02110005 CITY OF CUPFKrINO ' % i -
BUILDINGDIVISION PERMIT CONTRACTOR INF„ORMATION:,'. -
Bm 1 ESR DRIGUES AVE 14E WALDRON CONSTRUCTION COMP 3NfITN(02110005
IF�§KFvE:BILTMORE APARTMENTS P O BOX 598 APPLICATIIpNISV"IlTF/2002
PHONE (408) 377-8186 SANITARY NO. CONTROL NO.
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
X00 LICENSED CONTRACTOR'S DECLARATION I
�o IherehyaffirmthatIamlicensedunderprovisionsofChapter9(commencing REMODEL-KITCH4RPhffffl9m^]ALL A/C UNITIFLOOR
with Section 70fXB of Division 3 of Ne Business and Pmfcssinns Code.and my license is
a in fall onwardeffca. AND WASHER/DRYER.
��_ Li<cnse Class Lic.M
DyFp Date Contractor 0 9M A LIED
QQ ARCIII'TEETS DECLARATION
I understand my plana shall be used as public records
de LicensedProfdssional ,IAN 0 2 2003
OWNHR-BUILDER DECLARATION
�P 1 hereby affirm that I am dxcmpt from Nc Contractors Liecnsc Law,baron,
m
00 following reason.(Secion 8131.5,Business and Professions Code:Any city or county
6 ie 3 which m bmims a reread to coustluel.alter,impl..ve,demolish,nr top it any struamre � $34660
=i 'dorm its issamove.also requires the applicant fm such permit In file a signed sutemenl
< that he is licensed pursuant it)the provisions ofNeContramorsLicense Law(Chxpmr9 Sq. Ft. Floor Area Valuation
�Fp (commencing with Secion BNaBof Division 3oflhe Businessand Pmfcssinns Cede)m 36903008 . 00
y
that he is exempt Iherefmm and the basis for Use alleged exemption.Any violation of
tion]B11.5 M1y any applicantfor a permit subject Nc apPlicammacivil penally of APN Number Occupancy Type
ore Nan five hundred dollars(53110), 101 - FOUNDATION P Y YP
ss owne.of the prood. or
my
employees wire wages as their sole compensation,
,11 o Inc wort,and Ne swcture is not imended or offered(..sale(Sec.'/(N4,Busineu 102 PIERS
and Profession,Code The C.nmchux License law des not apply to an owner of 10 3 - UFER Required Inspections
property who builds or improves Ndruml and who dcessuch work himselfor through his j
own employees,provided that such impmvcment art not intended or offered for safe,If, 104 - REBAR
however,due budding or improvement is sold within one year of completion,the owner- 105 — ANCHOR BOLTS
builder will have the burden of proving that he dm not bund or improv,for purpose of
sato.). 106 - SEWER & WATER
h as owner of the property,am exclusively contracting with licensed contractors to 2 02 - UNDERFLOOR PLUMBING
incl the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
cans,taw does not apply to an owner of property who builds or improves thereon.and 203 - UNDERFLOOR MECHANICAL
who contract forxuch rejects with a carnations)licensed pursuant o the Contractor's'
License Law204 — UNDERFLOOR FRAME
❑ lam exem a Se. ,B&P C fm this re'faso� 205 - UNDERFLOOR INSULATION
n
Date ll-�-Ud- 301 - ROUGH PLUMBING
ORKER'S OM ENSATIONDECLARATION 302 - TUB & OR SHOWER
I hereby affirm under penally,or perjury one of be following declarations: 303 - ROUGH MECHANICAL ,
0 have and will maintain a Certificate ofromenttoself.insumfor Wmkrr'sCrmpen- 304 - ROUGH ELECTRICAL
Nation.as provided for by Section 37W of the labor Cafor
lc,for the performance of the
work for which Nis permit is issued. j 305 - FRAME
❑1 have and will maintain Worker's Compensation darecoce,as required by Section3 06 - HOEDOWNS
370(1 of the Labor Cole,for he performance of the work for which this permil is issued.
My Worker's Compensation Insurance carrier and Policy number are: 307 - INSULATION
Carrier: Policy No.: 308 - SHEETROCK
CERTIFICATE OF EXEM PTION FROM WORKERS' ,309 - EXTERIOR LATH
COMPENSATION INSURANCE
ohissacdon mordant becompiemd tithe permitlsforonc hundred dollars(S ltln) 310 — INTERIOR LATH
orIts'".) 311 - SCRATCH COAT
I ccnify that in the perfoonance of the work for which this permit is issued,1611 nm 3 13 — ROOF NAIL
employ any person Tuan cls mlpcomp{ ecttoZWnrkers'Cona,6satinn
Laws of California,D __JJ V 501 - FINAL ELECTRICAL ENERGY
Applicant .r�y, (�
been .IfOAPPLICA IL aIle maknFNtsCcnlllcatcofExcmpu.n.youshould 502 - FINAL PLUMBING ENERGY
lent hjca m the Worker's Cumpcnsatton provisipns of Ne IaMxCode,gnu must
z forthwith comply with such provisions(it this permit shall he deemed revoked. 5 0 3 '- FINAL MECHANICAL ENERGY
z o 504 - FINAL BUILDING ENERGY
CONSTRUCTION LENDING AGENCY
(-. h I hereby idirm Jet Nerd is a construction lending agency I the perfornme. of 505 - FINAL ELECTRICAL
C4 ? Ne work for which this permitisissued(Sce,3(H9.Cis.C.) 506 - GAS TEST
II]
Lenders Name -
a Iander1Andres,t - 507 - FINAL PLUMBING
U O candy
1 candy that I have read this application and stld that the aMvc information is 508 - FINAL MECHANICAL
11. F.. correct l agree ht comply with all city and county ordinances and state laws totaling to
building construction,and hereby authorivn represeaddives of this city to enter upon the 5 FINAL GRADE-
ahtive-mentioned o I fin inspection purposes.
9L pipets pe p p 10 FIN PLANNI G
(We)agree m Nose,indemnify and keep harmless the City of Cupertino against
F'y liabilities,judgments.coat and expenses which may in any way sector against said City 5 F N U LI WORKS'
tJz incunscyucnccnflM1 tingnfthispSrmil,
F-I APPLICANT RSTANDS ND WILL COMPLY WITH ALL NONPOINT Issued by: Date V
so U I NS. ON
a Re-roofs
Si me of pprcan✓Cmmracon Dred
HAZARDOUS MATERIALS DISCLOSURE i Type of Roof
Will the appllcunl or fmurd handing occupanl stone or handle hsmnluus material
as defined by Ihd Cupertino Municipal Cole,Chapter 9.12,and the Ileafth and Smety
- de,section zss3z(a),� All roofs shall be inspected prior to an roofing material bei. installed.
❑Yes r/\/No P P Y g g
Will the appficam ml(ulurc huildingoccupsnt use equipment ordevires which If a roof is installed without first obtaining an inspection,I agree to remove
emit hathouus all contaminants as Jcfir,d by the Bay Arca Air Qualdy Management all new materials for inspection.
Digno?
❑Yds 7sI No
1 have mad the hazardous materials requirements under Chapter 6.95of Nc Califor-
mallcafth&safatycor. dons255115,25533wdn51.1un&mwdthaliflhf building .
docs not curtcno'k�u cnan,,Nal it is my resWnsihility m notify IM occupant of the
requimmrmswhjfh dl mel pry'/J issuance of a CeNEaate,of°�wndrl Signature of Applicant Date
Gl/pa.m `Jd/�-�
o/dcr or authnriscd agent Date All roof coverings to be Class"B" or better
I I