02110003 i
CITY OF CUPER'11NO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION i"
Bu112it)(0904SRODRIGUES AVE # 7F WALDRON CONSTRUCTION COMP F1MrrN(02110003
KFYEBILTMORE APARTMENTS P O BOX 598 APP{.ICATI?N1sYa(!i`1rJ 2002
PHONE: (408) 377-8186 SANITARY N0. CONTROL NO.
ARCIIITEGT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
0 0 o
�0, LICENSED CONTRACTOR'S DECLARATION p
s�F Ihereby 07000frmshwlam licensed iunder
ssand I'miessof Chapterand
REMODEL-KITCHE7I�,B1ff �° FSI, F.�CTNITr FLOOR
with SCtZe and
Of Division hd the Business and PnJessinns Cndc,and my license is � �W L�
G mt'.11c nderre . AND WASHER�DRYER.
License Class Lic.N
IDZ—F;p Ila¢ Contractor
F. w ARCIIITI=S DF.CLARAI'[ON
�yYi$s I understand my plain a hall M used as puNie rtenrds JAN_.0 2 200
a06u
£LLp' Licensed Prnlccsional ��'�®I��
WOWNIiR-BUILDER DECLARATION
p I hereby infirm that 1 um a imsto form Ibe Comore rs
oLicense I.aw for the
C following reason.(Section 7031.5.Business and Professions Code:Any city or county
e. $_ which requires a pemtil Lit construct.alter,improve,demolish,or repair any structure $34660
Fly prior to its issuance.also requires the applicant for such permit to file a signed smmmenl
��yySa mat he is licensed pursbart to the provisions Of the Commcthr.License Low(Chapter 9 Sq. Ft. Floor Area Valuation
yFef (commend ng with Section 7000)of Division 3 of the Business and Proficonow Core)to 36903008 . 00
sty that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 9031.5 by any applicant for a permit subjects the applicant o a civil penalty of APN Number Occupancy e
not methenftvehundmddnllan($500). 1 101 - FOUNDATION I p YTyp
a owner of the pmpedy,or my employees with wages u their able compensation,
the work,and
the structure is not intended or offered for sale(See.7044,Business
d Pmteuions Code:The Conlmctor's License Law does not apply it)an owner of 103 — UFER Required Inspections
property who builds or improves thereon,and who doessuch work himself or through his
Own employees,provided that such improvements are not intended Lir offered for.sale,If. 104 — REBAR
however,the building or improvement is sold within one year of completion,the owner. 1OS — ANCHOR BOLTS
builder will have the burden of proving that he did not(wild or improve fur Pa. of —
106 SEWER & WATER
sownerofthe(umpeny,am Sec.
Business
Professions Codeq The Coontraaorai- 202 - UNDERFLOOR PLUMBING
n tM es not apply
to an Business and Professions ds or i pr vet tremor.
nd
whoclawdts for
chPlr man with
of property who sedpotimpfo the Corton.and 203 - UNDERFLOOR MECHANICAL
who contracts for such projects with a cumranor(s7licensed pursuant to the Co i memo's
License Law&dq�&
204 - UNDERFLOOR FRAME
[:1 Is.exee. ,Bas P C for this ream" 205 - UNDERFLOOR ;INSULATION
Dam 301 - ROUGH PLUMBING
4 Or •CffltiMI.N DECLARATION 302 — TUB & OR SHOWER
I hereby aRrm under penalty of`''ppeedrity one of me following deduwmns:
0 have and will maintain aCenificatenfcrnn
aenowlf-msummrwokm
akCrper- 303 - ROUGH MECHANICAL
cation,as provided for by Section 377 of the Labor Code,for the inconsonance of the 304 - ROUGH ELECTRICAL
work far which this permil is issued. 3055 — FRAME
❑1 have and will maintain Worker's Compensation Insurance,as required by.Section 306 — HOLDOWNS
3700of Be Labor Cole,for One performance of the work for which this permit is issued.
