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02110004 CITY OF CUPERTINO W, I +, BUILDING DIVISION PERMIT CONTRAC�TORINF�ORMATION Bulr-mBfOVOTSIRODRIGUES AVE # 14C WALDRON CONSTRUCTION COMP F�M1'fNh�)2110004 L,driKRlnBILTMORE APARTMENTS P 0 BOX 598 Appl.ICAHTN11/BOaTY2002 t I PHONE: (408) 377-8186 I SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MBCA 0 0 o P�^tOp LICENSED CONIRACfORS DECLARATION i I w F I hereby affirm that Ind licensed under provisions of Chapter 9(commencing O eD REMODEL—KITCH �f�Su R]ALL A/C UNIT FLOOR zt� with S.ction]IgMp of UivisionJnf NC llusincss anJ Professions Gmc.end myliccnsc is r UNIT, FLOOR infull how and effect. AND WASHER/DRYER. .OZ�, I.icenu Class I.ic.M Ualc Contra", rip � As shall use DECLARATION I understand my plans CT'S as pudill,ECLARrecords ILI,'115��a U LL0 Licensed Professional Q Oat I am exempt U mpt fr mDECLARATION 20OJ 1 hereby affirm that 1 am caempl from the Contractor's License law for the AN 0 M O following reason.(Section 7031.5.Basi....nd Profen ns Code:Any city nr county °'w$ which requires a permit m vommuct,alter,improve.demolish,or repair any structure i 3 4 6 6 0 Prior m its iamance,also myu;res the applicant lin such permiuo file a signed statcmear that he is licensed pursuant hr the provisions mthe Commcmrs ucen.,e Law eChapter9 Floor Area Valuation yh$ (commencingwith Sccllo.7a)(T.1 DivisionJnl the Business end Pn+lessinm Cmle)nr 36903008 . 00 '� — that he is exempt therefrom and the buil for Ne alleged caemprion.Any violation of J dl ' ]BJLS by anyappicantforaperiod"OjnsBnpp""tloecivil pc By ad APN Number Occu ane T e re thanfivehundred cuts"(".) 101 - FOUNDATIONp y ypowner oftheproperty,mmyemployeeswithwagesistheirtalecompensation, ±132 FiERS theworkandthe same; isnm imended or offered(..sale(SecJM4,Bonn.fcuina,Code:The Contractors Lirense Law does on,apply to an owner of 103 - UFER Required Inspections property who builds or improves thereon,and who does such wed himself or through his awn employees.provided that such improvements am not intended or offered for sale.If, 104 — REBAR however,the building or improvement is sold within one year of completion,the owner. 105 — ANCHOR BOLTS builder will have the burden.f proving Nat he did not build or improve for purport nl as 1 106 - SEWER & WATER I,as owner of the property,am exclusively contracting with licensed comnctors to 202 — UNDERFLOOR PLUMBING or the project(Sec.7040,Business and Professions Code:)The Contractor's Li- an selzwdoesnorapplytoanownerorprnpertywho Wildsorimproveathemon,and 203 — UNDERFLOOR MECHANICAL who contracts for such projects with a cormacmr(s)licensed Pursuant But,Commuctoi s u enna Law. 204 — UNDERFLOOR FRAME ❑ lam exempt on ,B&PC for this mason 205 — UNDERFLOOR INSULATION am Dam 301 — ROUGH PLUMBING ORKER'SCOMPENSATION DECLARATION 302 — TUB & OR SHOWER I hereby affirm under penalty of perjury one of Be following declarations: 303 — ROUGH MECHANICAL ❑Ihaw and willmaintainbyne Certificateio70of Chem.Code,for for Worker's ce of the 304 — ROUGH ELECTRICAL saloon.az provided for by Section 37q)of the Isnot Code,for the performance of the work for which his permit is issued. - 30 .5 — FRAME ❑I have and will maintain Worker's Compensation(psurantt,as required j Section 3 06 — HOLDOWNS 37W of Ne Labor Code,for mmite performance of the work for which this peris issued. My Worker's Compensation Insurance carver and Policy number art: 1 307 — INSULATION L Carrier: Policy No, 308 — SHEETROCK CERTIPICOMPEN COMPENSATION INSURTE OF EX FM PTION ANCE EORKERS' 309 — EXTERIOR LATH (TWsmnlon need nothcr.mplood ifthe permitisfmone hundred dollars(Sllxp 310 — INTERIOR LATH ,it 311 — SCRATCH COAT 1 ceniry mat th me per ��{the work for which this permit is issued,I shall not 313 - ROOF NAIL employ any pars",�m:xmc/An�t�i In thn Workers'Cum�envelinn 1-wsor Calimmia.Dme �A.f—Y/�Y/ 501 — FINAL ELECTRICAL ENERGY pv4�^3� N 0 APP�If.after making this Certificate of Eaemplion,you savaW 502 — FINAL PLUMBING ENERGY r� subjemtothe Workers Compensation provisions nfinelanmCode,youmust 503 - FINAL MECHANICAL ENERGY O ,� forthwith comply with such provisions or this pmmit shall M deemed meaked. ? CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY [r IherchyeftirmOat thereisaconswctionlending agency louthe performance of 505 - FINAL ELECTRICAL Ri the work for which this permit is issued(Sec.3097,Civ.C.) 506 — GAS TEST W Ca Lcndcr',Aamc 507 — FINAL PLUMBING n ItnderAddress I certify mat 1 have mad this application and aide that Nc.Wac information is 508 — FINAL MECHANI CAL Iy Correct,I agree to Comply with all city and county ordinances and state Ims relating In 5 FINAL GRADE' OQ building consouctinm and hereby authon.repreammoves of this city to enter upon the above mentioned property for inspectionpurposes. 94 Wo)a p p y ee10 FIN PLANNI G ( gore In save,indemnify and keep harmlessalad the City of Cupertino against V) liabililics,judgmcnts,cosrs nJcxpcnscswhichmnyinanywayacarocagainum.,City 5 F N LI WORKS U Z in consequence of lh gr ntg.f Nispermit. '—' APPLICANT U ANDS AND WILT.COMPLY WITH ALL NON-POINT Issued by: Date SOURCF:REG ,AT 3_& Re-roofs Sigpamrc of Applivin UContracrun Dam j ✓` HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will me applicant or lumrc building txcupam at.r.or handl.h t.doua material as defined by the Cupertino Municipal Code.Chapter 9.12.and the Ilcidm mid Safety F-]yes 25532(a)? All roofs shall be inspected prior to any roofing material being installed. Will rbc applicaOr nt or ummtbuilding acupanLum equipment or d.v,cc,whish If a roof is installed without first oblainii g an inspection,I agree to remove emit Dstrhajamnus air contaminants rte delined by the Bay Arca Air Quality Man gemed, all new materials for inspection. ict0 Yes Ihuveroadmch....d s wriaLsrequircnien¢underChapmrfi.95nfNeCahit)r- niaHcalN6Safctyc[v]c, ,.ions25N15,25533md25534,1underswndthatifmd building does nor currently base am.Nat it is my responsibility to nomy the occupant of the yuimmcros whit "met pct l issuance of a CcnilicK,ff ru ant: Signature of Applicant Date JV �— ✓ Owner oramhori.dagrnt Date All roof coverings to be Class "B" or better CITY OF CUPERTINO BUILDING DIVISION PJ%T Bu1l.00c6 OESRODRIGUES AVE # 14C WALDRON CONSTRUCTION COMP 3MITN(02110004 OwbMAKRIE:BILTMORE APARTMENTS P 0 BOX 598 APPLICATI1t/ISt/"TY 2002 HONE: ! .