00080033 .+ • CITY•OF CUPERTINO, A. ' PERMIT+NO,
BUILDBvcurvfsfON ''PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS:
' t SANITARYNO. j APPLICATION SUBMITTALDATE
WALDRON CONSTRUCTLON COMGAhIYQ�01T80033;
OWNER'S NAME: y 1 +' •�
�- p.. N/C CONTROL# ..
IDNL, FLAF!SE .B3LT TS 73'.HERBERT-..LANE -❑ . ' 08104"/ 000 '
,ARCIIITECI'/ENGINEER. _ - E bULGINQ ffIj Er INFQ
(408) 377 8i:8E
z O y LICENSED CONTRACTORS DECLARATION - 1
o z- I h by.atBrm chit I am licensed usurer pmviuons of Chepur 9(comma g Job Description' ,
:P law wINS t n7000)of D' son3ofr BusimssmM fmaions Coq myhmnwls - -
<Y f J 1n full force and effect `' - ', P
owg
License Class Wc.M JNTERIORr REMODEL
^ 3 u`.y Parc Contractor .
O - - ARCHITECT'S DECLARATION _ '•9 ! .r "
I untlerernnd my fa hall be cud u public records
NN o
i g o Licensed Prof sone) •. - t t '
} _
OWNER-BUILDER DEC MUON
> ' I harob,idlimarthat I a e mpt Rom she Contract s License Law for the
D
1011mumit e (Section 703 L5 Enamels and Professions Cad Any city of county kap
w
which ow permit to consiond,alter,improve demolish.or.repair any ideal,
a 3= P^ to is iisuance also on,aiesihe applicant forsuch pemm to file a ligand statement SLI.Ft.Flom-Area V Ua On' "
Nat he is licensed p0mmat m the provisions of the Cmftwtors Lieenm taw(Chapmr 9
that ie is exempt
anddhthasison3 of thceed exemption.
An ionsCde)m APN Number Olaf
Nat he is 11.5 b any
nafmm and dm bears far be alleged exemption.Any violation of - p,
Section 7031.3 by hur trud duo fora permit subjects @c epplicuno a civil pentltY of. 1
ctrl mom Nen Rve M1ondrcd tlollers(5500).1 a '
.(, ❑1,uownerofNeproperty,ormyemployttaaithwageeuNeiraolecompeesadon, ' 36903Q ljiC#0InsPections
will do the work,and Neaoucwre is not imendcd anarertd for sale(Sm.7W.Business
' and Professions Code:The Contractors License law does,.apply m an awn,of
,.,.y he builds at improves thereon,and who does such work humin(or through '
s•
his own employees pmvidd Nat such Improvement arc out intended or offered far " ' -. 16,1 -.'-FOUNDATION ,-
sale If,however,the bale g rimprovement is sold whin oney f omlkfiin th '102 .Y TERS.'
owe Pbmlder vat hew Nie buNcn of provmg Net be did not bin la -mprove fa p • '
of sale)' s .. cI ..
103 — LIFER
, 1.m owner of Ne property em uclusivdY conaedng w W bttnsd contractors ro s 0 ., t
Co.
ct Ne projem(S,.9000,Busineu ed Profeuiom Code:)91se Contractm'a Li- 1;�(}' — RE BA R, - ' ." , °
cense law dace not.PPI u owner of proR^Y who builds or improves thereon,end
who contracts for such cls with acamractorfs)Barad pursuant to the Contractor: - 105 ANCHOR BOLTS
ottianclean aa' err' esP6JG � 10E — SEWER.:& WATER-' ' "
0 " - On ' 202;— UNDERFLOOR PLUMBI-NG
,. WORKER'SCOh ENSATIONDECI-Mll"ON t 203 — UNDERFLOOR' MECHANICAL.' '' .
1 herby affirm under penslry of perjtuy one of the following dedamtrou. .
I have and will mainain:C#nificmeafconaenl to self-insure forworkers Counter-' ' '' 264 —'''UNDERFLOOR"'FRAME
cation as provided fm by"Section 3706.1' a
the Labor Code,for the performnce of the
2 15 UNDERFLOOR
wakfrwhichwapermi„si,aud ' ' IhISULRTION
❑Ihaveanewill maintain Workerscompen.ananloan ece,a:icairdbySedan 301 - "ROUGH PLUMBING .
e, 3700of Ne Labor Code for Ne performance of the work for whmh Nna perm aa'nsucd - " -
Myw kr cdmpenaalionlnaur.ncecaderand Policy number so, -w. . ,.302 "TtJB. A' OR SHOWER
Cameo Policy No.: - -
CERTIFICATEOFEXEMPTIONFROM WORKERS' 363. — 'ROUGH MECHANICAL .
