02070161 2'n•.N:•suzxarrrv:?`s'.i••.�wr. :r•m:nc i.'s5 ,.45Artv::=::.+. .:i _ _
? JICITY OF CUPERTINO..
£,,c Ij__lvcolVlslOv,; PE&T CONTRACTORrINFO TION
„ •-
BULLDINO AUDRES9t"i:' �, •'
.. :. �. ' . , PERMIT N0.
2'0040'r,.tRODRIGUES AVE ..#'"'11D WALDRON CONSTRUCTION COMPANY ' 02070161
OWNER'S NAME: APPLICATION SUB DATE
LAKE';BILTMORE APARTMENTS P 0 BOX 598 07/25/2002
�...� PHONE:;
tr.�.._ SANITARY NO. CONTROL NO.
ppp .r (408) 377-8186
00 ARCHITECf/ENOWEER: BUILDINGMIT G PERINFO
BLDG ELECP PLUh01 MECH
o i s •:."b LICENSED CONTRACTOR'S DECLARATION Job DeSCrlphOR
ozm .: '1 hereby sffum Net 1 am licensed under provisions of Chep,«9 lcommnrcing
wiih 5«dor 751001 o/Divuian7Orme Busineu and Pror«aiona Code,and my heanw INTERIOR RENOVAVATION-
u in full force and�rc effect.<
Ll'.. uc.0 - KITCHEN/BATHS REMODEL' NEW WASHER/DRYER &
.O Data Contractor
tBe6 is : • 7 7 ARCHITECTS DECLARATION WALL A/C/FLOOR I��I1g iN p fi-®
,1 understand say plans ahall be usad u public rtmrd5 LLff'"' 0�!J A LL�l�
a0 Licensed Pmfeuianal'OWNER-BUBDER DECLARATION
• 1 hereby affirm that 1 am«empt from me Conu«mh Littme law for the SEP 2 6 2002
J:?'s following moon(Section]071.3,Buwun and Pmfeuions Code:Any city or crony
F O :which rtquirm permi,to rnnstruct alar,improve,demolish,or opsit any summum
C$ 'p5ior.Wi4.issuvice,aliOrtjuiSu,he epplewtforwch permitw Eleaaignednaamna t
3—'wtpa 4Jic{med pursulnit me pmNsiom or me caneaemrs Liame law(chair.,9 S [ Floor Area kA-
�rcam�5/en<ingrims«u°n.�aoo rDi.iaioneormaBa,iMa,anaPmr«riarocaeel ,:eG.','. 1'."3 • 346 �luation
m dui He i1 a!mp m2rtfmm• Jm boas for Ne Jlhgdl eiemption.Any violation .I
-ofSecfion;]031:3 by enY.pplieint for a permit wbjecm the eppliemt m a civil pamdy�
mf not mare ma.fiw weared aml.rs rssaol. - 3 6 9 � t[t>�� - :i. .l:r, Occupancy Type
❑f iso n of me property.ser my employtta with wag«umnrsole rnmfamed.., '
^roll do dq saki'and the aW[mrc ii eot imedded'or offered for sale(Sec.7(44.
Busin<u,nd Prdfpriam Code:The Contrutm i License law das trot apply tow 101 - FOUNDAT I�QAuired InspeeGons"" "5:• ` --
r owner of propcny Who builtla or improv thereon,and who does such work himself
of through his own emplayeu.provided mal such improvements art act intended or 102 - PIERS
.I bffe"ted for gale.1.however;me building or imProvamert is sold within'One year - UFER
of
103 _... ..