My worker's Compensation Insurance carrier and Policy number am: 307 — INSULATION
Carrier Policy Nis: 308 - SHEETROCK
CIiRTIPICCOMPENSATION INSURANCE 309 309 — EXTERIOR LATH
(This rection need net be complemd if the permit is fortune hundred dollars($100) 310 - INTERIOR LATH
or leas') 311 - SCRATCH COAT
1 certify that in the perfo ce of the work for which this permit is issued.I shall not 313 - ROOF NAIL
employs,person, manner p_a hcWmg.sybjcctmmeW w,s'Cbmpocratrn
Lawsorcalimmi ""��—t/t/ 501 - FINAL ELECTRICAL ENERGY
APplicam /w O�//�/
NOTICE TO APPRCAW;1.ifmrY g miacenireamof Exemption,lod,mtuwd 502 - FINAL PLUMBING ENERGY
became subject m the Worker's Compensation provisions of the laMr Cole,you must 503 - FINAL MECHANICAL ENERGY
,'Z forthwith comply with suc h pmvisirns or thin permwoal l be deemed mvoked.
CONTRUCIONLENDING AGENCY 504 - FINAL BUILDING ENERGY
[—� IhembyanirmNal there isaconsuuction lending agency lathe leTormanceof 505 - FINAL ELECTRICAL
pY, 9 the work for wlerntldspcmtitisissued fsae.YN7,Cis.C.) � 506 - GAS TEST
top Lender's Name
Lender's Address S07 - FINAL PLUMBIING
z
U O 1 cenify that l have mad this application and date that One above information is 508 - FINAL MECHANI CAL
ig, (~ correct.I agree to comply with all city and county ordinances and stale laws relating to
building construction,and hereby authorive representatives of Nis city to enter upon the 5 FINAL GRADEI
r above-mentioned property for inspection purposes. 10 FIN PLF, G
(We)agree to save,indemni ly,and keep harmless the City of Cupcnintl against
l iabilitiea,judgmenrs nstsand expenses which may in any way attmc against Lilt any 5 F N LI WORKS
U z in amscyucncc f granting nftbispermif
'—' APPLICA N ERSfANDS AND WILL COMPLY WITH ALL NONPOINT Issued by: Date
SOURCE G ONS //_ I �'
(/�/IG)C/JL/$Jw//per/`" ��-3�Z Re-roofs
5ignamrc r pplicaITAZARucmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant remove ipal ole,Chapter
store(it and
Health and
az le.S,c by the Cupertino Municipal GMq Chapmr 9.12,and,hc Health and Safety
de.seehonzss3xar! All roofs shall be inspected prior to an roofing material bei" Installed.
❑rs � P P Y g g •
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District"
❑Y.
1 have read the Weamous materials requirements under Chapter6.95 of me Califor-
malleaWNtSafra Cole.Sections255115,25533 and 25534.1 undcrsoW Nal if Use holding
does note I have a len r,Nat I is my responsibility to r ndfy Ilw oeupwt of the
mqulrcm o n.tbe priormiromce0fa CeniOnhm ul pant,
` �p��/tl `�_°'i Q� Signature of Applicant Date
Ownerorabthoi1dagepl � Unto All roof coverings to be Class "B"or better
i
CITY OF CUPERTINO
BUILDING DIVISION PERn077
a,CQNTRACTI)I2'IN,T,O ON
Bulge 1803*E;RODRIGUES AVE 4 7F WALDRON CONSTRUCTION COMP FDITN(02110003
GW K94EBILTMORE APARTMENTS P 0 BOX 598 APPLICATIT.N1S7el02002
PHONE: "(408) 377-8186 SANITARY NO. CONTROL NO.
