02030089 CITY OF CUPERTINO
BUILDING Nc utvtstoN 5 _ NTRACTOR,INFORMATION:.
All µms. V_ a
BUILDING ADDRESS: PERMIT NO.
20090 RODRIGUES AVE # 8H WALDRON CONSTRUCTION COM ANY 02030089
OWNER'S NAME: APPLICATION 5yB DATE
LAKE BILTMORE APARTMENTS P O BOX 598 03/ 19/2002
(tel• PHONE: SANITARY NO. CONTROL NO.
(408) 377-8186
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
8yH
b2z LICENSED CONTRACTOR'SDECLARATION lob Description
SZ_ Ihertbyefrusnthat iamiicenxdOrder provisionsofChepmr9(commencing REMODEL-KITCHEN, BETHS�,WALL A/C UNIT, FLOOR
=f with fation a.Ad cf Division J of the Business and Profcsstons Code,and my licrnx
ep6� Licemllforeeand effect. l��u���tSvD
L;Aenxclms L;c.« AND WASHER/DRYER
5 LLa, Dam Contractor
a.v5, ARCHITECT'S DECLARATION
1 understand my plans shall W used as public records
oo Licensed Professional MAY 14 2002
' OWNER-BUILDER DECLARATION
y
1 hereby affirm that 1 am exempt frim the Convector's License Law for the,
2?C following reason.(Semi..7031.5,Business and Professions Code:Any city or county Bo,'EDI
which require a permit to convect,alter,improve,demolish,or repair any stmnur, b/
a°'13m -prionOsfice.nce,rmank1.the theapplicantfor mchpermes Laces La w(Chapte9 - - - - - -
dmthe,islicensedpubuan{m theprovisionaoRheConuactorsLicenutaw(Chepmr9 S FG.Floor Q[ea, •, , Valuation
(commencing with Section 7000)of Division 3 of the Business and Professions Code) �S 1'`, 1 :A.-.t-!.', _ c/;>!,�,": �',16 , l.
.,,hot he is ezenipi therefrom old the basis for the alleged esemq;od.Any violation of Section 7031:5 by any upplicars for a permit subjects the applicant to a civil Malty-
ofFotmorethanBvehundred dollm(8500). A um er Occupancy Type
s _Olt as owner ofthe propeny,lir my employees with wages as their sole compensation, -
will do the Work,and-the'structure is not intended or offered for sale(Sec:1044,
Business and Professions Code:The Convenor's License Law does not apply,o an 102 - PIERS Required Inspections
owner of propeny Who builds or improves thereon,and who does such work himself
or through his own employees.providM the,such improvements arc not intended or 10 3 - UFER
gBe7ed for stile:If,howevcc tM1e building orimpmvemem is sold within one Year of- '- -- --- - ' '—- '--
, completion,the owner-builder will have the burden of proving that he did not build or 104 - REBAR
;mpmve for purpose" reale.). 105 - ANCHOR_ BOLTS
-w .._ _.. . _ . - - -- -'--
,ea owner of ba propeny am exclusively contracting with licensed contractors to 106 — SEWER & WATER ' . ... .
ria the priject(Sec.7044,Business and Professions Codec The Con,ranora 202 - UNDERFLOOR PLUMBING
License Law does trot apply,o an Owner of property who Wilds m improves theater,
.and.wbe contracts.forsuch projects with o comractor(a)Ecenxd pursuaut.to the .... . _.. .- 203- UNDERFLOOR--MECHANICAL' -' -- - ------- ---
C.A.me.Liccnx Law:
❑lam m Ader See. B&Pcfor thisreasen 204 - UNDERFLOOR FRAME'''
owner �0/ Due '3'aa''D� 205 - UNDERFLOOR INSULATION
ORW KER'SCOMPENSATIONDECLARATION 301 - ROUGH PLUMBING
I herby aRrm under penalty of perjury one of the following declarations: 302 — TUB & OR SHOWER
❑ 1 have and will..in'in'a Cmiecaie o curarat to self-insurc for Worker's 303 - ROUGH MECHANICAL
Compensation, as provided for by Section 37W of the Labor Code, for the
Performanceoftheworklorwhichth1spermi(isissued. 304 - ROUGH ELECTRICAL
❑I have aW will maintain Workers Cormaim ion lnsurance,as required by S&tion 305 - FRAME
3700 of the Labor Code,for the performance of the work for which this permit rs 306 - HOEDOWNS
d My Workers Compensailon lnsuren<e urea,and Policy number are
Canter " " Policy No '
307 , ,aINSULATION
"- CERTIF7CATION OFEXEMPTIONPROMWORKERS'j" � ' ' '369e -•' SHEETROCK � : s
.... ..... . ... COMPENSATION INSURANCE';( "., __....._.-_......