5 completion,the ownenbuildto will have me Wanda.or proving mat he did not bund or
improve for puryose client, 104 — REBAR
....... __.._._
l.uow°«pane popenpam Business
yd Professions
with The Contractor's
License
105 — ANCHOR BOLT$_—_
wet the project(s«.7044,Buxinev and Profession Code:)The Cew do oni, i i- 4;Li: . ... Jr• :'
Littnm Law don trot appy to an owner otpropetry who Ni1d5 m improve meteor 106 — SEWER & WATER
,and who contncu for such proj«ti M a conuwmns).licensed rsuant to me _
�eamwau mL: p" 202 = UNDERFLOOR'—PLUMBB'TNG"
❑t n5a�epw?nn�.d.rs BkPCtormiarewn 203 - UNDERFLOOR`"MECHAN'ICAL
G n r'� • G(J�2/XL'" Die -�/'DZ 204 - UNDERFLOOR FRAME
/r��'OIPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
- •l herpbr.ffmm under penalty of perjury one of me f011owmg eeclarttiona: 301 — ROUGH PLUMBING
❑,1'Aive soul"will'maintain'.Cmificam of Cartier,to self.imum for Worker's 302 — TUB & OR SHOWER
Cipeas providad far by Section 3]00 °f me labor Code, for me
:petformonce°(me..it for.which thin panni,is issued. 303 - ROUGH MECHANICAL
'oln.veegd'wilfinalroutu Worker,Compen.aoon lmurince,as rtyi,imc by Section 304 — ROUGH ELECTRICAL
- e which teas pemiir is
'isiued.,M Worke(s cam niation lusts«e eunier enE Polic aumher.te: 305 — FRAME
l o the labor Cad for the Slomientt f me work fo
a
a Y aF
:Canter. s' + .t - Policy Nor. .. . . _ 306
TfFICATION.OF EXEMPTION FROM WORKERS r r307 y INSULATION' - -
CER
� COMPENSATION INS CE
.eed nwxoom feted lnne - - ..308 ` SHEETROCK.._.
(Tlu union p pcnnn n for one hundred dollen
309 - EXTERIOR LATH '
aM1t II not em to"a m me peitorinance or the work toy wlueli mit perm.c.rssocd,1 .:- 31'0 —:.'I NTERI OR'.•LATH - -:' . - .--.- ..... - .-.....
l crxify'th
p y ray ninsoymanner so aYm beeme�sypgct tome Wmieri 311 - SCRATCH COAT "" ' rl
Com motiontiws, 1111
(/Ci
..Avidi r - ' C::' lT}v1r�Yr— .. ... . 313 .-_..ROOF NAIL..._..
!NOTICE TO APPLICANT:It.enter making this Certificate of ESemption,you should 501 - FINAL ELECTRICAL ENERGY '
• ,becomes bled t0Workers' se
me Wos Compe uun provisions of the Labor Code,you must
O C
forth w,mn9mPiywith wnnproriaommmup mtm.nb dttmearewka. 502 r FINAL_..PLUMBING_.ENERGY.....
- S '' CONSrnUMONLENDd40'AGENCY 503 - FINAL MECHANICAL ENERGY' "
N 1 hereby offs that them a coii5wedo .ding ,.,forthe Performatrce'
^-..I of me work for Permit is 309],Ci CI _ 504 - _FINAL BUILDING ENERGY
�.Q LaWe 'Nme .. _. ___.. .._. ..._. ..
•p,Z Leade;,aApdresa ' .. 505 FINAL -ELECTRICAL
r,•
U 05061 canary that 1 haw read this application a�state mat the above information is — GAS TEST
cat.1 agree tq comply with eR eity W.tool.mdinaacar and state laws relating 5 0 7 - FINAL PLUMBING
toWuWiii com uctien,aMherebyauthadurepresentativesofmiscitytoenternoun 508 - FINAL MECHANICAL
W me.bove-mentioned property for inspection puryoMs.
g1._ (We)agree m ave,indemnify onE keep hannlcis the City of Cupertino ageiut —
IIYLLI rn' 'pabilil(q,judgments,coats aM eapenser which m.y.in any way accrue against said 509 FINAL
city in consequence of me granting of Nis perms 10 F F A G 0�
APPLICANT UNDERSTANDS ANTr WILL COMPLY WITH.ALL NON-POINT Date
` SOURCE REOL'L.ATIONS. Issue Ip
' Signature OrAppucam/commetm.(': .1,'" '. .'.-.' Data.. Re-roofs
e HAZARDOUS MATERIALS DISCLOSURE '•n
Will the a'hunt Num,pule g occupont atom or handl hazardous turedal
Type Of Roof _ .. _
�u defied by the DPCm Municipal Cad Chaptr912 d me Hailm and Sa(ey YP .•" -,_. _ .„ .,.,.
