00080029 .CITY OF CUPERTINO PERMIT NO. ,
BUILDING DIVISION. PERMIT CONTRACTOR INFORMATION: ,
IIUILmNG ADDRC s:
SANITARY NO, APPLICATION SUBMITTAL DATE
OW'NER'S NAME: 20080 RODRIGUES #-, 10D WALDRON CONSTRUCT --":Nip .coNTROLg�
LAKF_ BIL_TMORE APARTMENTS 73 HERBERT LANE � '08/2!4/2000 '
�•': ARCHffECT/ENGINEER HOLDING PERMIT INTO
�o (408)377-8186
ya
t- i LICENSED CONTRACTOR'S OECLA
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0 –__�y (rn1 hereby an that 1 mer lice P Job Description
'� with Section 7")of Divisum 3ofN'ga4t I C ,W li
in full force aW effect. 1 -:--�
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License Cl
nain L.
a°O`
Date HD.E INT REMODEL
C v.O g ARC S DELLA
I undmshru my plants shall be uiW as public ow
n e. Licwud Profersimul
OWNER-BUILDER DECLARATION, r
l=Z a I hereby affirm that 1 am exempt froD'the Contractor's License Law for the
S,E'p following rcewn.(Section 1031.5,Business and Professions Code:Any city or county '-
p"7 F which nquucs a permit to em. ,elle,improve,demolish,or¢pair any slmcture S Ft. Floor Area Valuation
prior m its issuance.also requires the Applicant for such semtit w file a signed statement 9' '
Nm he is licensed pursuanno the pmvisiom of Ne Comrwtues License law(Chapter9
(commencing with Section 1000)of Division 3 of the Business mrd proressions Cade)or anC,APN Number Oceu
I that he is exempt therefrom W the basis for Ne iffe W exemption.Any viohtimh of P ` 00
Section 1031.5 by any apposed,for a pcmd,subjects the applicant to a civil penalty of -
nm¢ort Irian fve hundred dollars(5300).
❑LazowaroftheprapmY,ormycmplayaawithweguutwuwl<wmpcwtirn, Required Inspections
wMdo Newolk,andthe gross¢¢is mot imendedoroffertG for We(Ses.7044,Business 3690300tl. 00 - -
and Pmfsnon Code:The Conuaeme,License Law dads era apply to an Owner of I _
prdpcny who builds or improves thereon,and who does anch work himself at through
' his own employes,provided than such improvements are not intended or offered for
n1r.If.however building or imnovernion is sold within one yestrofcomplasion,the 101 — FOUNDATION
wnet.wtaet win have thq burden or Pmvmg that ere did aa,wild or improve for pr- - ].0L' P I E RS
Fine
frolo)
av owner or the property:fen exclusively Professions with:)The Ccoduimou m .].03 — LIFER �' I
t Ina project(Sa.]IN4,Businss and Professions d.m hero Confeeremi.Li- --ll
cense law docs ndi apply m m owner of proprny sono builds or imprbven Ihemon.eW .. 1.04 — ' REBA R t__
who timings for each pacts with a contractors)loomed puiruent to Ne CautecOm"
License ecce. n 105 — ANCHOR BOLTS
❑lam==cm0 .B&Pold ,106 — SEWER' & WATERIs 'Fro-40
Owner WORKER'SCOMPENSATIONDECLARATION I . - UNDERFLOOR .PLUMBING
Ihereby ar ntounderPenaltyofperjuryoneofthefouawingdeclaratm,a:. 203 _ UNDERFLOOR MECHANICAL
0 I have and will mairulna Cenificare of Concent to self-inaum for Workeis Compeer;
cation,as Providedfor by Section 37M of on Lacer Cods.for the prifmmance of the 204• UNDERFLOOR FRAME
MIhavk for w dwillapaintan .wed. 205 — .UNDERFLOOR INSULATION
'9 ❑I have end will maintain Worker's Compensation Insurance,n requited by Section -
3lraoftheLebor Code,for thepeformanceoftoework for which this permit isissued. - 301 — "ROUGH PLUMBING .
