00080034 y
:..CITY'.OF CUPERTINO - - PERMITNo. , -
nmr m vc brv�stoN ' PERMIT CONTRACTOR INS Q.RNITTOAI:
Bml.omcADDRrss`0050 RDDRIGUES R . 14BWALDRON 'CONSTRUCT""NI A ALDATE
OWNER'S NAME _LAKE 'BILTMORE APARTME T.S. ,73„HERBER•T LANE
' wc� tFr
PHONE ' r El
(408).377 8186
ARCHITECIENGINEER' ; - °• UJIalsio PERMIT INFO
Z O. e�= LICENSED CONTRACTOR S DECLARATION , - _i,
1 hereby atlirm that I am licensedundern ons of Chapter 9 my livens g Job DCSCrIIpK
5-.� wiN S«to 70d0)ofDivuian3ofNe Bui im and ProrenlanacWe.aha my ha« ' + I TER OR REMOU L'
555'Yz d3 mfur andeRem.
w LICerPt Class WC.M ,
3 LL H
Data—'- Conrractw�
C g O G ARCHITECTS DECLARATION ' ,
1 understand my Plans shall be used as public mounds
y Creamed Prof.
OWNERBUR.DERDECLARATION -
C ¢ I h rcby iRirm Jut I am tramps from the Contractors License Law for the
D
following aw (Sem _ 7031 5,Business and PmRassona Cade A,city or cou ty
Wes m
which mt _ Permit in wt alter'impmve,demuhsh,ormpmranystiuctur, , t. Foo ea , Valuation
prior to tissuance,als resumes Neapplicamforeuchpemnrtofileasigrtedauamnt ,S i.c ,g2501ata '
Nat he is lircnsed e,amaresu Ne pmvisiona applicant
Ne Contractors License signed
mu comic
'(aomimncing wimsacf 7000) rD iaian3orNaeaaaeaaaw pmrnamnacWe)ar. - APN umber ”' - �^.' Occu ane T e
, r•
that he is a.mi"therefrom and Nc Mais for On dlegedexemption Any violation of •, P Y Yp
Sectors 7031.5 by any applicant for a Finnic vubJ«a tsc ePPlment to a hurl Penalty of + 3r.--: Dos. oo ' -
m more Nan rive hundred dollars($500)
o ,❑I......rofNeprogeny,ormyemploy N gnnNe" I ampen.0 - -Required Inspections r
wdl do Nc work,and NeeWmurc is intim vded r R mdfm al (Sec]094.Bua mss 6 _ -
and P,.,.,fesk nes Code ran Canrraamra Lice as La does not apply to an Wmar or _ , P '101 ,�FOLINDRT ION .
Prany who semina or imrove
p .Narcan,and ho don each work himrav or tbrngh 102'.— PIERS
his wn employers,provided Nm such Impmveme t are not Intended or oRe sm for r,
ale,if,hoem the building ormprovem useld within one year ofcon,letio the y �' 103 UFER
s own iasiaridas) Il ban Ne h Ne of proving that he did t
Wild ar mpsove for P N +
104 f REHAr
+ I-T y' R
1 as ow;of Ne properly am a onti
else 1 vly cscting N livened conteacroa to
tdue p ject(Sec.7W,BusinessandPrr sion;Code)The Commustuts a 105 ANCHOR BOLTS
cone Law does nutply m an owner of pmpcnY who builds or impmva Narcan,and - A'
,whocontmmsfora c pmiecmwiNacomnctor(a)hcensedpuausnitothe Cmnmcmrs - �] 06- SEWER & WATER
ren d -202 ..UNDERFLOOR PLUMBING
Mame mr P ' .B&PC
owiter Data•' I eel, -'UNbERFL00R ,MEGHAN I CAL:
WORKER'S COMPENSATION DECLARATION( G44 UNDERFLOOR FRAME ,
1 hereb efirm un et of r e of the fallowm ciecbntions. - .,µ_. -
dn'Cc " pe'"n g 205 UNDERFLOOR INSULATION' ,
❑Ihave Browill]for
eGenfate of Comm�Or Crude.areforerforomoo of IN ,y` d
swoon es provided for by Section 3]00 of Ne Labor Cock for the peAomunce of rhe . .,.,tD1 'ROUGN'. PLUMBING
work for which this permit iissued "
❑I have and will maim Worker's Cnmpeneninn Insurance,as`respired by Ser - '., 302' TUB &' O R. SHOWER ,
