02070162 f.CITYYOF .. - --_- . .r:_•e....v, - n . .
ri HUQAINC DNISION �gFjl' T CONTRACTOR INFO TION
BUILDIMGADDREiSS: - PERMIT NO.
200;5,0 ,RODRIGUES AVE # 14F WALDRON CONSTRUCTION COMPAIrY 02070162
OWNER'S NAME: APPLICATION SUB DATE
LAKE' BI,LTMORE -APARTMENTS P 0 BOX 598 07/25/2002
SANTTARY NO. CONTROL NO.
pp - " '(408) 377-8186
O O ARCHTTECf/ENGINEER: BUILDING PERMfT INFO
BLDO ELECT PLUMB MECH
zZM, '•LICENSEDCOhhR CTOWSDECLARATION .
�ldLS Ihereby alfum that I.Bcemadunder provisions or Chapter9(commeraing Job Description
Fye 'wiNSe ion 7000)orDivi,lon3°frhe B.rinen and Professions Code,mdmylicense INTERIOR RENOVAVATION
in roll rode and effect.
Sir < ;is
eoas Lic.0 KITCHEN/BATHS REMODEL r^N�E��Wp�WppAfSf�HHER DRYER &
3 u.0 'Date•"' ConaracSDECror F"Oy�lALrED
Ego ARCH ll he usci public
WALL A/C/FLOOR
�•"1
understand mY Piw shall x used u public mmN,
a. ao dUc,naadProfessiond .. , gip 2 6 2002
5t I! :t�,"W: ,, OWNER-BUILDER DECLARATION
.1 hereby efr.that 1 em exempt from Ne contractors License Low for the
t:? 'following reason.(Secdon 7031.5,Busies.and Profession Code:Any city or county
F O
which
requim a permu m rnnsuuct.dtn.impmrc.demoliN,or up'u any Ie..3$.•Four Biauvtme,use require me apPli,inr fmauN pemdtm Gla a,ignrd,mmmenr .• RthIDING
."a[�Gla limned ppnuen[mplt pr,rvisiaM or me Conrtutofa Littnu law(Cxprcr9 S Ft..Floor AiBa'
Icomme�icioew,im Septian,]t10p) fDivixionSof me Baines,and Rofessiom Cede) ('! }`t +';•i. .9', ., ..+r r.; " % "- 'I 34 ua[ion
br met he irelemd,menefeom and dre basis far the dleged eemp[fod.Any violation •''-
• -of Sadden]0313 by any"
Tor a permit subjects tx applicant m e l Pendry
ar ma
mare rhea Grcoperr<a eau.n(sso01. 1••.':.'• Occupancy Type.
Ol,aownerof me properly
.ar my employee with wegesameinole compewtion.
wlll'doe'woK and meswcmrt V va intendm or oRcred for We(Sec.70U. - - - - ---- --- - -----..--__-- _a.in—
Professions Cade:The Contmcrvr',Liceve law does not apply m an 101 - FOUNDATI&quired Inspections! -
owner a(pperly Who builds or improves Merton,and who dos such work hims if 10 2 - PIERS
or Woughp
In own emplayma.providM Nat such improvements see nm imendcd a
',offertd Tor Lie:Tf,'however;the xOding br irapiorcmeni ifaold-within one year of-
103 - UFER
iompledon,me owner-builder will have the burden of proving that he did nm build or ,j ' '` "' ' "•' "
impmrc For purpose or sale). ' 104 - REBAR
_-- ------ -----.___.. .......-----.,...
u owner o[the o rt,em esclusivel
-BOLTS--y d Profession$ da:e he Contemn m I0 5 ---ANCHOR �--';-_.__....
_ r the project Isec.Tto a,Bums.and ere,who
code:)The Contractor'. 10 6 - SEWER & WATER'
.
