02070159 ...w>.uc..tiwrv,. - - I t. l•_
.I• - .-'n'. .r . ..rtr
` CITY OF,CUPERTINO .•^'"
r _. P T CTOR INFO' TION c
autinrPlc n[vrstdN'.
BUILDINO ES
ADDRS: . PERMIT NO.
2.003;0 `,,RODRIGUES AVE ' # 7K WALDRON CONSTRUCTION COMPADY 02070159
t OWNER'S NAME:
APPLICATION SUB DATE
LAKE,^'BILTMORE. APARTMENTS P O BOX 598 ,07/25/2002
/...� .PHONE:.•{7 .
(408) 377-8186 SANITARY NO. CONTROL NO.
pp -
'W 0 oF ARCHITEC(ENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECN
< Lt =::i O CGJ
1 y'i 11 LICENSED CONTRACTOR'S DECLARATION
;_' ':` 1 hereby aRnn that I am licensed under previsions of Chapter 9(commencing Job Description
� t. withSecuonToso)=fDivision3oftheBusinessandPrefenionCode.andmylicense INTERIOR RENOVAVATION
. Tome and eReet.'uanreclan Lic.« KITCHEN/BATHS REMODEL, NEW WASHER/DRYER &
,aa1 •D.e ARCHITECr'SDECLARATION WALL A/C/FLOOR
Haj t, 1 occasional my Plan shall b=u id as public rtcods
m '6.p'o ?Licensed Professional :'m L`il tea lG®.
;a�,9, „ OWNER-BUILDER DECLARATION
'1 heretiy aRw that I am eumpt from she Co...,',Liana Law for die SEP 2 6 2002
F 3<
wort reason.(Sciences 7031.5.Business and Professions Code:My city a county
'f O which requtes ia permit to construct.dter,improve,demolish,or moms any structure
3 iPrinttoib iwum aW require Uma applicant for wchpemutmfilea sipral suwrcnl - ,. .. ...
't(Acoormh6nelsrclicn¢gnsendpvo.lheo isaesofbeCo a LiiasLew(Chapter 9
Ch r9 Sq.
F[.F,IOOCv Area
reSincrio,]000).IrdDiim oldie Busimssprd Pr ...Coebv8luatlonBVILUM
'•br auihils dlemP'i thEkfioln'and Ne buil for Uma alle8�exemption.Any violation
'. -ofrmstnu o03L5Ive hundred
mbjau the applicanluacivil penalty Occupancy Type
:ref sit more thanfim hunertd dollen(x500). :e;:�-: �. .
., 369 4S
1... PrePmdY Ycmp y wagcau their sole rompermsation,
D ftmauowinrof Uma ori Io mwith
TI do the wore:'end'th Code: o Cormorants not(rLi dr eALaw Por sol=(Secy in1an - - - .- l-- - - - - - -- -- ----_----- .... -
Bnorof Pandro erty an Code:The ofd License Law aces not apply m an 101 - FOUNDAT I B4iluired Inspections""
f property em loy.or improve thereon,and who does such work tumid( 10 2 - PIERS
r or thiaugh his own=owt t.provided that such Improvements are not intended or
" oRried Ter idle,If,ondwewq Ne Wilding a ikPk'vemai is sold within dna Yev of "'"�` �'--- -- -�' ' ' '----" - "'. '-'—""-_"--'--"'_"'_..__,__.._.._......
completion,Ne owner-builder,will have the burden of proving IMI he did not Wild or 10 3 - UFER •. • -
peowt up Is.fuk.). 104 - _ REBAR
o(Wc property,am udumlyconwcaugwroth ca:)nromn.n..m 105 - ANCHOR BOLTS
lrw the does
(Sa n. oweBusieeaeanderlywhoncode:)Th=ve carets 106 - SEWER & WATER
r ank Law dad not apply m an owner ofproperly who Wilds a Improves Hereon, '
..Lad who emanu u foaauch _ B
D PreieeuDa�a oomermrtr1lrt licensed p Onvw m= .- - 203 _ UNDERFLOOR PLUMBING - -- "
C grail s License La 202 UNDERFLOOR
°lama ranee sa B&PCforthisa.son "MECHANICAL
7- z- 204 UNDERFLOOR FRAME
p W.."DPWOMPENsAltDECLARATION 205 - UNDERFLOOR INSULATION
' 'i femby rtfirm mderpenalry dgeri:ry one of she following dakratimes: 301 - ROUGH PLUMBING
° 1 hne'iid will malow."is Cardficau of Consent m sel6iume fee W=ren's 302 - TUB & OR SHOWER
Comomencon;ae provided w is by Section 37W of the labor Cada for the 303 - ROUGH MECHANICAL
of Oiemsore far which this pewit u issued.
