01080074 CITY OF CUPERTINOr "
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BU _ ING ADDRESS: PERMIT NO.
RODRIGUES # 12K WALDRON CONSTRUCTION CO ANY010y80074
o3LN�I:A""hILTMORE APARTMENTS 73 HERBERT LANE AOSG�Tjo5% 2001
��PHONE: (408) 377-8186 SANITARY NO. CONTROL NO.
z z ARCHITECTIENGINEER. BUILDING PERMIT INFOm. _ BLDG ELECT PLUMB MEC
i. I=J LJ LJ1711
_
Z y Z LICENSED CONTRACTOR'S DECLARATION Job Description
0440 Ihereby affirm thot l,anlicensedcode rp.....F avFfChapter9(commencing INTERIOR RENOVATION.
p vtt ao "in Section 7000)nf Divisicn3ofthe Busleassnnd Prodeconv Code,and my license
�xf5 i,in muromeandaffect (REMODELED KITCHEN & BATH, NEW WASHER/DRY
zena Danveclacv Lieu /C FLOOR COVERING. )
�<3 e¢ Commaar
WALL A ,
ARCHITECT DECLARATION
a O< 1 understand my plans shall be used as public records
as6 p 0 Licensul Prefessinnal
�f OWNER-BUILDER DECLARATION
ill= I hereby umrm that I am exempt from the Contractor's License Lew for the
F'Z c- following reason.(Section 71315,Business and patrolman,Code:Any city o,county•
S at e which requires a permit u)arnomaaltea.improve,demolish. repor any structure
i
3lc prt t t Irequiresth ppl' trotsuchpe ltfI signedrtementof ac
mane balanced b is tt he Povennes ofn Cinematic.,Lielanne L
(Chapter
h un,Cody) ,Sq..)Ft. Floor,.tArea, • ,
$346)&&ation
or that heifexempt therein m end the hasisfor the alleged exemption,Any
violation -
f 5 70315 by any upplirvm fora p ,subject,th appl' acivil' pe Ity
idath f m ne,ee collar.(ssnol. 3 6 9W3TMI8rlb@l0 Occupancy Type
I, r of the propene or my employees with ages as their sole compensation,
will do the work:and the srcuetme is not intended or offered for sale(see.7(u4, 101 - FOUNDAT aired InspelaionS
Business and Professions Cotte:The Contractor's License Law does not apply m an completion,
fproperty Wn builds p thereon, e n d n work himself 102 — PIERS
throughh ply p ddtht hmp m t not intended _ _ . ..._ . . .....
ompleiffemal I is e d b have
t pr ementi .ala lh y of 103 = UFER
0omplm theh Id III the bud provingfthat hdid Ib Id an
cop ro,tur,i Idt.), 104 REBAR
r tn
i p p t 1' Iy I r e with e t t t 105 -`ANCHOR BOLTS
r oil Po,je,SIN 7Bi4Bamimes,andP f. as Cod )The Connector", 106 - SEWER & WATER s
License
i L t pply 1 f P p ty h bu Id 'mPro thereon.
and whom t .fo dp s 'a the _202- UNDERFLOOR -PLUMBING
p ) u.wtha m
oltmt"a"rsea Bthin203 - UNDERFLOOR�,MECHANICAL h
btu 011ie /7 D��n 2 04 - UNDERFLOOR FRAME
"WOR SCOMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
Ihreby alum under Parldry ofperjury. of the following aeemmtlons: 301 — ROUGH PLUMBING
. ° Ibase and willFormula a C'
crofieFac f Consent to selrntsme I Fel mker's 3 02 - TUB & OR SHOWER
Compensation. as provided for by Section 371() of the Labor Code, for the
carbntateofthew kr which this < t sped,, 303 - ROUGH MECHANICAL
°In ve and will mu tat W kers Compo t "m,aean '.r<gmma by section 304 - ROUGH ELECTRICAL
3700 of the Label Code,for the pe,foi .no,of the Work for which thin permit;is
305 - FRAME
EXEMPTION F.1 1, y nc
i�dMyW kL0 pe t ' I11 1. nu oe<n< O
�� T FI f E OM WORKERS "(.�. ... .._ 3 0.6 Iia IQLDOWNS_.
