Internal Remodel Permit CITY OF CUPERTINO
a N: PERMITNO.
BUILDING DIVISION,' PERMIT
CQNrCTQR-JNn+ 4d '
BUILDING ADDRESS - i - �u
- : 20080 'RODRIGIJES A' 107' . ,''WALDRON''.CONSTRUC NIB MI_AL DATE
OWNER'S NAME:. ._ ., , -
LAKE BILTMOREAPARTMENTS '73 HERBERT.' L"ANE 'N/C ' 08/049°LT'I 00
+-
PHONE: ', L fT'p o IS41CC ,.ARCHITECTIENGINEER, ' f. ,..t 408) 377 81.gal-
"
t (.
u
c'z ',z 'LIC ENSEDCGNTRACfORS DECLARATION
N l nisr`vby affirm that I on hrmaisd aMet proviai«a of Chylm 9(commencing " ',Job:Description.
F t wlNSectim7000)ofDivnion 3 ofthe Busimesand Profession Cad=eralmyhcc se s
ia(uRfarceand<Bat I ERIOR REMODEL/ ITCHEN' ATHSADD, WA
pp Data Class ICanN _
w u.a.y,
Data ConuECL
r;O¢� ARCHITECT'S DECLARATION - L 1
ga 1 d nmM
mye,lansmall be,ueeL as public reverna
4 q rL LI[eMEd Plaft661alal
u%] 4
OWNER-BUILDER DECLARATION
C G f h by eRhm that I em a mpt from N=Contract ret -Any c Law for the r
S m
followingta (e coon em 5.Business and Professions Coca-Any m s county r
i
Fourwhich req rel a perm.m w t Mon,Im'p`rove.eemousn l aan r amiame I S[I::FC Fl- o' ea r' Valuation
pn t 't issuer«,ale requ the pplicam for each permit files Signed bhmenP ;p '
that he is licensed Pursuant to the provisions of the Connacmrs License Law(Chapter 9 .$25000
• (mmmcncmgwiNSmilen7M)ofDiviaion3of0eBusiness Said proressicnsCode)m A mb + ''Occu ane e"
that he is ra=mp,therefrom and the basis for the alleged nx=mpum.Any violation of p y Typ
Section 7031:5 by any applicant Earn permit subjects the appliesnt1.a civil penalty or
W mom Nen five huiidnA dollen(SAID).
❑,L as owner ofthero
ppcy.nor my employees with wagesu their mp
Win 6oesauon, _ _ ^."Requited Inspections
will doNework,'and the mucmre nnot mmndedoroRemd parson(See.7004.Honduras �' -
and Professions Code This Contractor License law does net apply to an owner of - 101 — FOUNDATION. '
pmpcmywho builds or pm thereon,oral who does such work himself or through i a i5' . f r+
his own employees Provided dim such improvem«n art no,intended or offered]for ' 102 a— PIERS -
We.If,hrwercrshe building a'improvement is sold within meyeerofmmpleton,do
balder will have Nc buNenof proving Ntn did net boiler mpro fop 103. .LIFER . '
al )
q
gain, 1.64,Ne properly ase lou ly no- ung with li«used co neem t .. 1.64, ,REBAR - .