(408) 377-8186 ' SANITARY NO./ v 7 CONTROL NO, ARCHITECTIENGINEER: I BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 00 0 (� �00 LICENSED CONTRACTOR'S DECLARATION � F I herebyaffirm Nat I am licensed under provisions of Chapter 9(commencing _ d 0 4 with Section 7")Of Division Sof th.Buainc,s and Professions Code.mld my llt'CnY'16 ^n //E�R�,�� KI TCHE�,�7��S�,�IALL A/C UNIT, FLOOR FF�,a in fun Tose and effect. II FYI IY�H(yi�HER/DRYER. i zpyaz License Class Lic.0 Fy F, D8N cm VOCs. ARCHITECT'S DECLARATION 1 I understand my plans shall W used as public records JAN 0 2 2003 Ea G Licensed Professional £ ! OWNER-BUILDER DECLARATION K u��E I Mmby affirm Nat I am exempt from the,Contractor'a License Low for the BUILDING Rs E O O following moron.(Section 7031.5,Business and Professions Code:Any city or county b$� which requites a Permit in construct,alter,impmw.demolish.or repair any museum $34660 h Z>2 prior to its issuance,also require the applicant for such permit o file a signed suumcnt £ o Nat he is licensed pursuant to ft pruvisions of the Contractors Umw Law(Chapter 9 Sq.Ft. Floor Area Valuation y (mourrocingwit Smooth 7fu))ofDivision 3ofshe Busine adProfessors Coot)or 36903008 . 00 9 that has u exempt therefrom and the basis for the alleged exemption.Any violation of Se on 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of .m man fiva hundred doll.rs ppN Number Occupancy Type 101 — FOUNDATION ownerof the ndproperty, re is employee wisewagesutheir side compensiness me woh,and he su«wm i¢not intended aroRered ronele sec.7044.Business and Pmre s ens Code:TM Contractors Li«nae Law dots not apply to an owner of 103 — UFER Required Inspections property who builds or improvm memo.,and who dans«h woh himself orthrough his own employees,provided that such improvements am not intended orrRered formic,If, 104 — REBAR however,the building or improvement is said within one year of completion,the owner- ' builearwillhawftburdenofprovingf,hedidnotWildorImproveforpmpns,of 105 — ANCHOR BOLTS 1 106 — SEWER & WATER j I.asownerofthe propery,amexclusively contracting with licensed contnuum,to 202 — UNDERFLOOR PLUMBING o ct the project(Sec.70aa,Buined and Profusions Code:)The Conuacmrs Li- emelawdmnotapplytoanaw=fofpropertywhoWildaorimprowsmemon,sand, 203 — UNDERFLOOR MECHANICAL who comment for such projects with a contractoos)licensed pursuant to he Contractors License law. 204 — UNDERFLOOR 'FRAME ❑I;am e.emptnoS . _ B&PCforthismason 205 — UNDERFLOOR INSULATION Ow=r 301 — ROUGH PLUMBING COMPENSATION MPENSATIONDECLARATION 302 — TUB & OR SHOWER I hereby affirm under penally of perjury ono of dm following dedasati... 303 — ROUGH MECHANICAL ❑1 hive and will maintain a Certificate of Consent to self imum for Workers Compen-- doon,as provided for by Section 3700 of he LaWr Code,for the performance of the 304 — ROUGH ELECTRICAL wort for which this pemmit is issued. - 1 3 05 — FRAME 0 I hese and will maintain worker's Compensation Inure«e,m required b3,Section 3 O 6 — HOEDOWNS 3700 of the labor Code,for me performance of the work for which Ni.permit is Issued. My workers Compensation Insurer=carrier and Policy number m: 307 — INSULATION Cartier: PolicyNr.: 308 — SHEETROCK I CERTIFICATE OF EXEMPTION FROM COMPENSATION INSURANCE ORKERS' 309 — EXTERIOR LATH ITLlssemion uednmbeeomplemd iftbe permit is Won.hundred dollars(Si l) 310 — INTERIOR LATH or lC3S.) 311 — SCRATCH COAT I unify that in the perfvrbance he wart for which his