00080032 CITY OF CUPERTINO PERMIT No.
BUILDING DlvtstON - PERMIT CONTRACTOR INFORMATION: ,�wr)T�''� 'mg-..l Z,
BUILDINGADDRESS: - . -- V � V vv�'
SANITARY NO. APPLICATION SUBMITTAL DATE
owrvr:R's NAME: — WALDRON CONSTRUCTION COMPAP Y00080032
NIC • CONTROL#
iONC: LAKE BILTMORE AFIARTMEbTS 73 'HF_RBERT "LANE 08/04-/2000
ARCHITECTIF.NGINEEK - BUILDING PERMo INFO
�, (,408)377-8186 '^
oO
z O,N= LICENSED CON.exi Wd R'S DECLARATION' -
,Qz_o. _ lherthr,Rr,nmol.mE«nrednneerpro„ann.nren.pters( MinBJob Description
w w .with Scction]000)of Division 3 of On Bmineas and pm4uions Code;aM my It..is
-� in PoII force aMta effeu.
E
w LhAmeCI. Lic.# INT REMOD •
p 3 sea.N Dau Co.
•. - '
C LL O a ARCHrfECI S DECLARATION
S�y� I undersuM mY Plans slWl be used as public rcwd, ' - IIV///N/1 ,
d� 00
m Wns
ceed Profeasions) r
OWNER-BUILDER DECLARATION IU
$6 1 hereby affirm that 1 am exempt from the Cantrutoh Li<eme Lew for the •,r 11 -
Z O following reason.(Section]031.5,Bmircu And Pmf Ions Cricket Any city or county
C which mquires.#email tc camcroa,alter,improve,demolish,m iepur any roucturc
5— 'roh.i.....mc,.IAo me. l ...forsum rmitmneasi ed statement ' Sq. Ft. Floor Area Valuation '
prior mt the pine pe signed ., ,
'Net he is licensedit Section 7o theprovisionsvision.the Connumsa LkenseLawarim Clupter,
that he
exempt
Setcon]000)of Division ertheeged Business Any
Cedel or APN Number: Occu an Aa 00
that he is esempt thaerrom ant me burs far the cts the
exemption.AnY l violation of P ”!�i14
Secdon a than five
any Applicant doll fora permit subjects tM epplinnt to.civil penelry of r
t more man Eve hunthed tlollan($3001
OI,a..owner of the propeny,mmy employees with wegeau theirsolecompenution, 36903t7balili(90 Inspections ' ..
will sed the work and the evumum is mtinundN or offem4 fondc(Sec.]OaO,Builnns '
Add Prole siom Cods:The cm.1o1 s License Law coca nm apply to m owmr a
property who Wilds or improves themnn,and who does such work himself w through'is
own employee,,Provided that such improvements am not intended in offered for 101 ' — FOUNDATION
sale,If.however.the building or improvement is sold within me yeast ofcompletion,the w
ave itderwillhavethcbuNenofprovingthatNdldnotWildorimprovefimpur- - 1021- "PIERS +
of self.).
1,As owner of me property,am eaotnavelr contracting with bemrm emtmmnm to 103 — UFE R
1 tha project(sec.]two,Baaines.and Profea.mns Code:)The Contractor,U. , 104 — REBA R •
.an.Lew doe Plymm lec awne,of Property AWild,on i.......themnn.and . 105., — ANCHOR BOLTS .
who conn pOjccta wish a contractor(s)licensed pursuant to the ntracmrn
E Sac. B&P 106- - SEWER °& WATER
own x D.Ic O 2202 = UNDERFLOOR PLUMBING
ORKER'S COMPENSATION DECLARATION + 2Q,3 UNDERFLOOR MECHANICAL
1 hereby affirmperjury,under penalty of perjuone of the following declarations: 203 .