License law tact nor apply m an owner of property who xlice se improve t to the '
,and who rs contracts for auch.projena wit a conuumr(d.licen,ee Pwsuen,m the, ` ,,.,-_ --__,__-,-.-,_.
canrrxron License up... .. .. _ 202...- -UNDERFLOOR—PLUMBING--
ot.myy77m E2rSa.- BAPCfmmi.reasan' 203 - UNDERFLOOR'_:MECHANICAL
oiN6rl' liak' 7 '`�^ 204 - UNDERFLOOR FRAME
���OMPENSATIONDECLARATION 205 - UNDERFLOOR INSULATION
f hemby aRrm�nd—erN.Ityor6c,]*.y bye or sere mnawing emlmtions:
301 — ROUGH PLUMBING
� 1 have dead will'insinmiti'i Cmificeie of Consort to self-insure for Worker's 61 02 - TUB & OR SHOWER
Compensation;o: he provided for by Station J]00 of me labor cane. for me 303 — ROUGH MECHANICAL
Compennce or me work for which Nis permit is issued,of
olna.f:ad`win''lftbd�Worka,co�npemadad'tnsurance,asrequirtabySection 304 - ROUGH ELECTRICAL
_ - 3 par rte umrcaep:for me ya om„Ke of me wmk'fm which side permit i. 305 - FRAME
Issued My Warkaracorn peau[on t s mote,.Tier and Pol y n mxr ere
:3'06, -, HOLDOWNS..._w.
timer i�s u'EXEMPTION
ry . .... 1
CERTIPIQATI MPENSAIONIN MOM WORKERS - r 3 0'7' - "t NSULAT'I' ON% -
a " `` COMPENSATION INSURANCE:- •-
..:...,;:....,.. _ _ .-,.. .,,_____ ....._.. __ . .. .308 '-;,SHEETROCK..._..._�....-.__..
(This ieciio`n need not x completed if pend,is for one hundred dollars
uIooiorleaa.' 309 - EXTERIOR LATH
-. l ttsufy tier o the performance ar me work Tui wh ch tht permit is issued,I - ... 3 1.0---'=INTERIOR 'LATH -- - -_ - ---
CI
vnah0Pl any mdt(o pn0sgnto�`workers' 311 — SCRATCH
. ..Applicnt. (((/_.//LA o � �ts - .313 -. ROOF -NAIL_-. .- .. ... ___._
WOTICE TOAPP1I1AN'1`Ir enter akmg this emdcne of Eaempuon you should 501 - FINAL ELECTRICAL' ENERGY '
z become subjecto the W here Compe tion p om of tx labor Coda you mat
OOP forthwith complywm ch Pro aa..rwape tswlxdeemed revok,e ..__._,.S02 _-_ FINAL .,PLUMBING._ENERGY-
mrvsrRucnoNLENDINcecErcr 503 - FINAL MECHANICAL ENERGY''
1 hereby which
mat mart a conrd(See its d{agency(a the per(onnence
Ew:M arm.- kme -I . fpm- .ee(se309T,Cfve) 504 - FINAL 'BUILDING ENERGY
M 0 I pr citywp n C y... _ . ..___ -ELECTRICAL"'-
L;); - -.._ . _ _ _.. ...... .
z Imn,( �hatlhercreadNis b tion endsmmmtmeaxe 505 - FINAL Q -
n4e Nem ` \\
Lend f.Addn
U n.rarmaumi, 506 - GAS TEST
. rr.U caucc I a a to comply wvth dl aM o a aNme v us law,rotating 507 — FINAL PLUMBING
Q r,J t briding constmcuo,and herebyonthonas repuse tabu a of this city to enter upon
me ebovs-msrt onM,propenY ties purpose.. 508 — FINAL MECHANICAL
h' I eb I t(We)a{rte t n:un a an and keep haMNci the Cry f O,pemen.gues,
lodgment re e d apes.whichmey in any y e against said 509 - FINAL V V
U Qty n o sequence of m grant ng or Nts perms
dPPLICAVT UNDERSTANDSAND W ILL COMPLY'W RH ALL\ON-POINT
'- 5 URCE REcuLArIONS t Issued ix:0 ('` F A C' Date
StgnwreofAPPbcan UConvnnar, Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE ,..