permit is issued.I iball not i employ any Person ia0(t)moa{t/xc c mthe worten'Compemation 313 — ROOF NAIL Iawa of C.lifornie.Dale / 501 — FINAL ELECTRICAL ENERGY ApPliya � a� NGjI 'OAPPLICA II ILefw,maginghisCenificamofExemption.youshould 502 — FINAL PLUMBING ENERGY 0z 'We subj«uo the Worteri Compensation provisions oflW labor Code,you must 503 — FINAL MECHANICAL ENERGY forthwith comply with such provisions or this permit shall W dccmed revoked. z CONSTRUCTION LENDING AGENCY 504 — FINAL BUILDING ENERGY F I hereby affiron tat them is a construction lending agency for the Performance of 505 — FINAL ELECTRICAL 94 hework for which this p.it isissucd(Sec.3097,Ch.C.) Lenders Name 506 — GAS TEST Lk1 Q DZ Leader's Address 507 — FINAL PLUMBING U p 1 certify that I have read his application and sum that to salve Information is 508 — FINAL MECHANICAL U, Fconed I agree to comply with all city and county ordinances and sure laws relating to Wilding construction,and hereby allfGHM representatives Of this city enter upon he 5 FINAL GRADE 16 a O a above-mentioned Property for inspection purposes. 10 FIN PLANN'I G (We)agree to save,indemnify and keep humbled the City of Cupertino against rzn lubilitiu,judgmenu,cosu ndexpenseawhichmayinanywaye«roc against said City 5 N LI WORKS V w+ APPLICANTin eUf Ih gra ANDS ANDdb, WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REG AT $ v Re-roofs si mm or APVficardcontmmor Dam HAZARDOUS MATERIALS DISCLOSURE Type of ROOF ! Will the applicant or future Wilding occupant vote or handle hanrdoas material as defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety Code,Seen..25532u)7 All roofs shall be inspected prior to any roofing material being installed. • Ycs Will dm. tient or uwrc building«an If a roof is installed without first obtainin an inspection, I agree to remove Op g pant use equipment or device which g g emit hazardous aI,ronumi u as defined by he Bay Area Air Quality Magegcmcm all new materials for inspection. Disn ct7 L]Ye u ; I have mml the hamrdt smaterials requirements undo Chapter6.95oftheCalifm- niaHcalh&Safety Code. dmu25505,M533 and 35530.1 undeburW met ifthc Wilding does wt corm til,hew pant,thio it is my haspomibili y to notify the rccup.,of he quimments wnm ma pri t issoan=afe Ccrlificatforp«r ane. Signature of Applicant Date VN �— r Owner or auhodzed agent Dam All roof coverings to be Class "B"or better CITY OF CUPERTINO BUILDING PERMIT APPLICATION FORIM Building Address: 010 6606/ Owner�AName: Phone No: &GD S`1(o- 53�0 KKI�: I LTMDRE P�A21'Mt�f� Contractor: License No: R. C0IJST4zT'04 NG. Contact Phone No: Sgb-5308 5 WEavt�rt QRo7FcT pC�EfL. (/ Architect/Engineer License No: 9TAUM S�NCLAIF R55 Applicant/Contractor: 026 ArPPIO-rMeWS Building Permit Info: (circle one) Bldg Ele Plumb Mech Description: ll)9t�210R g9rWVA,rt00 IN R6Mor�-V q 6A '� 06U WA6(K�Mea , NEW w"l-Ale, N6W Ftme Coe�aG Residential: � IAI.TI-FAMILY Commercial: Sq. Ft. Floor Area: 1000 SF $/Sq. Ft.: APN # (Must provide): Valuation 311-03-Do tf Type of Construction: Occupancy Group: R I • Qty. if Fee /D 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 1BUILDING BSEISMICOM Seismic Commercial IBUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool IBUILDINU ZADDCHG Address Change BUILDING • X277 , 773 . ( 6