOR LATH .
I«tory i tom pertomana err me n r r Wn eh tet pertn;i t:lasuw:4 --- INTER I OR';`LATI-�
310 �
'shot not,empl y my pewis m y manner u yyo Imo R,W d to she
worsen' 311 - SCRATCH 'COAT
C0 pen bon laws o4C61
Rom ¢ / VC/'
,'APPI n, ` i dna ._ 313 ROOF.-NAIL ... _. .._. _
,NOTICE TO MSC N If r melons this Certificate of Exemption,you should - -
z b«"me,ubj&tmmeWa icompmotmp µmm of the liborCode.you mart 501 - FINAL ELECTRICAL' ENERGY
G 0 to"hwtth comply wuh such provisions or this Permit shell be deemed revoked. 502 F I NAL PLUMB I NG..-ENERGY
'CONSTRUCTION LENDINO'AGENCY' - 503 - FINAL MECHANICAL ENERGY;
F' 1 hereby affirm that mereµa comwcuon leading agency for the perfomunas
of the «krwwmmm permit is4mM(Se 3097.OvCi 504 - _FINAL BUILDING ENERGY
y.0 -oaten Nem' _.., a..- _ . ...... .... . .... . .
w1..,'� Londa a agree t.
505 FINAL ELECTRICAL,
506 - GAS TEST
V•C 1 aNlY met 1 b read m appnauon and satµmw th ave in(ormenOn is _
0 F mm di erg to comply he ill city and county etati s dnate lawser upon 507 - FINAL PLUMBING
- O;f) bbuudmgc uticto andherebyaudit) pryienuuvu tmucity toenmrupon 508 - FINAL MECHANICAL
fat
me abong
ve-manbonad property far inspection purpom..
IY' (WeI ajrte m'saJI,indeomfyandkap harmlessthe City of Cuwdino against
y' lubilitief,judgm<all.cash;and expenua whµh may in any way,accrue against said 509 - F I NAL
Airy in consequence of the jiienting D.sun L COMPLY
O 1 O NA G Tj r
_ SO RCIIRE I'DERSTANDSAYDWILLCONPLYWITN,ILLNON-PONT Date %6z,+C../
SUURCC'REOL'LATIONS.' - ISSUed Zil
nignamre,of ApplicarbConthctor ., '�'!'� ^''n." ^" '7:0aµ Re-Ioofs
HAZARDOUS MATERYALS DISCLOSURE
Will the applµent wfumre building occupant short w handle hanrNoua matenal ..-Type.0E.R0of.
o defd by the Cupemn Municipal Code Chap, 912 and Safety
Heath and Sef .. .- -. '>•.•. - . :.• .,.•.• .,•.•••• -•
Cade Section 2553]la)r - - •c '> _e t .
" `O: All roofs shall be Inspected pn6r.io.any roofing.matenal being installed.
wn thq apps sus o en re bu0dmg by me B y Asmequipment of Massa which If a roof is installed without first obtaining an inspection,Pagree:to remove
emua s u c norm anµu dcfimd by me Ray Arte Aµfludtry Management
District? all no -p rot source regulations', s _- y"
❑vrs -. ,,:. . - all new materials for inspection. Applicant understand and will compl with
n 'o' re sal ns.
I haft
word haatdxo m:ien:ls w,uirtmenti under Chapter 695 of the
California-Health&Safety Crile.Sections 15505:35533 and 35534.1 undennnd thus
'•ir thebuilding daa not carni have.µmem;that it is my responsibility to notify the -
• req enµw1wh moat be sun Pdof m issuance df a Cenifieeµof
Occu ane uthonaed a e
. occupant of
me vi m
p y //'''' Signature A Leant
_. •�t/�QA�' Q t 7�pL- g PP ..... _ .. . _ _. . Date
` ow.erpre g nt •' Date All roof coverings to be Class"B" or better
a:. ,.>. .
::.'... ..- . _ . , .... . ... . ..: ... OFFICE .___ .. ... .. _ _. _ ..
CITY OF CUPERTINO
BUILDING PERMIT APPLICATION FORM
t
Addreod 1RooetCxcEs A/E. 7A
{�Nvame: Phone No:KE iaMow MACTMIkrr5or: License No:
C0asfr GT w !-
Contact Phone No:
5 WEavgR PRDTC�r iY�2 GGv596-5308
Architect/Engineer License No:
S uF�cC SINCIAIR. KSS
Applicant/Contractor:
o¢E APAerMC-*tTS
Building Permit Info: (circle one)
Bldg (' Ele Plumb Mech
Description: 11JMAt A5Pr-VVAn04 19CLLDLOW& Ir5inaVe4.E0 W BA )
NEW WA6ihM1Veyrae , N*W WAd-A/c NEW RIM¢ Coje-RJ JG
Residential: tAULTi-F M104 Commercial:
Sq. Ft. Floor Area: 1000 Sr- S/Sq. Ft.:
APN # (Must provide): Valuation
3ld1-03-00 4f 3'F X60
Type of Construction: Occupancy Group: R I
4ty. if Fee ID 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
BSWIM Swimming Pool BUILDING
ZADDCHG Address Change BUILDING
• e
CI But ems my TIIINO .•CONTRACTOR'INFORMATION:
PERMIT
BUILDING ADDRESS: ,,,- -
PERMIT NO.