I hair eHd will muu
nm� Compensationer' Compensation Insurance.a required by Sxtion 3 0 4 - ROUGH ELECTRICAL
°
.3700 of the Labor Code for the Performance of the wan for which this permit is
305 - FRAME
C Issued My Wo keel Compc uuon lishormare car ar and Policy number am:
3 0 6' .. .HQliDOWNS
c.mmer• " CEUIFICATIONiOTEXEDMONFROKWORRERS' :307 � - 'INSULATN]IO
-
COMPEN:rSATION INSURANCE '" 308-t.—
.. - ., .. .-, .. . .. - - —
flhms'sectiov ee>d not be completed d the permit a for one hundred dollen
(s101B.Iu.)., 309 - EXTERIOR LATH
: 310 - INTERIOR.-LATH
1 Co. run at In the performance of N k for which this*",is issued,l '-
's1W1 ami ploy allyy pend I y ma is.jk_Ta am ro be workan' 311 - SCRATCH COAT` '..
Compen t ore LevSbf C�q�rsima Due
313-.-- .ROOF NAIL-.- --. .-
'NOIiCEIU"PLICANI'Iralter malkgthsC ifictim.1aaempnoayousheta
bac me s 501 - FINAL ELECTRICAL ENERGY
blauo dm Worwe Corape ratio P provisions f Ne Labor Cade,you moat
O'Q forthwith comply with such Provisions or this permit shall be damcd revoked 5 0 - .,FINAL PLUMBING ENERGY_._-__
_
coNsrRumoNLENDINGAoe9cY;" 503 - FINAL MECHANICAL .ENERGY"."
" 'I hereby affirm that them is a consuuclion lending agency for die pertormanee
(done work for which this permit is issued(See.30)y,CIv.aC.)., 504 - FINAL BUILDING ENERGY':Q L=rdefs Name._..,.....-_ . . _ ....
Ianaq'c Adores:•.. 505 FINAL ELECTRICAL
U'O •I cndfy that I have reed this application and sou that the above information is 506 - GAS TEST U -
: coirtce 1 agree to comply with all city and county ordinances and sum laws relating 507 - FINAL PLUMBING
to building construction,and hereby authorize representatives of of this city to enter upon
she anmomentioned property for inspection purposes. 508 - FINAL MECHANICAL
q
(we)agree ro save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs mil eapenxs which may in any way accroe ageimt said 509 - FINAL RAD
: V,.� Ci in romaquence of she Booting of this Pemut. C 0 0 F A G
- APPLICANT UNDER she AND WILL COMPLY WITH'ALL NON-POIM''' p,-{1
SOURCE REGULATIONS: Issue Date
_ SrgmmreopAPplitim Conmvror : 'r - �,:., "Date Re-roofs
• HAZARDOUS'MATE RIALSDISCLOSURE
•• W'll the applicant be future Wiling occupant drone m handle huardom maudel .Type OERoof ... _....._ ......... .. .. ... .... .. ....... - ....... ....
as defined bY.the Cupertino Municipal)Coca,Chapter 9.12,and the Healon and safety p .,j, -
Cade Sauoq 25532(.) 0:'t
;;4 '' - : t
tlYn All roofs shall be inspected prior to,any,roofing material.being installed..-
If
nstalled. -
If a roof is installed without first obtaining an inspection; I'agIee'to remove
emit haradom air contaminants as defined by the Bay Amo Air Quality Management
Dunot all new materials for inspection. Applicant understands and wil]_comply with
all noti-point source regulations.
,I.Health be Safety Culus mean,2 505.m nnu under .1 un 6.93 of Be
Celut,l Wmlth a.t,u Code.Sections m,du ill,r y r 25537,1 ily m maif Nat
I'lln..Ptilding eas no-chis y breve a at be, et prior my reuarre of a ro Certificate
the'
occupant of the r uirememe which must be ma prior m issuance of a Ceniflcam of '
Occupancy. - .
'7-3,4-.47 Signature of Applicant Date
Ownerp ;renamed agent, Dae All roof coverings to be Class"B"or better
-
.,_., OFFICE. ... . ... . .. .
• CITY OF CUPERTINO • G ZJ J/ ��
BUILDING PERMIT APPLICATION FORM
t
Address: o oP-1 ��vame: Phone No:
KE ILTMDRe P^kT'MFNf5 GSD s`1G- 53o0
or: License No:
COIJSTRUGnOnf Nc.
