02110005 CITY OFCUPERTINO •' "w `
BUILDING DIVISION PE&T .-CONTRA AINFQRI ,ION:
kUlQl80VrDEsRODRIGUES AVE # 14E WALDRON CONSTRUCTION COMP ITNq6211OOO5
owffuN ,,E4E:BILTMORE APARTMENTS P O BOX 598 APPLICAD9.N1SIYBtggV2OO2
ONE: .(408) 377-8186 SANITARY NO. / CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Oo Lm that ID CONIsed under
provisions DECLARATION
1 ion 7 )of this 1 em llmnxd under tilPoeaof Chapter 9(commencing p O
with Section 701107 otDivision 3oflM Business and Profeuions code.andmylicenx is REMODEL-KI TCHL��,S�.Y��,gAALL A/C UNIT, FLOOR
I.fall force andef(ea. AND WASHER/DRYER. 1
ZOS'A T-t Licenx Class
Das Chromium, FONaLED
ARCHITECTS DECLARATION
1 understand my plain shall be used as public records ,
Licensed Professional JAN 0 2 2003
u.0lg-y .I It
DECLARATION
a 2 e 2 I W.".".Sat 1 am exempt from the Contrxmr's License law for she j
sd OO following reason.(Section7031.5.Business and Professions Code:Any city or county BI I' IAI�
x 2 which requires a permit to consuun,Blur.iroprow,demolish,or repair any sWeture {J k�
prior m its issuence,aleo requires mcapplicantf.reuch permits.fileasiyedatasmem
< thatheislocatedpursuantumeprovisionsoftheContracroisLicenelaw(Chapur9 Sq. Ft. Floor Area Valuation
al (commencingwim Section7W)nfDivision 3 ofsM Busineuand ProfeuionsCode)or 36903008 . 00
that he u exempt therefrom and the basis for But alleged claund on.Any violation of
tlphn'/03L5by any applismto'aperem .......Inappl',beacivilPenalsyofAPNNumber I OccasoemanEvehundreddollara(gsm). 101 - FOUNDATIONpancyType
uownerof thepmpeny.or my employes wire wage astheywk mmpchsstion,me wads,and me aWcluhe is not intended.cofferedlocule(Sec.]Old,Businessrofeuions Code:The Convecror's License Law does not apply to an owner of 103 - UFER Required Inspections
property who builds or improves thereon,and who doessuch weds himsel(or through his
own employes,provided that such improvements are not intended or offered for sal,If. 104 - REBAR
however,the building or improvement is old within one year of completion,me owner. lO5 - ANCHOR BOLTS
builder will Mw the burden of proving mat he did not build or improve for purpose of
'e1e)' 106 - SEWER & WATER
l.asowner of the property reexclusively contn=ting with licensed contractors m 202 - UNDERFLOOR PLUMBING
ct me projectBusiness and Profeuions Code:)The Contractors Li.
ansa law dais not apply to an owner of property who builds or improves thereon,and 203 - UNDERFLOOR MECHANICAL
who concocts for such orjecls with a conu¢mr(s)licensed pursuant to me COmrazmr's
Lkenxlact 204 - UNDERFLOOR FRAME
❑ lam exemp u S e. _ ,B&PChaud,..a 205 - UNDERFLOOR INSULATION
o ORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
302 - TUB & OR SHOWER
I hereby alrmn under penalty of perjury one of the following declamations:
303 - ROUGH MECHANICAL
Ilmw and will forbynection 37Micate of the Lmt.Coda,fort for Workefa Compeer 304 - ROUGH ELECTRICAL
cation,u provided for by Section 3]00 of me labor Code,for the performance of the
work for which this permit Is Word. 305 — FRAME I
❑1 have and will mention Workele Compensation Inurmuce.as inquired by Section 306 - HOEDOWNS
3]00 of the Labor Code,for the performance of the work for which this permit is issuad.
My Workers Compensation Insurance carrier and Policy number an: 307 — INSULATION
Canner: Policy No.; 308 - SHEETROCK
CERTIFI ATE OF COMPENSATION INSURAPTION NCE 309
309 - EXTERIOR LATH
(This section need not becemplcted Brie permitis forone hundred dollars($]W) 310 - INTERIOR LATH
Of1C6s.) 311 - SCRATCH COAT
I I unify that in the performance of me work for which this permit is issued,I ihall not
employ any person in an crs wtgprppael�'ectm me Woderi Compensation 313 - ROOF NAIL
Lawsof Caliromirs -/7 V .� 501 - FINAL ELECTRICAL ENERGY
Applicant ,F/f/yam
NOTIGFJI'0 APPLICA : L a ter making this Centficate of Exemption,you ahould 502 - FINAL PLUMBING ENERGY
truce object to the Worker's Compensation provismnsofthe Labor Code.You must 503 FINAL MECHANICAL ENERGY
O,Z forthwith comply with such provisions.,this permit shall M deemed mvnkcd.