CHITECf/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
foo LICENSED CONTRACTOR'S DECLARATION
1 hereby affsm Nn I ant licensed under no,W al of Chapter 9(commermin
�`�' with Section 7Ufq)ofDohno Sof the Beat.and Prureasimu Copdo.and my fear.is REMODEL—KITCHAb, 5fifAO ^]ALL A/C UNIT, FLOOR
� y in full force a ad affect. AND WASHER/DRYER.
zg3 License Class Lic.g
OZ— Datc Contractor
F= ARCHITECT'S DECLARATION 11—'011'C7 'Ak ICD
I understand my plans shall o t ud as public records u cl//mak IIGG
c O0D
1- Licensed Professional
tr�03 OWNER-BUILDER DECLARATION JAN 0 2 2003
e��M I Wo by affirm that I em exempt from the Contractors License Lew for the
. Q following mason.(Section 703 L5,Business and Professions Code:Any city or county 4 6
e.6
$� which requires a Permit to construct,alter.improve,demolish,or repair any structure
Fid^ prior w its issuance,also roquires N .f
e applicant for such Permit a signed statement 121 pop rikis,
< that he is licensed pursuant thepervisioortheContractor'sLicenseLaw(Chapter9 Sq.Ft. Floor Area Va6 0
ronsluation
,, OQ (commencing with Section 7")of Division 3 of the Business and Professions Code)or 36903008 . 00
5— Nat M u exempt therefrom and the hssu far the alleged exemption.Any violation of
Section 7031.5 by my effluent far.Permit subjects Ne eppfnm to a civil penalty of APN Number Occupancy Type
not ore than five wndrea do tern(ss00y 101 - FOUNDATION p y yP
..
owner of du property,m my employers with wgw n Heir role Business
IRS
the work,and the structure is not intended os.ff red for sale(Sec.7000,Bufinue 1:82 P1
il Professions Code:The Convectors License Law does ata apply to an owner of 10 3 - UFER Required Inspections
properly who builds or improves thereon,and who dors auch work himself or dooughhir
ownempl.yaca provided that such improvements an,not intended in offered foci We.If, 104 — REBAR
however,the Wilding or improvement is Bold within one year of completion,the owner- lO5 — ANCHOR BOLTS
Wilder will have the burden of proving that he did not Wild or improve for puipm,of
106 - SEWER & WATER
downer of the property,am exclusively contracting with licensed contractera. 202 - UNDERFLOOR PLUMBING
1 Ne project(Sec.7044,Business and Professions CWcJ The C.Ouracmla Li-
cense law does not apply to an owner or propeny who Wilds or impmses thevon.and, 203 — UNDERFLOOR MECHANICAL
who contracts for such projects with a con®aor(s)licensed ponuenl m the Cor nicer
n204 UNDERFLOOR FRAME
Licese Lew.
❑lamereat Sec. BA,�P�C�fogris.
��s�..��.a 205 - UNDERFLOOR INSULATION
w
Onar n Dain( Zg/ 301 - ROUGH PLUMBING
A OR CI.NDECLARATION 302 - TUB & OR SHOWER
I hereby afire under penalty or parlor,one of the following dedantions: 303 — ROUGH MECHANICAL
❑1 have and will maintain a Certificate of Consent to art Nature for Worker's Compcn-
Wine.as provided for by Section 37M of the Later code.for the performance or the 304 — ROUGH ELECTRICAL
Vrk for which this permit is issued. 305 — FRAME
1 have and will maintain Worker's Compensation Insurance,u inquired by Section 306 — HOLDOWN.S+
37M of the Lear Code,for the performance of the work for which this parent is issued.