Contact- Phone No:
U-Is GGp Sq6- 5308
Architect/Engineer License No:
S uJ3t� ANCtAIR. RSS
Applicant/Contractor:
J ORE APPOr eWS
Building Permit Info: (circle one)
Bldg Ele Plumb Mech
Description: ImIMAt RVWVArnOlJ iN RBmaoELZIo 1G 0
fjw WA6amjpeytke , 06W WAU-0.1c., NEW Raw Cgl&RJAJG
]Residential: IMAM-FANVLq Commercial:
Sq. Ft. Floor Area: (000,SP S/Sq. Ft.:
APN # (Must provide): Valuation
I 3/i1-03-00 tf 3Lt lobo
Type of Construction: Occupancy Group: R I
. if Fee ID Fee Description Fee Group
Applicable
BTEMPPERM Temporary Bldg Permit BUILDING
BCONSTAX Construction Tax BUILDING
BENERGY Energy BUILDING
1 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
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
ZADDCHG Address Change BUILDING
. 77 '_
CITY OF,CUPER. .
Br1ILDING otutstonN ` - CONTRACTOR INFORMATION:
PERMIT
' .BUILDING ADDRESS . ,. . : - PERMIT NO.
20030`,,RODRIGUES AVE` # 7K WALDRON CONSTRUCTION COMPAbY 02070159
OLAKEN'r BE. APPLICATION SUB DATE
ILTMORE_ APARTMENTS P 0 BOX 598 1 .07/25/2002
PHONE SANITARY NO. CONTROL NO.
(408) 377-8186
MOO F
ARCHITECT/ENGINEER: BUILDING PERMIT INO
P 'BLDG ELECT PLUMB MECH
'rgd u'-k -. L'7` C= LJ
O Z LICENSED CONTRACTORS DECLARATION Job Description "
I li reby offirm tat l am licensed under provisions of Chapter 9(commencing
°tet°, iwlhSection 7oW)ofDivision 3nthe B . ,a ad Profiessier,Code and my license INTERIOR RENOVAVATION
se Licenseeclas: J` .» KITCHEN/BATHS REMODEL;` NEW WASHER/DRYER &
° ate ont
m DCtctar
I iau-''t; 1•" � ARCHITECT'SDECLARATION
WALL A/C/FLOOR
""O'S ,yj I understand my plans shall be used as public records
na,
OWNER-BUILDER DECLARATION .
p I hereby'affinpi that I a.exempt from the Cioum[ s License Law for the
"F•Z�',Q 4 following ossa perm 9031 5 But ten lend ve.de on Cada:Any city or county
an ae O which requ res a permit to .tract,aver improve.demolish,or repair any structure
t`n32 ;p ft II provisions
ine Cmanrmrs License
Lowest tit -
.4 ;nth-(nal licensedparsanit m provisions of[heConimctmsL'ttmeLaw(Chptcr9 aSq,Ft,FloorArea r ';ail :� $3'466V8luation
(ommepc ng pit Secpo ;70pb)of Di n 3 of the Busyness and Profess oa Codes a i 4 _.t 4`
.I_ ..V: a6 kr
or int he is 11:5 b tankfrom'and the basisforthe enempntt Any violation n
tifs t-ne031.5baundreddollarsape aaameetamapplicantroacivil,wooly t�f6'W g{ Occupancy Type
of n
tmore than fivehundred (85001. ' �. " 369��U I���V '�1"'' ''"`^'1
!D I necof Ne pd the structure
my employees w intended
or offered
f r safe(See.
-
4 II a the workless the ode:T 'C not tactor's en offered for sale,Sec'9044;' - p-"- -"-" "--_-----" '- -- --- -
'owner i'end Professions Code:The Contractor's,and
w Law does not apply m an 101 - FOUNDATI�€IIluiied Inspections
;:ownerofproperty,Who bills orimprovesthereonmpr whoe s hwork h If
or through his own empbyees:provided trot such intent j sol t intended or 102 - PIERS ., 1
._ emelt sold With, - 'f - ____ __
t:oR edwit,me:ane arm build s' trop r' 103 - UFER
• 1 :complebon;me owneobuilJer will have me burden of proving that he and nm build or
l
Yimprove for p rpose of sale.). 104 - REBAR -
as m trbe pmpeny a exclusivelycontracting with licensed- contractors to 105 - ANCHOR $OLTS n
as
as r the project(Se 9044 Business a Profess o s Cad )Th c t [ 10 6 - WATER
SEWER &' '•"'
t ens Lad es not apply to an own f p pert who builds r'mpmves thereon, ,
.,.and ho contracts for such,projectsWith aContortionist licensed pursuant an the _ _....2.02 .-. .UNDERFLOOR_-PLUMB.LNG _--
C nta mss Lsenu L
DIam c /ry.q.�toad sec "` B&PCfor theaat 203 - UNDERFLOOR"'MECHANICAL
owne Dt 'T✓70''7� n 204 - UNDERFLOOR- FRAME
V
Compensation,-
'�„5COMPENSATlON DECLARATION 205 - UNDERFLOOR INSULATION
�mby affirm od r penastyofp j ry one ofthe following declarations: - 301 - ROUGH PLUMBING
a to 'c d1r [ f c aIt t; Ir- rc for wnrker•a 302 - TUB & OR SHOWER'
provided for by Scxr37W of the Labor Code, for the
perry cetnhe kr which this perms s issued., , 303 - ROUGH MECHANICAL
DIn ang lii'm m w kr'Frap atpnln'suv req redtiyseadoF 304 - ROUGH ELECTRICAL
,37W of the Labe cad forthe pert rine en of the305 - FRAME
,Iss ed My Workers C pest 1 e came, rod Pkl'Y which
this parte is
HOLD,OWNS
CERTIFICATION,OF EXEMPTION FROM WORKERS' -30-7 1�I�NSUIlATION'�. )
COMPENSATION INSURANCE )',,.r , ._. _ .. ._...,.._.