CERTIFICATION OF
NSULATION. "
COMPENSA'110N MSURANCE ' 308.,-F- SHEETROCK '- - "- -- "----
.I"'" ,(Th "'lien metal nor beenmpleactidhePantrsbut.,ahundred dollars 309 - EXTERIOR LATH ")
(5100) I ss)
,. I I __ ..310. .-_..INTERIOR_ LATH
1two,fYthat i thepet fth work far hths pe i a is issued.1, L� :_. .
shall nit motley any pe a any a,a'n so a�to becom subject 10 the Worker' 311 — SCRATCH COAT ( �-'`
ppp` - .Date •. ... ..313. _.-..ROOF._NAIL_....
Com t Laws of Cal forma a..one ., .......... ._.._....._... _._._ ..__... . ....._._.,
'NOTICE TO APPLICANTvB,after making th ( d M1aim L n�co^ky,should 501 - FINAL ELECTRICAL'`'ENERGY
be m bj ti 0 Workers Co lie. t p
O rd withsuch IF �.aanao thisp 502 - FINAL PLUMBING ,'ENERGY_,.
a II by Af(rmCDN
that CONSTRUCTION FNDINGtlA6agC yfonhe pertomtu SOB — FINAL MECHANI CA'L ENERGY -" - 1` �"
Z L a work I hath ate.. 506 - FINAL
ELECTTRICAL-
rental Civ:C) E
o col,wo S lend
aW 505 BINAL ` ELE1 . F.
Add e
-� I tfyO Ill a
correct.f r mdad:'tprprl, county
ty ,cot aces absuite laws relating
sg
507 - FINAL PLUMBING;on la g t etaan any m p rm_ tri merupon
508 - FINAL MECHANICAL
'the b0`4
',at op i" a ,Peet P m
e m le hryanake<pn coir=ln�rtyTcpea�noagains' 509 — FINAL GRADE
Fn Vi
liabilitiesmarls.c t d pense both may to.any ay ne ti,srmd said'
U z ;cig1eneofthe t gafm p tt 510 - NA ING
LNI TA USAM1DIVILLCOMPLYWI AI NON OURuL TIO -, t Z Issued fin. Date
Sigarartsmr, ppfinan✓elm,. nr.: :'.�.,.9ate.; '.. Re-roofs
Fur d f d b the,C n hl MATERIALS DISCLOSURE �I
pp 'or h dl h ti ,n t Dal' ' p
Inde Section Co,alt m f t b alT 1 Ch p�e9 1_nonlife H Ito and s fery e Of Roof.,
P
Z5532
plc P1 f'- ' as' if
Bay
:. Quay swhich
q _ .
°Y °N All roofs shall be-inspected pno[to.any roofing material being installed
.. e 1 d ......... . ..
1
r '
wu to ac t f i b-Id f e e q n n If a root is installed without first obtaining an''fnspecUtin;�h agree to.remove
en h x d us at,cn t t J b the Ba Area Air I t Management
District!°Y` °No allnon-non-point source regulations.,�. , 1 „`I-, d will comp
t all new materials for,ins inspection. Applicant understands an
p y with: ...
I hme mai.theM urdouv mater 1 qtm cro'larial,Chapter 6.95 of"the
rCaofmieahh&Safety Coda Sections 2550527533 and 255}V 1 understand that
if agd0es pm elly haveatll be thatiwnyre.ppmhtryto totifythic b,t b m rpolar m i, nee of a,Cd'bcmc 0ft ry
y ed1 t nnm,.
-S
Signature of Applicant _. ..,, g. ,. Date
ow mnaz g t Dam All roof coverings to be Class"B"or better
OFFICE. . . .. ...., . . .. . .... .. .. .