... ...... 3 0 9 ---:EXTERTOR 'LATH-...__,. ._....._ . . ..._._.. ..
' 'Cm9 iridddncad not W completed if the permit is for one hundred dollars
(s 1DO)or las.) 310• - INTERIOR LATH '
I tte ify ilmt in Am priformancrof the work for which phis permit is maucd;l 311' 'SCRATCH' COAT' - •"
shall not employ Any person in any macmer so as to become subject to the Workers' 313 - ROOF NAIL'' '
Compensation LAW,of Cobforni..Data
Applicant. 501 FINAL ELECTRICAL ENERGY
NOTICE TOAPPLICArrrIt.after making this enrircmeofExemption.you should 502 - FINAL PLUMBING ENERGY
become subject to the Worker's Compensation provisions of the Labor Code,you mus,
Z tonhwweomplywhnxchpri
- visions orthis p mmananbeaeemmmvoken' 503 FINAL _.MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
F 4 e CONSTRT504 - FINAL BUILDING ENERGY
I hereby nffrm that there 1,A camonaction lending agency for the performance -
Wt>" of the workrorwn (Se
i. 505 - FINAL ELECTRICAL
Cx'A 'Lenders Name--. _.
Lenders A3dr4ss' 506 - GAS TEST
V0Iccnify,hatlhavemadthisapplicationAndstamthattheaboveinformationis 507 - FINAL PLUMBING
(s F corona agree to compwith all city and county,ordinances and state laws miming 508 - FINAL MECHANICAL
G U to Wilding connma ¢lybandhereby auNodserprexntativesofth;icity toenter upon
>„-rte the above-mentioned propeny,for inspection purposes., _, 509 — FINAL GRADE
0. (We)agree to save,indemnify and keep harmless the Cityof Cupertino against
v0` liabilities.judgments,costs and expenses which may in any way accrue against said 510 - FINAL P ING
V'� City in consequence of Running of this permit.' n 1 Ot
'APPLICA. UNDER ANDS AND WILL COMPLYWRHALL NON-POI NT' Al1 N WORKS
�7RCEE uL�I r� Issued by: Date
SI'gna am of Applican oAkAbtor ' ate Re-roofs '
HAZARDOUS MATERIALS DISCLOSURE' '
Will the Applicant or future Wilding me...At start or handle haimdous material Type of Roof. - . . ... .
As defined by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
Code,Section 25532WI _ -
ElYeS ` - :' .. ... All roofs shall be inspected prior to.any roofing.material.being installed... ...
Will the applicant or furore building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection;I agree to remove
eon hezadrus air conmminans as dcfi ed by the Bey Area Air Quality Management
Dlavia,? all new materials for inspection. Applicant understands and will comply with
fi 9Ys' all non-point source regulations:
I'have'head'the hawdou,mAmbl,requirements mder,Chapter 6.95 of the
Califamia Heahh Q Sa(�y Code,Scnlom 25303,35333 and 15534.1 understand that
if thc.Wildmgd AS
9urently haeeatenanbthathis my usponsibiliry to notify the " '
a6,ratt of ruts w/
Si
h///I/��//h///)j/A4sstt bbee�me,prior to issuance o�flA Ccnifc ba of
OaupancY. /�•' "V/Nv"tili - �'�(0 iQps- .. ..
f V
Signature of Applicant Date
OwaarOr an odred agent - - Data All roof coverings to be Class "B" or better
OFFICE
MAR-19-02 10:40 FROWPROMETHEUS REAL ESTATE GROUP 650-596-5.74 T-046 P.02/04 F-258
CITY OF CUPERTINO Oa�3m
BUILD NG PERMIT APPLICATION FORM
Building Address:
• v�60 D_ 6D,elGu Es E � g
Owner's Na Phone No:
Wet Arrrn�e�s 6Sa -5ef 6 -5 �
Contra tor* License No: (�`i b 3
l�At n2orJ Cou�T2ucr r�i. I/vc. z¢-
contact: Phone Na:
04ef5 Lt1��GK _ iso - 5q6 - SOL
Archite /Englueer S License No:
`Ipl�Lt,i)OO s7Aul3E(� INCLPrttL PcP.�lii - F(-
Applicant/Contractor:
SApplicant/Contractor:
Building Permit info: (Circle one)
IbeW
dg.? �EIc.cF ' Plumbs ech )
Deseriptim-' INTE*2 O?- (StJuJATTu�1 WIP6ll 0&10 2, NEW WALL, A/C., NEO FL062C�JG^2WG .