owns topiojmt(Sa 7044 Business dProfesslonsCoce)The C vaemr c- a: f05 `RMCHOR BOLTS
' cense law d«s not Iy m m owns df pmpeny who builds or improves N<rebn end - -
wh c nett ret p 3«iewitheconwemr(s)licensedpunuantmNeConvect re 105' SEWER R•,<WATER
"i'vocan
❑Ions ism - "' B�rQfyr ' - X02. _.UNDERFI_OOR'•Ft_UMBING_ ' "
ow«
but, ,203 UNDERFLOOR MECHANICAL`
wOR ER ScOMPENSATIONDECLARATrON. 204 — UNDERFLOOR.,FRAME
I heiebY affirmiKER penury of perjury one of the follawinL declarations! ' +
olnavis ane wiumemsan.0 ninrate arConaisn,m if-macre rorwatkera comp n- 205 — UNDERFLDOR' iNSUl_ATI'OC`I
cation,ai'pro'vidW for by Section 3700 of Ne Labor Cade,for.the ierfomunce of the '
work for thi.pcnchisisland "' ^_.301' ROUGH PLUMBING
" ❑I he cand will mormm Workers Camperalim Insurance as required by Section•
3700of the Labor Code for Ne perf0tmance ofthc work for which this permit is issued *`., 302' TIIB (�• OR SHOWER "
My Workers Compensation Insurance coer and Policy number ale:
Camier mPolicy No 303 ,--.'ROUGH: MECHANICAL-
CERTIFICATE OF EXEMPTION FROM WORKERS'. 304 ROUGH ELECTRICAL_
COMPENSATION INSURANCE
' ('rh erect nneednotbecnmploed'fN Enron fro haialreddallan(SIM) - 305- 7 FRAME
f• d nifyMatinNeperfomnan¢ofth krgrwh,chN.pemntismuea lm91 - 30E-- +'HOLDOWNS '
`•not employ any penton in any manner so as to become-subject to the Workers Compen- 'i - ,
mOon Lawsof CellPom nm - - ' ' '•" 307,'— INSULATION
'A ,Applicant - ..3a � u
NOTICE TO APpucANT:If.aR<r.making this Certificate of emmptinn,fon ahume' ' - ;;;,q-308 -' SHEETROCK',' a '
he«me samect to the Workers Compensation pmviamnr of the Labor Crate.v«must ,'309'.-- EXTERIOR LATH .
forth 'th comply wed sucM1 provinons a Nis permit shall be domed revoked. n '
CONSTRUCTION LENDING ncervcY 310 INTERIOR LATH -
O p IherebyaRumtothenisacomvuc0onlendingagencyfortbeperformanceof 311 .r SCRATCH COAT. -
i the work for which Nis pemlit is issued(Seo.3097,CN. '
p cndraName • 31'3 - ROOF NAIL :'
" a'> <erI Ariaddress 501 — FINAL ELECTRICAL ENERGY
w a nify o co have read Nis applicniun ane dine that the above laws
r on is
cuirecn.I mrs,ostr c comply In all city arm roomy ordinances and aura laws reining e `} — ">_
obuilding mins n.ewnembyaptlwdmrcpreeennuvaann city to mteraponthe .50c — F31VAL GLUI+IBING ENERGY:
Saba met edpropertrforInspectionpurposee' . 503 FINAL MECHANICAL ENERGY'
W 1�. (We)agree m x vet mdemndy eiW keep humieas the City of Cupertino against' m
OfV Imbuwisa,ja rat, ananaeapgreawnirnmayinayw.r.= sag nai..iacaY 504 —. FINAL_' BUILDING ENERGY
r,w imm�aega m'r granting of thispermiL S05 —, FINAL.
ELECTRICAL.,
kiaQ+ APPLIC Nl'f STANDS AN 'ILL COMPLY WITH ALL,Nf -POI;T '
U souac iltec it . ' - Q 50E - GAS TEST
p�,(h� O Q QD- _ 507 FINAL PLUMBING
SiBintun ApplicenVContiss,«' .. - 'Doe
"HAZARDOUS MATERIALS DISCLOSURE rr3�8, : �I NAL M€SHAIaI-r Sfll_
Will Ne appbcani or futurt building capons non,or handle haurdouc material ,Re-roofs -
ae deB«d by Ne Cupertino Municipal Code Chapter 9 rz and me Health and Safety '509' — F I NAL;G RADE -
Cache,Section 25532(a) --Type.of.Roof510 r" FINAL_ PLANNING.
Will the applicant future building me pant use equipment or devices which All roofs.shall:be I'is Betel ,rpftr,tVUK I6ot5di��t5terial being'
emit Incautious an conwn ter defined by Ne Bay Area An Quality Management installed. If a roof is Installed without first obtaining an inspection'
1, •I agree to remove all new materials foi•inspection. Applicant `
,pees � No
d .
naoeoaama�a �gaMonroe,
695 fdv c.i- understands and will comply with all non point sourcefregulations.
.famuth afery Cade S cti ns 25505,25577 end 25534 1 u mend the if the
buildi d s cu endy he i cast,
om the is my responsib t nerd(gdseaaupenf '
0 of N o bar
m ,t ua«e of., c �
4 i'4I� Y Signature of Applicant- " Date '
' ow« a amhadaea agem - Dam
All roof coverings to be Class"B"or better
OFFICE.