' Will d,e eppl cent or rum`l WHuai upart More or handle barna-,anen-t _Type Type of Roof . .. ...... .. ....... ... .. . ...-.,.:,, .-N .__.,..
"asdef m by trrt C put m,M nmtpaa Code Chapter 9.12 a d me Health and Salary
Code Section 2553211 �1 "' } ',ti ,`.; ', '. 1 t"
roofs shall be inspected prior to any roofing,material.being installed.
Wllmcapplt emorfumre ildingm pan, see5yup , rdeAc.,which If a roof is installed without first obtaining an•inspection;'I agree to remove
con harorel us.0c ontominann a defined by the Bay Arcd Au Quality Management
Dim"°' all new materials for inspection. Applicant understands and will comply with
°Ye all non-point source reglation&
'I have need the biise!mi m6unalsrrquimaemi der Chapter fi.95 of the
California Healthk Safety Code,Sections 25505,2553)and 25534,1 understand Net
if Ne building don not curnently have.mnanL and it ism,res -
y po srbility[o ificeamf
o tupant of me rcqu menu which must x ma poor toss ace a(e Cenificem of +
o wn y. Signature of Applicant Date
O�Pf %3�o2, _ .
own Tar euthortpee agent / Dam All roof coverings to be Class"B"or better
::.. ...,. :.r .. OFFICE -. ._ .. . .. _ . . . . ... . -.
CITY OF CUPERTINO 020
b L
BUILDING PERMIT APPLICATION FORM
wilding Address: ado SD
Owner's Name: Phone No:KE I
LAxwze- Pv0A21-mew,5 GSD S`IG- 5300
Contractor: License No:
Colusr¢t acvw . W6.
Contact, Phone No:
Nels l Gz S96 -5308
Architect/Engineer License No:
S uam 51MCIAIR KSS
Applicant/Contractor:
006 AOWMEatTS
Building Permit Info: (circle one)
Bldg Ele Plumb Mech
Description: jKrr tot R6nlpvArnonl W R6maoEa Ec W Ba
NEW Wa6Nee/DeYee , wnu aIc NEw Ftode CoiERa�1G
Residential: Mu�TI-FgMILV Commercial:
Sq. Ft. Floor Area: 1000 SF $/Sq. Ft.:
APN # (Must provide): Valuation
3/i1-03-0o S, � 3� iobo
Type of Construction: Occupancy Group: K I
4pty. if Fee ID
Applicable Fee Description Fee Group
=BOER
Temporary Bldg Permit BUILDING
Construction Tax BUILDING
Energy BUILDING
Energy Add Multi BUILDING
Inspection Overtime BUILDING
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
7 �3. 1 �
f T.CITYt,OF CUPERTINO
`I nml.Uwc DvISION ' PERMIT CONTRACTOR INFORMATION:
Bufi 61NG ADDRESS: - PERMIT NO,
200'50„RODRIGUES AVE # 14F WALDRON CONSTRUCTION COMP Y 02070162
WNER'S NAME: APPLICATION SUB DATE
LAKE' BI,LTMORE APARTMENTS P 0 BOX 598 07/25/2002
11 'NONE:, ': - SANITARY NO. CONTROL NO.