Residential: ?
lMutT- >"knll� Commercial:
Sq. Fr. Floor Area: DDD S/Sq. Fr.:
APN IF (Mu atprovido): 36� _0 _ OGn Valuation
Type of Construction: D Occupancy Group:
Qty. N Fee ID Fee Description Fee Group
Applicable
. BTEMPPERM Temporary Bldg Permit IKUILDING
BCONSTTA — lConstrUCtIon Tax BUILDING
SENERGY JEnergy BUILDING
sF-NERGYADD Itnergy Add Mulli 113UILDING
ROVER IME Inspection Overtime BUILDING
BPERMFEE Bldg Permit Fees BUILDING
BMITIGAT H usin Miti ation Fee BUILDING
BPLANCHK Plan Check Fee BU L ING
BPIAD NCKADPlan Check Aad Mufti BUILDING
BPLANCKREP Plan Check Re eat Fee BUILDING
BREINSPECT Reins ection Fee BUILDING
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
HTP—ECTAL Special inspection BUILDING
BSWIM Swimming Pool BUILDING
ZADDCHG Address change BUILDING
CITY OF CUPERTINO -
umt.otNc orvtstoN PERMIT
'CONTR'ACTOR(INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20090 RODRIGUES AVE # 8H WALDRON CONSTRUCTION COM ANY 02030089
OWNER'S NAME: APPLICATION SUB DATE
FLAKE BILTMORE APARTMENTS P 0 BOX 598 03/19/2002
HONE: SANITARY NO. CONTROL NO.
(408) 377-8186
�
z0 ARCHITECT/ENGINEER: BUILDING PERMIT INFO
e m- BLDG ELECT PLUMB MECH
J
- I� C1 C=1 L:._1
6 d
LICENSED CONTRACTOR'S DECLARATION
` H I hereby affair iN 1 am licensee under f CM1a ter. mommenens Job ETH tion
Z4 0 ) Provisions a P B
with fallSection
rm and of Dmison3nfine susm<sa and Pror<.aiona Lime,arta my license REMODEL—KITCHEN, BETH ,WALL A/C UNIT, FLOOR
Sash Loran mace arta<rre" AND WASHER/DRYER.
z a 6 License Class Lic.A
P 3ac Data Commay
ARCHITECT'S DECLARATION
u.0 1 understand my plans mall he used a public recalls
Nury
7 6 p 0 Lice ad Professional 1 C
o OWNER-BUILDER DECLARATION 1Ir tr
1 hereby affirm thin am exempt rrom the Commnar's License hW Low for the / A qo0
whiching reason(Section 90315,Business and P e,cl,yrns Code:Any city oicowry Y C
4 O which requires a permit ro ronnwed they,improve,demolish,nr repair arty nmemre
a 3. 'Pr rt Is. I q" th PPI tf hP mtto file signed rat t.
prat he.l c meapursuing n the provisions f the Contractors License La (Chapter 9 S Ft FlOOPACea p . -x t r, /pg�aluation
(c g with Section 7000) f6 9 of the Bs' es dProfession,Cd) ✓"(N1s 1 i,.a."o 1�&b...AL .d.'9 r 'f F1"t +Si°ii 1_c:',' gtVr
or that he is exlmpi th refrone.rad the bass for the alleged axe alitimi Any violation
-of not mo 703 n iv o u dred dollars
o ll fora Permit subjects the applieam to a civil penalty
;of not more than five hundred areata t550o). A N umber Occupancy Type
°I,as owner of the property,or my employees with .,as as their sole compensation.
'will do th ork;and the structure ii non intended or offeredfor sale"(Sec 7044,`
Business and Profed s Code:The cant Limas License Law toes no apply to an 102 - PIERS Required Inspections,(' ,
owner of property Who builds or improves thereon,and who does such work himself
r lhro hh' mply ..... dor I .P.improvements wdit aq __........ 103 - _UEFA. ._._ .____ _ _....
g _._.. . __--
.orae df T V'n th building - P t Ia-hitndnot;uildor- 104 - REBAR .,;- �,.
cb pl t' N b le will Not,theburden fp' gthath d'dn lb Id ��� � �z
rap er P rp f l ), 105 - ANCHOR BOLTS
- - .
a fihe property am exclus ely ntr�ang 'th leen o de t i 106 - SEWER- & WATER t'....
