02100035 CITY OF CUPERTINO . 'At
BUILDING DIVISION PERMIT CONTTRACTTOR INFORMATION:,.
BUIl&9flLh_0I4EsRODRIGUES AVE # 7G WALDRON CONSTRUCTION compixkmirl,102100035
owl,1A1QDF!BILTMORE APARTMENTS P 0 BOX 598 APPLICATIQg9;ygy41l/2002
Ak
IFIIONE: (408) 377-8186 SANITARY NO. CONTROL NO.
ARCHIITCT/ENGINECR: BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
wao LICENSED CONIRACI'OR'S DECLARATION
Ca-FIthereby.1110.thmla.licenseedunderpnoisioneofCname09(Commencing REMODEL-KITCH=—,gh"T"9 BALL A/C UNIT, FLOOR
�7Hwituth Section 71XXFof Division J Of the B.miarssind Prnfcasiom CnJCanJ my been.is r r
in n force and effect. AND WASHER/DRYER.
20 n?; License Class Licp
@NFw Date ComruCL ������®
ARCHITECTS DECLARATION
1 understand my plana sM1,ll be used as public records
6pWD
KLLat; Licensed Pm terminal DEC 0 92002
g OWNER-BUILDER From
UECe Conti ON
s a 5 I hereby,Irian,her 1 am exempt from,hc Contractor's License law for the
p 0 following reason.(Section 7031.5.Business and Professions Code:Any city or county
x$� which requires a permit m construct,alar.improve,demolish,or repair any structure 60
ca—u, prion its issuance.also requires applicant for such pconat to rile aligned Statemem
1Z< that M1eislicensed pursuant tothe provisitov,Of heConmcmrsLlecom,Law Whapte,9 Sq. Ft. Floor Area E*galuation
,ro (commencing With Section]IXp)(if Division 3ofthe Businessand ProfessionsCoale)it 36903008 . 00
a 3— Nat he is exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section 713 L5 by any applicant for a permit sulcets the applicant to a civil penalty of APN Number Occupancy Type
no,... ban cv<hundred dollars(s5nm. 101 - FOUNDATION
I.as owner of the pmpcdy,or my employees with wages as their mile compensation,
will do the work,and the structum is not intended or offered for sale(Sec.7044.Business
and Professions Code:The Commerce's License Law docs not apply,o an owner of 103 - UFER Required Inspections
property who builds or improves,hemon,and who doessuch work himself or through his
own employees,provided that such improvements are no,intended or offered for sale.If, 104 — REBAR
however,the building or improvement is gild within one year of completion,the owner- 105 — ANCHOR BOLTS
builder will have the burden of pmving Na,he did no,build or improve for purpose of
le 106 — SEWER & WATER
I,as owner of the propcny,a exclusively concocting with licensed contractors. 202 — UNDERFLOOR PLUMBING
I the project(Sec.7(144.Business and Professions Code:)The Contractor's Li.
Law Eoes no,apply m an owner of property who Wilds or improves thereon,and, 203 — UNDERFLOOR MECHANICAL
whoconmctsmr eh projects with a contowboms)ficcowd pursuant lir the contractor's 204 — UNDERFLOOR FRAME
License La //yy,u�
0
1a.e an der5 __,B&PCT this�anon 205 — UNDERFLOOR INSULATION
owner t Da I /U 301 — ROUGH PLUMBING
WOR KERS COMPENSATION DECLARATION 302 - TUB & OR SHOWER
Ihereby affirm under Penalty ofperjuryone onnefoBpwingdeclarations: 303 - ROUGH MECHANICAL
Immand wnl mam,ainacenireme nraansemnr selr.Wsurt ter wmkerscnmpcn' 304 — ROUGH ELECTRICAL
smiun,as provided for by Section 3701)of the Lade,
Code,far
,he performance of,hc
work for which this leoatis issued. 305 — FRAME
D 1 have and will maintain Worker's Compensation Insurance.as mquimd by Section 3 06 — HOLDOWNS
971X1 of Ne Ichor Code,fnr Ne performance of the work for which this permit is Issued.
My Worker's compensation Wsumne,carrier and Policy number am: 307 — INSULATION
Cartier: Polls,No.: 308 - SHEETROCK
CERTIFICATE OF EXEMPTION FROM WORKERS' 3O9 — EXTERIOR LATH
COMPENSATION INSURANCE
nhissectecomAerc
ion need no,blJ ifthc permit isforonchundred doll,rs(911)() 310 — INTERIOR LATH
of less) 311 — SCRATCH COAT
1 certify that in the performance of the work for which this permit is issued.I shall not 313 - ROOF NAIL
employ any person in any manner ms as it,become subject u the Workers'Compensation
Laws nfcmifnn. Date 501 — FINAL ELECTRICAL ENERGY
Applicant
NOTICE TO APPLICANT.If.after making this Cenificte of Exemption,you should 502 — FINAL PLUMBING ENERGY
bccoesubject to the Workers Compenmtion provisions oflhe"hot Codeyou most 503 - FINAL MECHANICAL ENERGY
2z0forthwith comply with such provisions OfthisPermit shall hedeemed mvoked, 504 — FINAL BUILDING ENERGY
CONSTRUCTION LENDING AGENCY 505 — FINAL ELECTRICAL
I hereby affirm that mere is a construction lending agency for the pmfnrmee
anof
C4 > the work far which this permitisissued(Sce.30N7,Civ.C.) 506 - GAS TEST
ZLendcr's Name
IC der'aAddress 507 - FINAL PLUMBING
U O 1 eenify Our,1 have read this aplties lhrn and.socc that he above Infortroda is 508 — FINAL MECHANICAL
W FemeCel.IagreemeomplywithallCityandcountyOrdinancesandstatelawsrelatingto 5 FINAL GRADE
O U bui Wing conswe,ion,and hereby amhon,s,mpresenmtivcs of this c i,y m enter upon the
above mentioned property for inspection purposes. 10 FIN PLANNI G
Fr+ 6W. (Wc)agree to save,indemnify and keep harmless the City of Cupertino against
fq liab"toffil
asands.apcnxenwhichmayinanywayaccmcagainstsaidCi,y5 F N LI WORK$
incorraining ofNispermit.
. ANDS/Af]tD' WIL CO�WITH ALL ryON-pOINT Issued by: Date
6/ /6j
Re-roofs
Signature of Applicanvcommc,m lime
IIAZ RDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building sccupam more or handle la.duus material
as defined by the CoNnino Municipal Code,Chapter 9.12,and the Health and S,le y
Colic,section 25532(ar' All roofs shall be inspected prior to any roofing material being installed.
DYe� �,j,(�N^
Will thea rear,orf lure bails. n,use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
pp dby the
a
cm i,hvamnus air comaminanu ax JelineJ by the Bay Area Air Quality Management all new materials for inspection.
UimriRt
❑Yes r
I have read thuba.w iberialsrequirementsunderChapterh95oftheCalilor-
niuHealth&Sofe,y uk.Sec,i,ms255115,25533a d25534.1unJerma^dtWiftM Nilding
Jres nm curt 'w:u to�^„that t,�^�Y respnrsibili,y lir notify the oOupam al,hc
nequimmcn wit r to I I sea t�cen;Rcamnraco � d2 Signa[ureofApplicant Dale
owecrmaummiea agent (//�/ Date All roof coverings to be Class"B” or better