(408) 377-8186
Ore ZO ARCHITECGENGINEER: - BUILDING PERMIT INFO
PQM ❑❑ BLDG .ELECT PLUMB MECH
z6 I—"i LI LJ L''J
"LICENSED CONTRACTOR'S DECLARATION
Z lnI hereby affirm that 1 am licensed under provisions of Chapter 9(commencing ]Ob Description
FS=Cues ;ai,h Smlion7M)of Division3ofine Busincssand Professions CWc., dmylicense INTERIOR RENOVAVATION
gs c< licensin e Clare and effect. Lic.x KITCHEN/BATHS REMODEL, NEW WASHER/DRYER & -
't-
°aH 'Dom^ Carl.,., WALL A/C/FLOOR
" v` . ARCHITECT'5 DECLARATION
t]lb O "I ehae,stand any plans shall Is,used vs public accords
�r
�.p ILicensed Professional
Oat I Am cUILDB r..tha RATION -
99 w I naso aff,m on 1 oro emmpt from Ne Contracm o License Law for the
following requires
a.(Santo 9031.3,Business and Professions Cade:Any city or county
F F O
which req trts s Permit to construct.cher,improve demolish,at mpe4 any sanctum l
3 m..p�orm u ftsW p m 9 th apdons of for cud perme micense Ida A gaW Chapter t - -- -that he glansedpursmmothe proisionsofmcConsmdorsLiccnseLaw(Chptr9 .S F[ 'rea
(r ac . ,. uation
mec gwithS ti n]NA)of 3 of me Business and Professions Code) q” FloorA., - '�3 4 ss ,,
r. :✓L': i, �. ' 5.Y.. $346
of Net he t7031.5ib any
Applicant
and the bays fns me alleged asempnt to "p�k tti�tt ��ttF�f3 tt�,��� -of not rob th n v any applicant for a permit subjects the applicant m a civil pcnelry 3 6 9 U�'U U`6 TIO
'
of notmortthanfivehundred dellan(g50oA m � �1•'�1^rl,y OccupancyType
O 1,as owner of the property,or my employees with wages as their sole compeasmion,
t -will-do the work,and the ode:The
not emended orofferedLa dTor role apply to Art -
:B f propProfessionsty Cm me Centacrmn a«awe law ases not apply m an 101 - FOUNDAT It aired Inspections
owner
f progenybuilds or improves theme,thereon,and who doer such work himself
o throughas . n employees.provided that such improvements i not intended 102 PIERS
pff dfors le lf;ho - r"te Wilding mprovemmn
eold nh oncy of "'�_.., _. . ..
'completion,the owner budder will have the burden of proving that he did not build or
103..... UFER a
imppvAf°rpatpaweafrale.). 104 - REBAR
as net fthppropenyamexdus lyccoraci gwithlicensedcontractorsto 105' - ANCHOR BOLTS
o met the project Isea 90u Business and'Professions code 1 The Contractor's 10 6 - SEWER & WATER t'' ',
License La d s not apply to as owner or[y f m.pewho Wilds nr improves thereon, -
-' and who contracts for such projects.with a connactods).licensed.pursuant t me.. .._..._ 2'02-' '-'UNDERFLOOR"'-PLUMBI'NG -1' --- — -----
c ntracrors License Law ' I. ,
pl j arfil de Sd - ° `I';B&PCforthisrtason 203 - UNDERFLOOR"NE' CHANI'CAL
G ` 204 - UNDERFLOOR FRAME.
MPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
_ IhertnyafrrmundApen.By°fp11FJ 66afinefauawiagdechusumr: 301 - ROUGH PLUMBING
t .,❑ I'ha a and will'mmain'o'Cenifi m f Canneniio self orate for worker's 3 02 - TUB & OR SHOWER
V. Compensation,, vs'mrA,dAd for by Section 37W of the Ultur Cade, for the
Performance of me work fpr which mis p mh i.I...AL.... 303 - ROUGH MECHANICAL
0 1 hwvaand will'matman Workr'i Co pa u Insumn 'gaited by,Se2tion 304 - ROUGH ELECTRICAL
39W of the LAror Cad fit me peifasma of the work far which this permit is
- issued,Mywak sc pct bonInsa < e adPl y number 305 FRAME
t - --.0 ---. HOLDOWNS.