.... ... . . ....
All roofs.ihall be inspected prior.to.any roofing material being installed.,_.._-_.
- Wllmssun--i torrunuab1fidedbytheBayAding occupant ea irQ tot Management If a roof is installed without first obtaining an inspection;I agrde'toremove
ten hezaAo au conuemunts u defatted by me Bay Area Au Qua] Management
°into' �,,//' all pew-materials for inspection. Applicant understands and will comply with _
°Y" Y m° all tion-point source regulations;'.
I have reed-he hazudoui materials requirements under Chapter 6.93 of the
California Health k Safety Cade,Sections 25505,5333 and 33534.1 understand mat
it the Wilding does not currently haw a tenons that it is my responsibility in notify the
.,. occupantpkbof me firemen which muslin:met prior to issuance of a Certificate of '
Ocpdry.,
OZgApplicant_
Si nature of t
Owner ser quthonzed agent- 1' Data All roof coverings to be Class SB"of better
.. .I .. ._ :.... . .� .. OFFICE
,
• • � �/ G /
CITY OF CUPERTINO az 7
BUILDING PERMIT APPLICATION FORM
Building Address: gm�62 Q -R-16, eE5 k6F. � // D
caner'sAName: Phone No:
`-
{C�l: (LTMBW APA2TMaNf5 (n 50 Gar 4- 5360
7contact&,,,
ontractor: License No:
CONSf2LtG7104 We,
Phone No:
UIEiWt�C PPjj re r A&CR G 5`16-5308
Architect/Engineer License No:
gag LWOO, S u Siodwr- K55
Applicant/Contractor:
O" APPADyw rS
Building Permitlnfo: (circle one)
Bldg IEle Plumb Mech
Description: /moa Frsi- V^nO4 19 WIDW& F-Crm6ce -D W Ba
NEW WACAWt/Dtyee , NC-W WAU-A/a NEW FkMe CAejej#.1G
Residential: MULTI-Ff1MIL`I - Commercial:
' Sq. Ft. Floor Area: 1000 Sr- $/Sq. Ft.:
APN # (Must provide): Valuation
3141-03-DO 4f
Type of Construction: Occupancy Group: R I
ow. 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
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
1 BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
ZADDCHG Address Change BUILDING
273 . /
I;CIW OF,CDPERTINo TRACTOR INFORMATION:
,( UILDINBGDIVISION,',{ PERMIT CON
BUILDING ADDRESS + .. PERMIT NO.
f
'20040 =rRODRIGUES AVE ,,#"11D WALDRON CONSTRUCTION COMPANY 02.070161
WNER'S NAME: APPLICATION SUB DATE
LAKE`"BILTMORE APARTMENTS P 0 BOX 598 07/25/2002
PHONE i SANITARY NO. CONTROL NO.
(408) 377-8186
O O ARCHffECT/EN
1 1 V GINEER ' BUILDING PERMIT INFO
oa Z
: BLDG ELECT PLUMB MECH
Q
Z 8 w )' •
Z- s r LICENSEDCONTRACTORS DECLARATION Job Description..
O Z 1 be by-Po m t I 1 d d
provisions of Chapter 9(commencing
P4 1 ' ions,Section 7000)of Division 3 of the Business ad Profiwaimn,Core,and my license INTERIOR RENOVAVATION
asl is to fall mit eftein.