? 0 CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY
F. .N.. I herehyathrm inn there iso constructed lendingagcncy fnmhe pcffmongol of 505 - FINAL ELECTRICAL
Old the work for which this permit isissued(Sce.309],Ch.C.) 506 - GAS TEST
WW Q Lender's Name
Z Londer'aAddrcaa 507 - FINAL PLUMBING
UO IceneetoclhawrcadNiityancciunandsuummmestatelia rmaintio 508 - FINAL MECHANICAL /
W U
correct.1 agree ro comply with all city end county ntathis of and slate laws Tsupong e 5 F I NAL GRADE
0} .1boveng construction.pro end Mreby wmonpt rcprexnusivcs of this city m enter upon the
(•+w shove.meei.&..mmve.indperty for emnifyaddkephon a. 1O FIN PLANNI G
0.a (We)agree to dew,indemnify and keep harmless the City of Cupertino against
fn liabllitieajudgments,costs and expenses which may in any way ammc against said City 5 F N U LI WORKS
U Z in eonxquenec a(d=ng of this permit
^' APPLICANT NDS ND WILL COMPLY WITN ALL NON-POINT Issued by: Date U
SOURCE RF U 1 NS.
l�as IL 3 Re-roofs
Si urcof pplic.rVCommcmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle Wasublous material
as derided by the Cupertino Municipal Coda Chapter 9.13,and the Health and Safety
Code.Senior 25533(a)7 PAll roofs shall be inspected prior to an Foofin material being installed.
❑Yes Nn P P Y, g g
Will the epplicvnt.r future building occupant uxequipmentordevices which If a roof is installed without firs[obtaining an inspection,I agree to remove
emit hazardous air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes )kNO
I have rtad me hazardous materials requirtmenB under Chapur6.95 of the Califon
rialicalth&Safety Cale, tion 25505,35533 and 25534.1 understand thnifthc building
Joes not curremly m,N s it is my respmuihilitys notify LM.ccupem Of the
requirementswh' naetp ssuanceofaCcniricateof npan=y.: Signature of Applicant Date
C<dcm GUl�itycc
nnra.morima asea, D,te All roof coverings to be Class "B"or better
_! • • >
CITY OF CUPERTINO
BUILDING PERMIT APPLICATION FORM
uilding Address: �,/
0?00?0 �00�(Gu�S rv, T
Owner's �v ame: Phone No:
LAKE ILrMDRE p�PA2rMW715 &Go S°16- 5300
Contractor: License No:
CON.SfR.( -nog .
Contact: Phone No:
S WEAVW PRO35GT MAdJAGERL Gsb 596-5308
Architect/Engineer S License No:
tce+;e SrNdwr- f�5 S
Applicant/Contractor:
LAKS OgE APPOrl19*nS
Building Permit Info: (circle one
Bldg Ele Plumb Mech
Description: IpliC9ZtOR /2Vr1pVAT10r! W Iz6mooeG-o IU Ba ��
,NEW WA6QMjA9Yrae , NGW WALL Ale. , NEw Ftoee C4eEw#.1G
Residential• Macfl-FAMILY Commercial:
,Sq. Ft. Floor Area: $/Sq. Ft.:
X000 SF
APN # (Must provide): Valuation
3f�1-03-00 Sf 3`f 660
Type of Construction: Occupancy Group: R 1
•Qty. if Fee ID Fee Description Fee Group
Applicable
BTEMPPERM Temporary Bldg Permit BUILDING
BCONSTAX Construction Tax BUILDING
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
' BOVERTIME Inspection Overtime BUILDING
BPERMFEE Bldg Permit Fees BUILDING
BMITIGAT Housing Mitigation Fee BUILDING
BPLANCHK Plan Check Fee BUILDING
I BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BREINSPECT Reinspection Fee BUILDING
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
ZADDCHG Address Change BUILDING
Zc2 77T
-773 . 16