My Worker's Compewunn Insurance carrier and Policy number ma; 307 — INSULATION
Carrier: Policy No, 308 - SHEETROCK
CERTIFICATECOMPENSATIONINSURANCE OORKERS• 309 — EXTERIOR LATH
('Ihissecllon ncetl not be completed ifthe permit is Intone hundred dollars SIW) 310 - INTERIOR LATH
Orissa.) 311 - SCRATCH COAT
I cenify Thal in the psi if once of th work for which this permit is issued,I shall not 313 - ROOF NAIL
employ any peruni manne�vID Mpgw¢s.bjauo Ne Workeri Componvtion 501 - FINAL ELECTRICAL ENERGY
Laws of Califomi a'l�—ffll tt//
r Applicant vliw O^�
FOAPP f.((,alter tn�krng Nis Ccnifcatc of Exemption,you ahoulJ 502 - FINAL PLUMBING ENERGY
hccpme rvbjen to the Worker's Campcnsetion pmviaions of Ne tabu,Code,you muv 503 - FINAL MECHANICAL ENERGY
OO foMwiN comply with such provisions or Nis permit shallWdcemcd revoked.
z 0 CONSTRUCTION LENDING AGENCY 504 — FINAL BUILDkNG ENERGY
[—� 4 I hereby affirm that alert is a construction lending agency for the arformmncor 505 - FINAL ELECTRICAL
Gi > the work for which this permit is hound(Sec.3W7,C.,C.)
Len506 - GAS TEST
W Q der;Namc
z lender;Address 507 - FINAL PLUMBING
U O 1 emir,Nat I have read Nis application and sum Nal Ne move mrore.d..is 508 - FINAL MECHANICAL
m F Correct,I agree 10 Comply with all city and county ordinances and state laws"Isting to 5 FINAL GRADE!
Q Wilding convection,and hereby sullied=representatives Of this city to enter upon the
dove-mentionedpropertyfor tau ctionpurposes.
a. a 10 FIN PLANN G
4 (We)agree m save,indemnify and keep harmless the City of Cupcniny against
N Ind,I 0ea.judgments osis end expenses which may in any way same against lad City 5 F N LI WORKS // 1
U z in consequmce�Qf granting of this permit
APPLICANp'f[N ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE G ON
lea ��-3aZ Re-roofs
Signuureo
HAZARDOUS
Date
HAZAUS MATERIALSDISCLOSURE Type of Roof
Will the applicant or future building Occupant store 9.12.handle hewdoand Safety as defined m the Cupertino Municipal Coe,Chapter 9.12,end IM Nca1N and Safety
Coda.Secdoazss32(a)+
❑Yes All roofs shall be inspected prior to any roofing material being installed.
f7FNa
Will the applicant or future building occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazaNnus air contaminants ss defocd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑YC9 r�a1V
I
have read Ne WmNnusm "otsreyuiremennunderChapvrh.95ufthcCalilm-
nie)icaOye, c Code.Srd 255(15.25533 uM25s3d.1 undcruard NuiftM Wilding
don
net c ccc I have a.n 4 Net it is my respo_ihi""an neufy IM Occupant of IM
mquicon lt ' aslM a pnonoissuance ofd Ccnifca of .pant.
I c 1 i Q Signature of Applicant Date
Ownaroraa.huri,< ,ml Date All roof coverings to be Class "B"or better
• •
CITY OF CUPERTINO 0 2,-
BUILDING PERMIT APPLICATION FORM
Building Address: ado-30
jw-lGi1i✓S f��• -# IF
• Owner's NName: Phone No:
LAIC I�rMbFe P^eITME9T5 1050 157`14- 5300
R.
Contractor: License No:
coijgmL -ricJ oc--
Contact Phone No:
5 WC1WE2 PRDZcT A602- (/GZ 5-110-5309
Architect/Engineer License No:
S 1.!?L�C SINewIR 2s5
Applicant/Contractor:
LAKS DRE APPermeWS
Building Permit Info: (circle one)
BldgEle Plumb Mech
Description: 1wmAz /tGnlovA non W 1r6maPe4 -o Kt Ba
NEVI WA6pee/De'JeeWW WALL A/C., N@W FLM2 COJ62106-
Residential: MaLT1- FANVLq Commercial:
Sq. Ft. Floor Area: $/Sq. Ft.:
1000 SF
EAPNIust provide): Valuation
oonstruction: Occupancy Group: 91
Qty. 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
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
ZADDCHG Address Change BUILDING
r2 7 7
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