E' license class Lia.» KITCHEN/BATHS REMODEL, NEW WASHER/DRYER &
ec�(o,,:u .Date Contractor WALL A/C/FLOOR.
t,y i; -;': ARCHITECT'S DECLARATION
OyI understand my plans shall be used as public records
6 p C :L dProfession I :
+' OWNER-BUILDER DECLARATION
o to 1 hefeby;affrm that 1 am exempt from the Convector's License Law for the
d-z'a jfollowing reason,(Section 7031.5,Business and Professions Code:Any city or county
f F O
iwhivh rcipairas a pe t in comonicn,site,, p e demolish,or rep any structure :
u�613 _;poo taus isan.tic,alsoun ire d -pplivism fm,u,hita filaisti,madaidemand ❑ ._ _ ... ... ..
mthai9liemosdi nq the provis s fm C macs) License Law(Chapters) 1 ,SLI,M1t Floor Areaf iJ 6' 1 . [� j/gluation
jf �eemgwnh,Scoo ]oDk))mfD J ft he Business and Promesioos Code) r , ) AJ IA,- y -.-�, is $3466'8
1 or that he is exempt theuffom and she basis for the'allege3 ekemption.Any violation '- - If
-icf SbidraO0315 by any applicant for a prmt.subjectvhe applicant tanC civil Penalty- Occupancy Type
f « than ave hundred dollars(5500) 3 6 9 � � P Y YP
Cpl inv rthe property,ormy employees with wages as their sole compensation, _
swill do the work.'and the'onarura is not intended or affected for sale(Sec.
lBu mus'and Professions Code,The Commnor's License Law does not apply to an 101 - FOUNDAT I ONuired Inspections '
ownerof property.Who builds or improves thereon and who does such work himself
r through his own employees provided mbar such improvements re or intended or 102 - PIERS
......._._.._
ff rd lim-ole,If.however,- thebuilding improvement i -Id thin one Y of """-" - _" -" ..._...._. .. ....._.. _..._ '
'completion,the owner-builder will have the burden of proving that he did not build or 10 3 - OF ER
'improve for purpose of sale.). 104 — REBAR '
I as owner of the ,amexclusively .... .contractors
ont ..._. .. -1
.._._. .. . ...... - ,_._...__.._.
p(Sec.74, us contracting with licensed Door t" to 1OS — ANCHOR BOLTS' t'
awes the project(Sec '1044,Business s arta P ofeahe Cade)Th Com t rx 10 6 - SEWER &. WATER
L la does not apply t owner of properly who builds or improves thereon,
C
... ._andova ho contracts,f ch_p i hi 'th a.co dr ctnrf)1 ce sed.pursuant to me __.__'"'2 02'"" UNDERFLOOR"'"PLUMBING j•.,:.. ...._,..._.__
i'I License L _
Clarna.c I an Se &PC for this reasons 203 - UNDERFLOORiM 'CHANICAL `
Dn r L-!•``�l�U(/L.'"o t - -�o ?/" 204 - UNDERFLOOR FRAME
fyeoPENsnnorvDecLARAnoN 205 - UNDERFLOOR INSULATION
1' " I hereby affirm under pc'nuty of pe) ry one,of,the following declarations:
301 ROUGH- PLUMBING
f. ❑ I�ha e`end"win i' 'e'Ccrtifcam ofConsent'io selGinsure for workers 302 - TUB & OR SHOWER
^'b.'$- 'Compensption;as,provided for by Sermon-3]00'of the Labor Code, forme
prt peebfmaw kr mentor pmnai.,aed,y,, 303 - ROUGH MECHANICAL
'Olh '' dwiu'in t Wokr's,Cmpensauonhishi regliireJbySection 304 - ROUGH ELECTRICAL -
P b Nn
o]oo f m L m cid f m p rr rman«ar thr k r n i m: t
permit is 3 0 5 FRAME
.-s ed My W k s C p t p 1 e and P I y be
Clime J COMPENSATION INSURA ( 306._. NLDQWNS :. �:_ . ..... .v.