Ihave and well mtuded.a CMu m ificaor Cmucam self-immor for Worker.Comcn-p ^ —
ration..sprmvidedfor byS.A..3]aoefthe vft
LAIN, ert...ohe 204 UNDERFLOOR. FRAME
. work for wroth this permit i,issued. . ,205 — UNDERFLOOR - INSULATION
O I have and will maintain Worker's Campenauim Iium moa.As rtqumed by Section 8 '
37IXl of the LeborCooe.for the performance ofine work for which thispurrout is issued. 301 — ROUGH PLUMBING _
My Worker's Compensation Insurance carrier aml Policy numbs art: — _
Carrier: Policy No.: 302 TUB & OR SHOWER
CERTIFICATE OF ExEMMON PROM WORKERS' 303 — ROUGH MECHANICAL '
COMPENSATION INSURANCE
(This section need not beeomplarodifinepermit isformtcnu ineddohma(3100) 304 — ROUGH ELECTRICAL.
or les..)
lanreyOat inmeperfnmtanceorthework fownichthispernotisissued,Ishall 305 — FRAME.
not employ any Person in Any immner.oa.to become aabjecr no the worker:ComFA.- 306 — HOLDOWNS -
oad.Law s of California.Due
Aph.1 - 307 INSULATION
NOTICE TO APPLICANT:IL after making this Cenlfic.re of Ekemption,you should �f, +
bemme Subject to the Workers Compensation provision,of the Labor Code,you muse ,308 SHEETROCK '
rmtnwith tnmply with sutra provi,mm pr thi,pemtit.nanxa«med re.oked, - . 309 EXTERIOR LATH .
CONSTRUCTION LENDING AGENCY
02 1hmebyalBrmIn.themit.mmm¢uonlcnding.ge.cyfforthe puftemec.1' 310 — INTERIOR LATH
the work for which dd.permit sissued(See.309].Cis,C.7 311 — SCRATCH'ICOAT
E.: Le Z.Name ..
m > 1°`r`Addne" 313 ROOF NAIL
L41 a cent centhat I have read rola aMdcation and slate that the Above information is
.a. a mrmcLlagree to comply with Ali city And county omimncesmdstate laws reladngto 501 — FINAL ELECTRICAL ENERGY .
U O building consbucuon,and hereby authmire representatives of this city to Artier upon the _ ,
y eWve-Perniuned,ropertyfnrimpecuonpuryosee .- "502' FINAL PLUMBING ENERGY
w Ew (WA)agreatoRaw,indemnify.ndkeep hmnle.sthe City ofCnpeninoagainst 503 — FINAL MECHANICAL ENERGY
V lubiliue.judgn¢nu u aMeapenses which may in any way action against send City \
y W facto Yrs mnhngotdo,
p.it. 504 — FINAL BUILDING ENERGY
�+ AP oA tf ' iSl'ANDS A'DS I LLCOMPLY W ITH ALL N N.pc rr -
V soD1c11C _r/ s. p 505 — •FINAL ELECTRICAL
O
FER506 ,— GHS TEST
Sigmmrt of ApplicanJCommcmr Dare
HAZARDOUS MATIAIS DISCLOSURE • — FINAL PLUMBING
Will the applicmt or future building occupant store or handle hazardous maunal Re-roofs. 08
xFINAL' MECHANICAL
�� - '
—'
_ u defined by the Cupertino Municipal Code,Chepur 9.12,And the Health and Safely Y ,
Cede,Sutm.]9532(0? Type of Robf • ' 509, - FINAL GRADE
❑Yes ON. - - - ���7p
Will the apPn"Ard'o nour"ilding occupmruseequipmem or dcvias which All roofs shall be 3>> ecte6�-t(I1''df1 rUO}I31 material being
mi+hervdous a'v conumimnu udefned by the Bey Arca Air Quality Mmagcmcnt
installed. If a rooftR cristal - IthRl r;Pol�fir an inspection
IF """ I agree to remove all new'materials for inspection. Applicant
OYu ONo g
I base 1 "ou"aamaterial.nonimmenta miler Chapter 6.95 of the Cali. understands and will comply with all non point source regulations.
fmnu He h ty Code.Se ns 23YJ5,25511 end 25530.1 understand Nat if the
builtlin o d my m,mot it ism aibili m ti( t occu -
of me t y�y ante of a C<n yvq�y
r q,� y mapnn.'ad,
7/�� Signature of Applicant' Date
Owner ambos end agent .All roof coverings,to be Class"B"or better
OFFICE