3'7W oftic Labor Cada,far Nc pco mumu ofilm work for which N' permit isinued a -
MyWorkersComperoationlnsurancecamerandPolmynumba •„303 `•RgUGH',MECHANICAL-
Comer CERTIFICATE OFEXEMPTIONYFROMWORKERS . -,304 ., .:' ROUGH, ELECTRICAL:'-
COMPENSATION INSURANCE - -
�.(Tho" «tion nnbcomplerlfNe pcmr ivforolm tiurW dollars 5 ' FRAME
or a)
-
30E — .HOLDOWNS
11 certify durmrhe performmice aline weak for wh ch ihispemtt iainued lahall t a
,. riot empl y any persod'in any inanmr sex as to become subject in the Workers Comps
satinLowsofcaliforaDMe 3!D7 ,.. INSULRT•!ON
Applicant 308 SHEETROCK '
NOTICE To APPLICANT If,after making this Cemficem of Eaemptim,you sho Id l1
became sub;«t to rhe Workers Compensation Provisions of the Labor Chap.you must :309.;!-,'EXT.ER:IOR LATH
fonhwiNcoml with such ronsionx or this noir shell be d«Illed rcvokW.� �,'” -
., „Pr P pe 31m. = INTERfiOR L'RTH; • '" ' .
CONSTRUCTION LENDING AGENCY '. -' 311 — -'SCRATCH• COAT.
I hereby affirm that them is a commason lending agency f the perfmoance of
.. Nnwork for which this .is is issued See 3097,cn y c) - 3 f 3 — ROOF .NR I L, ' 'a•+ ,. . ..
Lenders Name '
z > ;Lewer.Addmaa 501" — .'F,INAL (ELECTRICAL,, ENERGY'
'W qIcamfyrhmlhacereadthisapplicationandstatethattheabuseinformazan i 502 — -.FIhIRLi PI_I:1MB'ING ENERGY -
tr �+ coirem I&gree m comply with all city and county ordinances and sate laws missing to - ,
5 z building commuction,and hereby summers representativesofthiscity tomeruponth 503 — FINAL' MECHANICAL' ENERGY
U.O' mo Wen d piopeny for inspection purpose.a -
Gr. " (We)agree to rave indemnify and keep harmless Ne City (Cupertino against t' 504 -+. FINAL. BUILDING' ENERGY, " "
tEj Bamlwrs,iudg'A ta, asumde:penasswhichmayinmyway.eemeagainatsaidCity _. - .505 FINAL, .ELECTRICAL., .
imm�s n thegra rm'.fNispe.mit. -
• r1a APPL q' DERSTANUSA UWILL COMPLY WITH ALL N;POINT
v z 'sac CE t JI TbNg. I 506 — GAS TEST
507. .FINAL: PLUMBING
.y SiBnarore ofApplicenUCrmac r , , Dam 508 '—' F,I NAL' MECHAN I CAL_ '
y - HAZARDOUS MATERIALS DISCLOSURE -
WiBNeappucautorfuture Wilding;..,ntamreor handle hazardous mined.[ Re-roofs509 — ,FTNALL GRADE I � 'j
•1 as defined by rhe Cupemoo Municipal Codex Chapter 9.12,and the Hamh and Safety'
Cede section Y5532(.)? Type'of Roof •. .. 51.0 — FINAL PLANNING . ,
C Yes N - f �'tg r lloott RKS.
'
Will the epph<anI or future building«cupam use equ pment or devices which
All roofs shall besiecte I m terial being
m,iitharerdouaairconami"ansa•definedbytheBayAm&AnQuallryManagement 'installed. If.:roof is'mstalled without first obtaining'an'ins pection'
"Dis°let'_ 1 " 14 ree.to remove all new materials'for inspection A licant
.(Dyes - :o Nal ( , " g P PP
Ilene , Ne6 eirdwamarerialarcyuiremenisuMcrCheger6.95oftieCali�.. Understands and will comply'with, all non point source.regulations.
''fomes sty Code Surians 25505,255)3 and 25534.1 und_elxand Nm if Iso- - '� I ,
huJdi dos Jyh t Nm r' myrt ponsibil' r nolif he occupant i " , '
Signature of Applicant , Date
Own rhe t Ionz�i�W agent Oaa ' :. n "' '
All roof coverings tome Class;