f@ns uchon need no[be completed d the perm t
11
' ii (s {CLRTIFICATION OF E%EMYPTION FROM WORKERS" f3O7- J NSULATION`, ll f -
NCE 308 SHEETROCK_ _
(5100)orm ) n iy _ _ 309 - EXTERIOR LATH
b d uea
.:, fy, Y ,nma,ymcfYhswrkfbA/ 'sOCi a al :. 310 :: _ `INTERIOR LATH
shun n t employ an me W ke ' 311 - SCRATCH COAT
C��Om en mro La spT�"aufmnL t g ,313ROOFNAIL-. -
I nil' tE t th R tm which th n
P
i OTICETOAPPLICANrlwaxCe anti misCenlflt fEa pfo o an.you ma" 501 - FINAL ELECTRICAL ENERGY
Z :be s blectto with
W such
C,.penrtonp 'ins fin ab drev or um'st
Oforthwith z.mpty kea 502.. -._..FINAL._P.LUMBING.. ENERGY
I herebydfrmi that mere is a conswhcbon lending agency f the pc
'ofthew ,""-', CONSTROCTIONLENDINGAGENCY " 503 - FINAL MECHANICAL, ENERGY,°.
hchRun pemiiu Issued(s 309ae c) ';rt e: .504 _ _FINAL BUILDING ENERGY "
a:Q Lede Nme' ` ...- 505 FINAL ELECTRICAL,', - .._.__. .. .__.. ._.._, ......
a,.z Londe Add si I
Icendy rhos l have reed this•appl at and state that the ame iofowabon is 506 - GAS TEST
FT+"[r ,cotrcct Degree tq comply with all city and county oN oats radiance laws relating 507 - FINAL PLUMBING
Q V 1 b Id gco .truttn dhereby auto ze p sentat ftmscity,.cnmrnpon 508 - FINAL MECHANICAL
y the eb e e t d p pony f inspection i po s.
_.y
(we)ignee to save, d 'nify and keep harmless the Cry OfC p nnoagainst -
IFI liabilities J ndguents ss d expert a which may,in y y rue..Lunt said 509 Gs. FINAL RAD
V- Cly n efacra fth g nt g'of
di pem,t .: `. I. 1O r F A G 5Z/
i APPLICANT UNDERSTANDS AND W ILL COMPLY WITH ALLNON-POIJ'f' IssueA4
Date
SOURCE REOULATTQNS
} ;e sd 8 t re t'APPII an✓Comme,.r - •,' ,::Dart; Re-roofs
7553 n
y' HAZARDOUS MATERIALS DISCLOSURE
_J Will m applicant f t re iv Id g ce p m vole f hone) hazsndou mat I ..Type Of Roof
.adafcdbymeC pin M plCod Ch pr 912 ash H hhand Safety " 'r'Jv
cdsen t
CY F i$ All roofs shall be inspected pi otto any roofing.material.being Installed _• ,,.�_,_..
_ Wnmeppplantorfu«rebindim,accupamuseegmpmemordevic which If a roof is in4alle'd'without first obtaining an inspection;I'agiee'to remove
Dist, ocautious rcontaminants sdefinedby theBay AreaAir Q hry Ma g t ,
Lt all new materials for inspection._Applicant understands and will comply with,
1 have mu ° • .. ..
a9s nr me all non-point source regulations.,,.
Caiifomia Health, y asenals re ser mem sed Ch tere
f &tSafet Cdd tSev n 25505 25533 cad 25534,1 cid r,mndthat
if dre buililm doe not currently have a tenant that it ism responsibility t non the
Y P Y q Y
which
Owner or authorized y trust b met prior t issuance of a Certificate of
�V .Signa[ureofApplicant Dae
t
occnpa t o t e r I men
O
g r Data.. All roof coverings to be Class,"B"or better,
,n.. .._. -OFFICE .. _...._ .. ..._.. --
-
y