3087— SHEETROCK
to
(Thi section be peatytr hundreddollars
309 EXTERIOR LATH i
310 ^- °INTERIOR-L-ATH `
Compplitimi"o , pate `p` __ 313 . ROOFTNAILOAT
n�aunmelpI r, onnewrkrr nom p 1 al 501 FINAL ELECTRICAL at
fortih nN wmP Y� I y a� �` uhyeet[ th Workers' _ '
certnion 7J[i
tbi
D C
" a fexemption,r should ENERGY
Z NOTICE TO APPLICAN If,after making Tca�fm Lobo Cd y , i -
bew a s re p y the Worker C rt o pm
with ch previsions
or inapt , roub a ainvoked. 5.02.__- .FINAL_PLUMB ING__ENERGY
rw r .. _. _... ...... ... -.._.
hereb dna hot herekaemi NENo1le tlngagncyf they 503 - FINAL MECHANICAL ,ENERGY",
G.wyp LendetaNam -.`tiny, int is 3099 cr c) rto 504 - FINAL BUILDING ENERGY
rof[he wok for Which _ - - _..._._ _ .......
D:z .Lende„Ada 50'5 - FINAL ELECTRICAL A '
U-p 506 - GAS TEST U
1 cert fy met 1 have read de it,hroilimi add sunt,tot the M e information t
W'F
conterA agreeIa comply,withall city and county ordinances and state laws relating 507 - FINAL PLUMBING
Wld_g, .t -tb ' dh by authorizerep .enrdu ftti city m enter upon
th boa boned, phyforinspectionparvx,es,,, - _ 508 - FINAL MECHANICAL
tF1�`r (W)"agree t de nlfy dkeep hmiles,the cal f6pertin Lint -
h liabilities,judgments costs and expenses hich y in y y came against.aid 5 0 9 - FINAL RAD
4.U_y City onsegaeni f m g tit g of this print Cj 1 0 F A L G 6 L,/
r r�PP�.ICAV'rUNDE.,,be $AND WILL COMPLY WITH NON-PONT" rI7�xZa'
SOURCE REGULATIONS.1 Issue Date
.$ignel r of ApPlicipVC
not
"art-111111- 1 Dat Re-roofs -
} JAZ RDOUS MATERIALS DISCLQSURE
z1 IsW 11 the-uppluxect future la ld ng occupant store m
handle hazardous atenal Type Of Roof, - - <•• *-r - --
asdf ed by theCartoon.MunicipalCod Chapter 912 ad the H Ith ands ftyy r a 1 Ifrl,l
Code SDaYon 15{32(]
l
All roofs shall be inspected prior to,any roofing material being installed
� Dt, DYa PP future occupant q parent
m<i If a roof is insta
lled'without first obtaining an inspection)>I agreeao}'emove
a` aaeab m BAe AQ ilYM %eall new materials
for inspection. Applicant understands and well comply with
. .-.- ._._
I he a,e d the h za do r:'. all non-point BOCILGO regnlatmn8. Il t p Jlts.I ,bF A,
Callfomm Health'&Sofet Coder pals regmrements under Chapr r'fi 95 of
the
Sect ons 25505,25533 and 25534.1 understand trot
tic ureter limn same
tn illi Cat's mY spo ibJity tb noufY the "' " ""'- .. _....._._ ..... .. . ....
'r occ
U'o()coup tlof[hep`,not
current"
r O y h vemost be me[p to Maxine ant of Cen f s of
y 3a-GL Signature of Applicant Date
Owner outhorit a agent oat All roof coverings to be Class B"or,better `
'. .. . ._..
r
_...._OFFICE .._...._.- _...._._ '. .. ._ _ . . ._... ..-. __.. .._.
1