2003.0' RODRIGUES AVE'' # '7A - WALDRON CONSTRUCTION COMP Y '02070158
OWNER'S NAME: - APPLICATION SUB DATE
LAKE'•BILTMORE APARTMENTS P 0 BOX 598 07/25/2002
'HONE: SANITARY NO. CONTROL NO.
(408) 377-8186
- PEWIT INFO
O O 'ARCHITECT/ENGINEER: BUILDING PE
BLDG ELECT PLUMB MECH
LL I
[ LICENSED CONTRACTORS DECLARATION - JOU DeSCnptlOn
Z t
line by. firm th t l licensed de pot ons f Chapter 9(commencing ,
with Section 7001 Dn Sof meas e.and Ptoms,i Cde.md my license INTERIOR' RENOVAVAT ION'
aF is nfullf and effect.
al s4 'Lmense Cross Lc.k KITCHEN/BATHS' REMODEL, NEW WASHER/DRYER &
i65°38,y Date cimmcor WALL A/C/FLOOR
ARCHITECT'S DECLARATION
$F.a O �, I dersmhd my plans shall be used as public records -
6¢c O LiccnsN Professional 4
s._ 'OWNER-BUILDER DECLARATION
m
s �,I hereby affirm that I am exempt from the Coloration's License Law for the
C?.Q 'following reason ISecdon 7031.5,Business and Professions Code:Any city m cmimy
which req Permit t construct,t al[ improve.demolish, p y structure
- g.�p o t its ss once. 1 q rc the appl'r tf hue t[ fl 'gmal stem t. --- -that he s licensed Pu ant[ the provisions f the-Contractor License Law(Chapter 9 S FI Floor Area .il
YF❑
C3 _•(omryemm�gwimsept iogBlpfDi�an3enneesat ,dPrgremncdeY �.�) 1 ;,,q'y _ ;. ',3 ,z,",r'P.:_,b`?4 :"' .. $346�IIuation
q or that he Is exempt therefrom and the basis for the alleged xembion.Any violation _
of Section 7031.5 by soy applicant for a Permit subjects the applicant to a civil penalty; �I�tt�i ta�
iof t moa man five hundred dollars S500). 3 6 91170 U�mSIb .,',r',' Occupancy Type
ccximirerofineproperly.army employees with wages as meirsole compensation!
-'wll do the work.-and the structure isnotIntended or offered for'sale'(Sec.7046;" -
�Buslnes5 and Professions Code The Contractor,License Law does not apply to an 101 - FOUNDATIftuired Inspectionsi(,, ',:r-'-
il
owner of progeny Who builds or improves thereon,and who does such work himself.
"n through h' n ply providedth t h' proyem msp notintended 102 - PIERS _.._.-...._.
"qRe dfor 1"If,'h to Fatima, 'proG- -y- _.__. .. ..__ ..._._
..... __.
improvement s Id hdid one f' 103 -
completion,me own builder will have me burden of proving mm he did not bold or
forpurposeofsale.). 104 — REBAR
_
- _ ANCHQR-BOLTSIa te r'ofthe property.5me<is exclusively g with do tractors to 105 - _ ...
t- ,
consumer the project(Sat 7046 Business and Pr f esion,CMa:)The Cmitionartims,
License Law does n 106 — SEWER & WATER ) ,,, ,N„
m apply to an owner of properly who builds or improves thereon, ,
-:and.who contreets.for such.projects.wth omracioos).licensed,pursuaaLto me......._.. ......._202_...-..'UNDERFLOOR.--PLUMBING .._.;:,�._ ..
C t ct L ensaLa t
QI pinna s -' a&Pcmrmi 203 - UNDERFLOOR-'MECHA'N'TCAL
'o ler Date 7- � �` 204 - UNDERFLOOR FRAME
A6C 1 1cLARATION wit 205 - UNDERFLOOR, INSULATION '
ENSATION DE
1 hereby affirm olderpenalty of peri ry onb ofthe following declarations: _ '-
301 ROUGH PLUMBING
,fill n ad will [ "'cadre ['of Conscni io self-insure for Worker's 302 - TUB- & OR' SHOWER
'Comptimpaair-n.provided for by S t 37x1 or the Labor,Code;for me
;'i pe nmanc ono wok,fnrwmgnm,,p -.I,, d.,, 303 - ROUGH MECHANICAL
,Q I have adill maintain worker's Compmm it oro ' q 'd by5 tion 304 - ROUGH ELECTRICAL
,3700 f th-Laborcod f r me pertnrm n f m work f which thus p<�r is 305 - FRAME
- .1 d MyW rk 7s ComPrnaatron is menccam
306,_ HOLD,
OWNS "
Camert ! '': hip Icy No,t .,.:.t 3bj' ^"INSULAT I-ON' y1 aw,. 3 .ul ,bli
CERTIFICATION OF EXEMPTION FROMWORKERS x i.'
t COMPENSATION INSURANCE °t ". ...._ ._ .„_...._...
