00080027 ` CITY OF CUPERTINO PeRMrr No.
BUILDING DIVISION " PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRMS:
SANITARY NO. APPLICATION SUBMITTAL DATE
OWNER'SNAME: G ] _ WALDRON CONSTRUE"T.L� = i I'h08Q1027
T NIC CONTI
R>N . LAKE BILTMORE APARTMENTS 73 HERBERT LANE 08/04/21200
ARCHITECT/ENOINELR
BULDINO PRIOvi r INr0
"oo (408) 377-8186 „
w
LICT SED CONTRACTOR'S DECLARATION
'o Z= O 1 hereby affirm that I am licensed under provisions a chapter 9(mmm.nrin8 , Job Description -
F,=t_w withSectian 7000)9fDivision3of dm Buainmr urd Rofnsi9m Coh;aM mYlivaeis _ -
4 y I� in full farce and eRut.
S ca LL license Clau
3.W Dat Connector ' INT REMODEL ,
01 ARCHIT
'Shia rc
ECT'S DECLARATION r
1 ancienond m ^
f y y plans be used public co ds "r '
{
K a 0 0 Wcerwed prefeulmW -
" OWNER.BUIIDBR 11 r •• . ' .•
I hereby affirm the,I atn eaeinpu hom-me or I erre th -
I- F 0 following mason.(Section 9031.5,Btislmss"Pm a ny ei 6 a l I -
C which trues a i,m conswct'after prove, tsh,o nu 7.
�3= pdmmi�nimurtimerlrmmi,eirerthe.tpl�tflImele tan ata an ' .Sqh;Ft.Floor Area Valuation
Net he is licensed pursuamm Ne provisions of theC eLi mLewI h a 11 �',�
(commcnciagwit Sution7000)of Davlsion3ofthe i feuioaC )
wt ht I.eeempr therefrom rd the b.'i,r91 M e i .Any vio c tpP.N'Number . Occupanc�.�' 00
Section 7031.5 by any applirmr fora i i dm app ant o e civil perp or ,
et more than five hundred dollar(5500). _ -
01.a nerofth.prop.ny,mmyempioceswithwegeswNirmlecompemmon, Re]ulrg Inspections
will Bothe thole and theawcturc irnm inmMedoroRered for ole(Sec.70aN,Buama 3690300t�. ��
and Professions Code:The Contractor's License taw duo nm apply to an ownu of —
propeny who builds or improves the.,and who does such work himself or through i
his own employee.,Provided that such ion m vemrnu art ran imm�ded or oRcred for 101. — FOLINDAT I ON
We.I[howevee the building or improvemea is sold within ane y...of completion,the
owner-bidder will have the burden a proving that be did not build or improve for Pm 1.02 — PIERS
as Woww�) of the pmprrsy,am exclusively conbandrig with licenwd contractors to �_• 103 - UFE R .
m m Ne projen IScc.7060,Busincn eed D9fesdom CodeO The Connamors Li-
.neaawdusnm.t treen9wnernrpr9penrwnnnaud..nrimpmammerenq..nd 104 _ RERRR .
who contracts ku roj.ma with ecomncmds)licensed pursuant to thhC9nwctorn . 1..05 ANCHOR BOLTS `
License La
❑lane in m: Beppg ----- 1.06 — SEWER & WATER
Owner 777 Dam d 202 — UNDERFLOOR PLUMBING
WORKER'S OMPENSATION DECLARATION
I herebr irrm under Maty of perjury one orme following denaralone: 203 — UNDERFLOOR MECHANICAL
•O,hay<andw0lmainanaeertinea.9remmtt9mlam.arcmrwpker.eompn- UNDERFLOOR FRAME.
safion,a provided formn br,Sm37M of the Labor Code,for the Performance of the 204 7,.
w9akforwhichthispumitisimucd. 205' UNDERFLOOR
INSULATION
O 1 have and will maintain Worteb Compensation Insurance,as required by Section _
3700ofthe Labor Code,for the perfir..9fth.work for which this o<mri,is issued. 301 — ROUGH PLUMBING -
My Wohces Compensation Insurume carrier and Polity number art: ' -
Carrier: Policy No: - 302 — TUB & OR SHOWER
CERTIFICATE OF EXEMPTION FROM WORKERS'
- - COMPENSATION INSURANCE -203 -ROUGH MECHANICAL
or less.)