'"
COMPENSATIONINSURANCE,, �. 'r ,
(This.edonneed not beconp)atdiflh,perhli.mturebandied dollars($100) 304' -. ROUGH ELECTRJ.cALcar less.) .
r. , •I awery that in th'pm
erforance ofte work for which ths perinil is ill 9 ad,I shall FRAME
not employ any person in any manner so a,to lasume.ab,.t to the Workers'ComPer- 306 -- HOL-DOWbIS �
anion Laws of C.hfomia.Dail - y Y
Applicant r - - ""307" = 11NSULAT,IOhI
NOTICE TO APPLICANT:If,after making this Certificate,of Exemption you should^ 1.
become,subject tomewarkersCompensation Provisions ofthe Labor Cast must .`308' —: SHEETROCK ,
fonhwM comply wit such provisions orthis permit shall be deemed invoked, 11 - I'
309'' — EXTERIOR -LATH J
CONSTRUCTION LENDING AGENCY .. 310 —' I,NTERIOR I ATH
�.� Ihereby affirm that ten is a mnstrucdnlndmg agency for the FeRomlmceof 4.
.,z i Newmkfor whmhthrpcmit' owd(S 3ov7.cmc) 31. 1 SCRATCH .,COAT ' ..
(ti Lenders Name
FGI LedersAMicia 313 ROOF NAIL i
' LTA I rectify that I have rind Wx a,licau n and love that the shove inform d.is - ty ^ �.
a.Q co.,.] greet000mplywithidlwyadwa
ortyand!...carandmehosseelabr6 g 501.' —;,FINAL. ELECTRICAL. .ENERC
� 0 h1xvic- cousvucuon erty hereby efirm urcprceenatives of th' ly to emer upon the a �,
' .� O alave.merllondpropertYfnrinrtPecnanp.ryoaea - 502 — FINAL. GLLIMIITNG ENERGY
(We)agree to save,indemnify and keep harmless the City ofCpertm,against .5@3 FTNRL 'MECHANICAL, ENERGY '
O V' liabilities judgments,rust and expose which may In any wayaccrue agshist laid City ,
w in�%VAIDJF)S ,
fthe gmntgafIN rmR ",504 = FINAL BUILDING ENERGY
AUNDERSTNDSANOWIhLCOMPLYWITHALLNON.POINT. ti" a. `i0S ;— ''f INAL EL:EC'LRTCAL5SipEamuof pphcannm�� -'Gage907 — FIN TEP IL` 0 G '
HAZARDOUS MATERIALS DISCLOSURE .. `- 507 FINAL' PLUMBING '� '
Will Neapilicent it,to,..Wilding«cupant stomas handle hecallous m.mnal Re-roofs _ 508 FINAL MECHANICAL_ ' "-Y= -
ai defined bytheCupertino Municipal Code.Ch.Pmr 4 d 12,athe Heald anal anal Safety
Cda,S.fi.'X55326,)1 •' Type of Roof ',; 509 .-.'FINAL, GRADE "
g pa se.ga,p Or d iew which All roofs shall'be vl�s' eateFi cB QN jh m te'rial being
Will the applicant o f t a Wilding occupant fimm �#4' ,g,,,
ptort h raid is air contaminants as defined by th Bay Ass Au Q al ty Management 'installed. If a rool=IA stat 11hat 1APO rrrt -an,inspeetlon
ism'711 I.a see to reinode all new materials for inspection. ,Applicant
Ihave thehaurdw'eruoda„rtgwrement.dcrChper5.9Saf�ncGali• ,understands and will corm ly,with all non point source regulations.
forma H th efvy Cade,Secbort 25505,25533 end 25530 1 undersand Nat ifft
buildt t' s urently heyc�gfenent,Nvit smyresponsibNryto mdy the arc an
pt
g of N ch mLM yepgsprmo who.. Y. ` _
Signature of Applicant .Date
•• OwTi'f or amd honzseem . Oats ,' 7 , - s ., ',. ,. � _ � ^ +
All roof coverings:to be Class"B"or better,'-;
: r' OFFICE