309 SHE TROCK..._
1 (Thsnot „ ...., 05 1J-Jt.a 1
308T
w ctnn ecobecnmpl t artmeperroti for enenumrmaollars — EXTERIORLATH '
- 3=10,
n oro uo INTERIOR =LATH
I mini CI that [h performancen� manner ct ors is ved I - I - _ ..._.
%
f m rk fur wh h th s rat t
Manu t , ply any pe I y, °tr ewo kem 311 - SCRATCH COAT -
c p b nr,,awt C_'f_")ilD�e . ..3.13. .._--.. ROOF...NAI-L-._ .. _ .-,: .. .__... ...--... ........
..APPh<am .. -........- .....
(NOTICE TO APPLICANT:lf, rmakingeats CenTcme fE empt :yn ;n le 501 — FINAL ELECTRICAL' ENERGY
become subject to the Wo ket' Comp, ato po sinus ofm Lbo Codey ust
O'Z 'fonhwuh comply' th hprovisions th p t hall bedemd revoked.O _. ._ _.._ _ ...-..502_...-..FINAL...P,LUMBING_.ENERGX___ . .... . ..........
�Ft.y1 r r colvsraualoNLervDp.�cncervcY 503 — FINAL, MECHANICAL ENERGY','
�iZ ” 1 het by aRrm that mer co t n n lend ng agency f [h performance' t '
'nrne ekfnrwmm�m pat[ issued(Sao 3097;Civ.c)Y , 504 FINAL BUILDING ENERGY
W A - Lende N _ ._.._. ...... - _. .- - __ _.-...
z L ate Aad 505 FINAL ELECTRICAL ,I,
U O 506 GAS TEST
I n fy m t I h read m app) t d t t m t m b form t is
w,F mom, 1 g ply nn n [y a ty a d t[ I g 507 - FINAL PLUMBING
p;q .[ liming sonar and here by continue repnesen[an s of this city m enter upon
�+.W the oboe t neap
remarry p ti p-p 508 - FINAL MECHANICAL
L 6a! IW) 6l6 live:iinde ally and keep h bisi the City fCpd o'against —
GGGrrr V1' liabil t s)dg_judgments,con a1.nd expenses which may n any y rue against said 5 0 9 FINAL RA
:..1 City m consequence f diagraming.f m pe u - _ 1 w NA G
APPLI NTUNDERSTA�DSANDttILLCOMPLYWtTHALLNON-POINT- Issued x: Date �7C/
" SbbRCE RLGULA710,NS -
Signature t ApplidnUCotnamon.o- f "r'• ?Dme '{I';•. RQ-COOTS -
IQY lCode, ha DISCLOSURE t 1 P.t pr t try g g
HAZARDOUS MATERIALS t
t W O me 5531(tit or f m b Iding uccupam r p halm nawN a matmal _All oofsRs6 ll be ms acted nor_to.an roofin matenal beat instal
as d fiee by me Cupertino M nm,pal Cade Chapter 9 12 and theHealth and Safety yp ,
Cad hSect o 2553 O t` r g p sl
v y f Quality all new materials d w led '^ _
Dat t rd PP t m...to as called b 'he fA-Q i r alt Maces b`h t for inspection Applicant anti s ectlon-(''agree to remove
k W1l thea Icnl[ ft b Ido coalition usee mem or eel
Management
all non
point source regulations,. erstands and will comply with _.
If a roof is install, ithout est obtaining an 1
4 1 ti eLreadthe h ardour aeienalriegmremen[s der Chapter.695 bf the p
Callfoirm Health&Safety Code:Sections 25505;25533 and 25534.1 ondersmad mat _
if Nr buildin%does wicurtently have a¢nnnCmar it is mY responsibilirymneafy the ._.. __.. .._._...__ ...._ .._. .._ ...-._._. -.... _.._,.... .. ..... .. ..._ _-. ..-...
'occupant ofm q m mh ch mu t be tett pr ro t smncr a of a Certificate of g pp r
._ ...All
.._._ .
hl�lU/� a<fCh f 7
Signature of Applicant Date
Datecoverings _Class."B" better ._ .... ..
. . _: ._ . .. I .,.. ,,'. . .•. All roof [o be Class B or. ..:
OFFICE