IThir tech..need ma be,completed ifth.Permit I,for core hundred&11 .lSIMy 304 — ROUGH ELECTRICAL
me305 — FRAME -
not employ my person in any manner m as mum
hoe subject to Ne Worgan'Counter- a t
sa0on law,of California.Data 306 — HOLDOWNS
Applicant
NOTICE TO APPI"ICANT:If.afe,making for Cenifrcae of Eaempder,you should 307 — .INSULATION
become subject to the Workers Comprnsatioa pmvisiona of the Lahor Code,yu most
forthwith comply with wcnprovisions orthis Permit thaubeclement rev9ked. 308 .— SHEETROCK
coeaTRucloNLeNmecaceNcr 309 EXTERIOR LATH
O p I thereby offrmThai Join is.construction lending agency for the performance of 310 — INTERIOR` LATH
z .—N. the work Im which this permit I616sued(Sec.3097,Civ.Q -
Leince.Name 311 — SCRATCH COAT:
a E ed.rI ' 313 - ROOF NAIL
1:7 1 candy that I have reathi
d .application and state that the above infomudon is
a correct_1 agm to comply with all city and county ordinances W nate laws relating to
5z buildingconstrcted,mulherebymormin.rePre.mutivemfffincitytoenterupontbe i501 —. FINAL ELECTRICAL-, ENERGY ,
U O
most-mentioned property for inspection Proposes. . 502 — FINAL PLUMBING ENERGY
(W.)agree to nave,indemnity and kap naradess the City of Cupertino against
O U Ilahili0ea,judg t is d..Penrea which may in my way action against mid eit9 503 —. FINAL MECHANICAL ENERGY '
} Lai in em,sequerce mE emntinB of Nis permit. �7r
F S APPLIC, r ' DHRgTANDS AND WILL COMPLY WITD AtAt.�ON7 INT 504 — FINAL BUILDING ENERGY
tj souRc. nAaloNs, '� 505 — GASFINALTEST ,ELECTRICAL '.
Signaarc of AppliuMCnan m
Data
'.50E. — GAS
HAZARDOUS MATERIALS DISCLOSURE. -
IWilltliart,ivantor future building occupant at=or handle naurdemamarcHd Re-roofs
as defined by the Cupertino Municipal Code,Chapter 9.12,end the HuIIh and Stacy 508 — FINAL MECHANICAL -
Cede.section n532(.)? . Type of Roof
❑Y.a ON. 50c9 FFINAL GRADE
µ',Il the applicant or fumm building a cap.,ate equipment 9r d,vcsrwhich .All roofs shall be .fpectl.o qr tpt�Pl9.�f[iIg material being" -
emit havlyd9usair c9nuunimmanudefinedbythe Bali AmAir Quality Managemem installed. If a too ,Insta ,�Mthp Irk o{ 1!1111 an inspection
Dlani.l7 I agree to remove all new materials or
inspection. Applicant
❑Yes ❑No
• Ihave matda Im.mnWre9ain..mtderCha understands and will comply with all•non point source regulations.
da Pres 695 of the Cali- _ ,
tomo H.ahh afet ode.Sncd 2 505,x533 and n53a.I Ydd sand that if the .. -
buildin8du a u dy uvea no 1. to.smYmpeamibiliry JJJJJJpppppp tifY the pant x. -
o(th<rtyui mcu ben i res sarce ofaCmil(a5
OO Signature of Applicant, , P - r, Date
Owner or nn edagent > Dam ,.
'All roof coverings to be Class"B"or better
OFFICE