Comer Pol c No ''''
r `s CERTIFICATION OF EKEMPIHON FROM WORKERS . ' r\` ? 3 O INSULAf. ,I ON' r
COMPENSATION INSURANCE „, r_ - _ .,, .•_ m .”.
8SHEET
. _
skiroA neW aat he ro,umleled f me permit is for are hundred dollars
cloaca 1._ i),' 309 EXTERIOR LATH ,
" — 310 INTERIOR=LATH -
- — --
I cavity
Net n me n a any pu arm
k for hich ams perm t issued,rf 311 —SCRATCH
COAT t l j t A
.shall not amp�rlej�A y (aJl!{Lof/�/ulfLy�Lry 3 �qc W k n —
. with
peateth�rmu. famok_..._ ...__ ,.-....313 ----.ROOF -NAIL----- ............ _ __ _ --------
501
._ --
Com tar Dam
A hcant
501 - FINAL ELECTRICAli"ENERGY
z shall
e, tame Code,d man
o m comply m rn m.. a -,'. , _---.._._.-_5.0.2.._=. FINAL -PLUMBING,_ENERGY.____
O CONSTRUCTION LENDING AGENCY ,
503 - FINAL MECHANICAL ENERGY"
In for is stconstruction 31 is.C.) r the p`�°�'°". 504 FINAL BUILDING ENERGY of the k(o hdhmspc t
w.Q Lend rs Name. �
t Lear Address 1, 505 - FINAL ELECTRICAL,„�.,
icerify,that'I have aced this application and state tht tahe aboveinformation is 506 - GAS TEST
fa.'F., it r t ,.Am.,,], ithAli it,and countyormnan rea and t,a laws.].it., 507 - FINAL PLUMBING
Q!IU to bu Id gasavct and hereby doth p -mn6so of m s city m cam,upon
W, In b a tpyepp Perot Inspem preps 508 - FINAL MECHANICAL
Ti
(W)ajrceto sascindeffinify and keep hl-uheCty ofC penmo gainst
IILrr VJ liabilifies,judl, st c shipsd pairs which may in anyway accout,against said 509 - FINAL
U z City in consequence org ming of ihts pertnrt - 10 (TU” t
( APPLICANTUNUERSt\YDS ANb-WILL COMPLY'wiTHALL NONPOINT Issued 3]!: Date `/ Vim/
SOURCE RECUhi\TIONS „r li'
Stgnot fAPPliccnVCdnaaa .•`� "" ,r ",, .Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
`wn'tne ppli ant orf t rcbd'Id gce pant tore or hardlc haraidws minimal ..Type of Roof- .
adfadby theCpenmoMunicipal_Cod Chapter 912.and Health and Safety ..,., .: ,,, i i u_ ; k .._ 1 '1'14
.' I,�. .. . ..
Cast S tam 255 1 el 1
'a 1L7Ysay'r.,� r I i [ v1 r P�:" t p'[,,. tis �:, �t� a { est t t (
All,roofs.shall be inspected pnorto any_roofing.materlal,being installed „- _-
Will the applicant future building occupant use equipment or dC 'rgs nm If a roof is installed without first obtaining an inspection:Fagree'to remove
arm,h ❑ us m,cot ant.as defined by the Bay Ared A Quality M aagement
D.trio - all new materials for inspection. Applicant understands and will comply with
..- .. P
all non point source tegula6ons
1 have read'N<haaardoo.momnol,requirements under Chapter 6.95 of me
cdifusma Health&Safety Cade,Sections 8505 :3533 and 25534.I understand that
...... t
if mama of does which
arm t that y 'y
' g Y Y Pon ibl r m not F the' ,
occupant of the qu m ni mch,mh t b t p ' m i mance of a C Wife t of
O p ncy
ao. .- _Signature.ofApplicant .. Date
!"
'Owner audairiedl ncra, �— Date . All roof coverings to be Class B" or,better
„ .
f 1OFFICE