a . My Worker's Compensation Inwrance currier and Policy number am:
Carrier. policyNo.: 302 — TUR R' OR SHI.IWER
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE v303 - ROUGH MECHANICAL ,
(Thissectinn needrwt becomPleed ifthe permit iv foronehurdeed ddlars(5100) ,-
urlsa., •' 304 — ROUGH ELECTRICAL
Ioyairy thminthe prrfomm�eoasm skrne s bicho the WmIuni'Cerpen- 305 — FRAME ,
not employ any person ld any mwat w n m hcwhn subject m th<Wdrken'Comprn- � - "
sadonlawadrealiromiaDise 306 — HOLDOWNS .
Applicant
NOTICE TO APPLICANT:If,after making this Cetifscatc of Exemption.you should 307 — INSULATION -
hecomc subject m on,Waeaces Compensation provisions of the Labor Cede,you mum
forthwith comply wit such provyionsorthis Permit shall kdamedmvoked 308 — SHEETROCK
CONSTRUCTION LENDING AGENCY 309 — EXTERIOR, LATH
Om -Ihembydffitmthatthemis..r.saromonlending agency for the performwcpor ,51.0 — 3NTERIOR LATH ..
Ina work for which this permit is issued(Sec.309].Civ.C.)
4 Iage^Nana 311 —: SCRATCH COAT
wLenders Address A I«Mfy thin I have hand Wa.,Iwilion and sem that the above inromudon is 31.3 ROOF 'N A I1_ .. ,h.
Or comet.I agree to comply with all city and county ordinances and sum laws miming to ,
Z building cdngroction.and hereby am
ronceottnerwifisMdolts City to enter upon th 501 — FINAL ELECTRICAL ENERGY
:.v O awae-nmmumed property for burping. urp•ea. . 502 — FINAL PLUMBING ENERGY '
W. P (We)agree to save,indemnify and kap humlexs Inn City of C.1man against ,
O,U [is biRts.jwgmwis,cmlamd1. 503 — FINAL MECHANICAL ENERGY
„ W in consequcrc of the granting of thin p=rmit.
APPLI NOF,R9rANf1S AND WILL COMPLY WITH ALL NON-POINT 5214 — FINAL- BUILDING ENERGY
soup ,f G'IAno ,
S. 505 — FINAL" ELECTRICAL '
Signature pplicanUec
Conntor Data `d 21Fi — GAS• 'I'ES'T,
- HAZARDOUS MATERIALS DISCLOSURE t)VJ —
Will the,applicantmfuture Wilding occupantstore orhandle Emissions material Re-roots ] - - '
ex defined by the Cupertino municipal Cade,Chapter 9.12,andthe Health and Safety . 508 — F I NAL ,MECHAN I CAL
Code,Section 23532(a)l Type of Roof '
❑Ye. C]No 509 — FINAL GRADE
Will the applicant or future wilding Occupant use equipment or devices which All roofs shall beqf
ereM
}pr t{1..ta'p}pv.4 i $ material being
emit haudous au conumiments as defined by the Bay Alda Air Quality Management ins ailed. If a rQQ ,{n �tLth�.r�a,r Q Ogg an inspection
Diafei"' I a fee to removeneerials or „¢spec son. Applicant
❑Ya ❑No' g
I hava the ha,sooks, mamneh mgaimment,mdar chapter6.95 of the'Coli- understands and will comply with all non point source regulations.
forms H th .rc,y Code,Sadao 15505,25533 and 15534.I uhdersasd that if toe
buildi mcumtnly a moan,,that it is my msponibllity ton ifYoccupan
ry t -
of ct w 'ch t w iseuwa of a C<n' of u aay,
_ Signature of Applicant Date '
Own Orr euthoneW agent ' h et '
All roof coverings to be Class"B"or better.
OFFICE