r the project(See.70T Business d Professions C d )The C t a t r s
License Law area not apply.o an owner of proo
property was builds or improve:thereon, 202 - UNDERFLOOR PLUMBING
.and who contracts for such projects with a mnrnemrls)licensed pursaam.m-the.. _-...._._.. .__-$03 UNDERFLOOR--MECHANICAL
__..."_.. '____....-...
Cosmonauts License Law. 11 1 „
°1 � pIn� a<�r$ � '-' B&Pc(rtMarea:pn 204 - UNDERFLOORi FRAME`'=
' owoet -tea O 205 - UNDERFLOOR INSULATION
COMPENSATION DECLARATION
301 - ROUGH PLUMBING
I hereby affirm underrayhyorPrl y . fihe followingdeclamtmns 302 — TUB & OR SHOWER
° I ba'Weed will in t Ceniflc to of Consent jo self-insure mr workers 3 03 - ROUGH MECHANICAL
Compensation, as,provided f by Section 3700 of theLabor Code. for the
performance of work,for wnich this permit is issued.., 304 - ROUGH ELECTRICAL
' °I have a d will ma t W k isComp at I orhn as rectorialby section 3 05 - FRAME
3700 of the Lam;Cnae,for the,perfgrmapcIa of the work for which this permit iiaiscmed:My Worker's Compensation Insurance craider 3 06 - HOEDOWNS
Comer 307.`
ayN' d Policy mbe are
4 ,1 INSULATION
F CERTIFICATION OF EXEMPTION WORKERS
-COMPENSATION INSURANCE ? ,
. r Int S308J - 'SHEETROC'&'',.� 17-
11
309:- EXTERIOR' liATH . .
flits secnoneoeW not be<ompleted if the permit is for one hundred dollars r_ 'f'" t.�i"`
310 - INTERIOR LATH
shal�nm em Io tarn to an my
311__- " SCRATCH COAT
G1 certify Y P which thispe t iss ed 1 - -
fc n( that nP the performance
o tofbemrit. subject the W k , 313 - ROOF NAIL!"')
Compensation Laws of California.Date
Appl Linn) " __- -..-.-, 5O1.---.:..FINAL ELECTRICAL--.ENERGY._ _
q NOTICE TO ate tof he pt you Would
502 - EINAL_MECHANICA'LFINAL PLUMBING NY
APPLICANTI after making th Cert fc
Z tie me ubl tt thcWorker's Compensationp ns of the Lebo Code y u,as, -
z 0 forthwithe ply -lbs such rthspermt h Ilbed d mocked.
50.3 ENERGY
CONSTRUCf10N LENDING AGENCY
a � ' 504 - FINAL BUILDING ENERGY
I he eby fi th t th a const et d gage cy far the perfo u
th orkr n'nms m t s sineels 3og7 cv.cl 505 FINAL ELECTRICAL
96q Eearary -_..._ -' ._ ._-.. ._ ... __...--
Z araAaa 506 - GAS TEST _..
t
U O Icemfythmlbnvereedthtsappli aonanaaialelnanneanrvemror,�aticat,t 507 - FINAL PLUMBING
fL [ti " <ctf g roc ply Ph 11 'tyand ty d < as tt I 'relaing 508 - FINAL MECHANICAL
0 V mb IJ ngc wcfo dM1 by rho p IYe (th sctyt enm pen
'y G>a the ab t Wed p pent'r n pest n P m ; .. _ 509 - FINAL GRADE
�y p.,1 (W)ogre io a d mmfy and k ep hwml sa Ih C ty of Cup n ag est
Fr W habl t ) dgme t t a d expe sen h h m y ny ay < g(n t 'd 510 - FINAL PL ING
V City s9 de rf g nt g fib Prml[ '. ` ,,,rQ1�
APPLICAh�f�UNDFh AND$ANDWILLCOMPLYWITHALLN�O(NPOINTa` 514 N WORKS j �LQ
5o eE�-� b Issued fs Date
St&nm rApp t' HA tractor.,, [ ",1,?!p :( Re-COOTS
as ,HAZARDOUS MATERIAI S DISCLOSURE
Wil ppl¢ t Pot building¢ v tsmre rhandle hazardous len 1 Type Of Roof_ .. - _ ... ....
defined by the Capetian n Municipal Code,Chapter 9 12 and theHealth and Safety ....... -
Code Section 253321) 9u P , "
U' .. - IV , f r.
°Y All roofs shall be inspected prior,to any roofing material being installed.
P PP.
ov m 1 t rut b na' ender cha ¢r yr m I all new materials for ins ection A hcant unde pecnon I agree to remove
ort a I e r m b ih B A t d
mth rd � QulryManag
Dome? _ rstands and will comply with
T, pp g p m see a roc is ]nsta a 'wit Out first Obtalnin an m
all'non=point'sourceFegulanons ,
have read gine hazardous maenala re anements p '�of the 1
ifCalif aHeshti&S a Ay Cade has,.
Raiders 25505;that
d25534.1 understand that
y P responsibility t notify the .. .-;: _... .. _._._
' e IId d n Wend n veele I th t t y
s e fyC Certificate of
a ze e n �Q Signature of Applicant Date y
rc
P v
Qw r t Jag nt 1 D ter All roof coverings to be Class`B" or better
, .
. OFFICE
( it 9