02100034 CITY OF CUPERTINO �srr
BUILDING DIVISION PERMIT 'CONTRACTORJNFORMATION'.
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Bulga0tpa8I&IsRODRIGUES AVE # 1OF WALDRON CONSTRUCTION COMP PPITNO2100034
OWbP'sRKeEBILTMORE APARTMENTS P 0 BOX 598 APPLICATTtUYV4lg2002
ONE: (408) 377-8186 SANITARY NO. CONTROL.NO.
ARCIII'ITfCI'/IiNGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
0 0 0 0
Ja00 LICENSED CONTRACTOR'S DECLARATION pp
a.F IheretyaffirmWmlamlivcnwdunderpmvisinnsofChapter9lcnmm=nciog REMODEL-KITCHE�; ShYfP O? s]ALL A/C UNIT, FLOOR
w wiN Sn'tinn)IXX))il lliviainn lnf ll+v dusinets unJ Pn+fmaiuns Code.and mYlicrnac is
inmlln+rceaoldfoo. AND WASHER/DRYER.
ZOO= License Class Lic.X
@y—O Dam ContractorDELL ��Ns „����
r'^1-w ARCHIIEC DECLARATION �YrtlGl
1 understand my plans shall M used as public records
OmU
LLo< Lifen °f "n°' DEC 0 9 2002
OWNER-BUILDER DECLARATION
`u� 1 hereby affirm that 1 am exempt from the Comracmfs License law for the
u�i¢00 following reason.(Section 703 1,5.Business and Proffviom Code:Any city or county
$ which requires a pewit Or container,alter,improve,demoliib,or repair any.asunum 34660
pdnr In if;issuance also requires the apPhCam for such Permit file a signed statement
p��'< that he is licensed pursuant mNe provisions ofine Cnnt...an's License Low(Chaffer 9 Sq. FI. Floor Area "Len Valuation
y�0 (commencing with Section 700(fof Division toftlm Busincssand Professions Code)or 36903008 . 00
so Nat M is exempt dtemfrom and the basis for IN alleged exemption.Any violation of
Section 703 L.5 by any applicant for a permit subjects Be applicant to a civil Penalty of APN Number Occupancy Type
not mom than hot hundred do)[..($50% 101 - FOUNDATION
❑ L as Ownerof the property,or my employees with wages as their sale compensation. T02 — PIERS
will do We work,and the structure is not intended or offered for sale(Sec.7144,Business
and Prefesdmr Code:The Contractor's License does Law donot apply men owner of 103 - UFER Required Inspections
progeny who Wilda m improrms dere..,and who does such work himself or through his
hn employees.Provided four such improvements are not intended or offered for sale.If. 104 — REBAR
owever.the building or improvement is sold within One year of temple ion.We owner- 105 — ANCHOR BOLTS
barldf,will have the burden of proving that he did not Miro is,improve fm loops.of
a4 . 106 - SEWER & WATER
1,as owner of the property,am exclusively contracting with licensed comrueM to 202 — UNDERFLOOR PLUMBING
met the project(Sec.7(44.Business and professiortt Code:)The Contractor's Li-
deLaw does Pot apply m an owner of property who Wilds or improves tbemon.and. 203 - UNDERFLOOR MECHANICAL
who cunructs for Ff+prgi=crw¢hacomraaor(a)Becnsup.ra.amm NC Conraclor'a 204 — UNDERFLOOR FRAME
License Low /
❑lam ex In cry ,B&PCfir thircaa.n 205 - UNDERFLOOR INSULATION
' 301 - ROUGH PLUMBING
owmfs I Date �4 (/Z
WORKER'S OMPENSATIONDECLARATION 302 — TUB & OR SHOWER
I hereby affirm under penalty of Perjury one of the following declarations: 303 — ROUGH MECHANICAL
I have and will maintain a Certificate of Consent m self Prison,for Worker'sCompen-
a stion,as provided for by Section TTXI of Nf Labor Craft,for the padmmamoe of the 304 — ROUGH ELECTRICAL
work for which Nis permit is issned. 305 — FRAME
1 have and will maintain Worker's Compensation Insurance,as required by Smunn 306 - HOLDOWNS
PIX)Of the Labor Code,for the pertormancc Of the work fir which this permit is issued.
My Worker's Compensation Insurance canter and Policy number am: 307 — INSULATION
Carie,: policy N., 308 — SHEETROCK
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 309 — EXTERIOR LATH
To,over.madnot N completed iflbe pf.,I is lir ono hundred dollars(EIIXB 310 — INTERIOR LATH
"r lest') 311 — SCRATCH COAT
1 ccnify that in the Performance of dm work for which this permit is issued,1 shall not 313 — ROOF NAIL
employ any person in any manner so as Or Ne.me Subject o the Workers'Compensation
LawinfcarfmOi. Date 501 — FINAL ELECTRICAL ENERGY
Applicant
NOTICETCAPPLICAN-L 11.a1wr making this CanifiVale Of Exemption.You should 502 - FINAL PLUMBING ENERGY
become subject 1.the Workers Compensation provisions of the laMr Code.you must 503 - FINAL MECHANICAL ENERGY
Z forthwith comply with such provisions or this permit shall N deemed mvoked.
z0 CONS504 — FINAL BUILDING ENERGY
z thathm is acIONLENDINGng P',mV
[-. LN.—I InerenyamrmNmNercitacnniwctionlendingupencylrrthe l+ertormaiccof 505 - FINAL ELECTRICAL
fy > the work for which this Permit isissued(See.YN7.Civ.C.) 506 - GAS TEST
4.1 7� Lender's Name
C Lcodcr'sAddress 507 - FINAL PLUMBING
UO ccnify that I have read this application and state that We above imam mom is 508 — FINAL MECHANI CAL
LLP unreel l agree to comply with all city and county ordinances and state laws rotating to
0 U building comruction.and hcmbyauNnrimreprcsentativcsofIMS City toenter
up�nWc 5 FINAL, GRADE
abovementionedprogenyfor inspcninnpurposes. 10 FIN /�y ?'_ NN G
(We)agree to save.indemnl fy and keep harmless the City of Cupertino again, 6 C`(L•,.A ]d`l
f-' y liahilitica.jud cn¢crsis and expenses which may in any way accmc against said City 5 N LI WORKS
in ennse nen lot We grunting oI this Permit.
^ ,PPI. UNDnRS'FANDs NDg L COMPLY WITH ALI./'0 DINT Issued by: Date
sou CE = llI y7� , Ice 1�/¢ Re-roofs
Sign cofApplicanVC,onom,r N/Y / Date
IIAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant stnre or handle haiardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safely
Crile.Seedy.25531m) All roofs shall be inspected prior to any roofing material being installed.
0 yes
Will the applicant nr f tarebuilding Occupant use cyuipmenl or devices which If roof is installed without first obtaining an inspection,I agree to remove
emit b.,urdnns ti,fnntamina elated by We Bay Area air Qualhy Mariageme.t all new materials for inspection.
Dishiclt
Ycs
Ihavemad charardnusmamriaLvcquimmenuunJrChapmrfi95oft eCaliOm
nialleuldl&$arc �.Ydc,Section 255(1,35533 and 255)4,l underwand Nat if plc building
Jces m t t tenunl.Wal it i.t y .pm cbilily P'moPy the p of the
mquimn olio bemetp mi /},faceniream.r/q�f r Signature of Applicant Date
' � - "F — ' "/ x All roof coverings to be Class"B" or better
Owner or auNurved agent Dae
I