01100015CITY OF CUPERTINO
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INFORMATIONd `".
BUILDING DIVISION PERMIT
y,CONTRACTOR
BUILDING ADDRESS:
PERMIT NO.
20100 RODRIGUES AVE # 9K
WALDRON
CONSTRUCTION COM
ANY 01100015
OWNER'S NAME:
LAKE BILTMORE APARTMENTS
73 HERBERT LANE
APPLICATION SUB DATE
10/02/2001
PHONE:
(408)377-8186
SANITARY NO. CONTROL NO.
Z ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LJ I"—'I CJ L-1
Z LICENSED CONTRACI'OR'SDECLARATION
Job Description ,
I hereby affirm that I am licemea under provisions of Chapter (commencing
with Secdon7000) of Division 3 of me Business and Professions code, and my license
INTERIOR
RENOVATION
aaffect
1
(REMODEL KITCHEN/BATHS, NEW WASHER/DRYER.
I-iccnal Class Lic.p
6 aeric lass
Dale Can,... or
WALL
A/C, MftfALC�NG. )
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records
NOV 2 8 2001
LicensedForassinnin
OWNER -BUILDER DECLARATION
I hereby atTmi that 1 um exempt from the Contmmor's License law for the
< following reason (Section 7031.5, Business and Professions Cade: Any city or county
O which requires a permit to construct, alley, improve, demolish, or repair any structure
Q .. pr i t -I ils the applicant for such permit to fie.simed anatomist
- - --
... .. _ .._ _...
-- -SUIL- -.- -- -
— L Law (Chapter 9
that h e ¢d Pura aht to the provisions of the he Business Professions Cods)
Seunom
;,y y a .Sq :Ft
I,i'I
{j�fa1
F30fp, 'Area ia' T 5 •• [�3 4 6 �CiatlBn
(cont eclexem and the basisoofihaBunm and
and the basis for the alleged exempboo Any
or that he rs exempt zany
,. eV.t, .1(iAv
Ilt+Lv. .:f .- ,.. �, - Y
!
lviolationnatty
of Section 90han v any doed d ll far a permit subjects the applicam m e civil penalty'
applicant
.of not mora man five nanarea aamm ($s(ro).
3 6 9b9`6�it>3'?b6'0 )-;-: Occupancy Type
❑ 1, as owner of Ne property, or my employees with wages as their sale compensation,
will' din a work, and me structure is not intended Li or offered doe unit (see. toa n
'Will
e d Profess) n Code The is not i ten License er doe. not apply to an
101 -
FOUNDAT 100ired Inspections'',
ow f property Who builds or improves thereon and who doe h work himself
10 2 -
"
Sr th gh h s own employees. provided that such improvements are not intended or.
' offered for sale If, o e e th ti ilding or Improvement is sold within one year of
103 —
_PIERS t
UFER
the emne l ilder will have the burden of proving that he did not build or
icompletion,
mprove for purpose of sale,).
104 -
REBAR
owher. Profile",ani wish licensed
s land
.. 105 ...-.
ANCHOR BOLTS .• ..-I _ . _..... ...
;
nconG�actor's
consumer ro urin Professions
BusinessContractor's
Code) The improves
the p sect (Sec. IOM, Business and property
_ License who
-' ueense Law men not apply to an owner or pmpenr wm milan or improver mercaa,.
_
106
,; t
SEWER & WATER
and who contracts for. such projects with a connanor(s).licensed pursuant to me
�
202
t
UNDERFLOOR PLUMB ING
:i Cot a L¢e e L
❑I aers ' B�Pcrrmiareason
203 -
UNDERFLOORI'MECHANICAL
ow' Date Io 9 0�
204 -
UNDERFLOOR FRAME
ORKER'SCOMPENSATIONDECLARATION
I hereby affirm under penalty of perjury one of the following comaiatiions:
205 —
301 -
UNDERFLOOR INSULATION
ROUGH PLUMBING
El I have'and will' onaiomin•a Certificate of Consent id ml&insure for Wmkaea
302 —
TUB & OR SHOWER
y! Compensation; ns provimd for by Section 37M of the Labor Coal for the
p amaneaaroiewarkrawnimtninpmitiniAnam;
303 -
ROUGH MECHANICAL
❑ I haveaa l will tnalntin worker'ss'cowansntlon insuaance, as required by Seedon
304 -
ROUGH ELECTRICAL
37M of the Labor Code, for the performance of the,'wmic, for which this pem d is
305 -
FRAME
issued. My Worker's CompensationIraniance c d
_
Comer
ipol
3O6,t
HOEDOWNS1--
n
CERTIFICATION OF EXEMPTION FROM WORKERS I
.k � ' t a 8 O 7 4
r i NSU'LATT ON p, y '
COMPENSATION INSURANCE.',',,
-.. ,....309 •-
SHEETROCK
' (Tn tidn need at x aoivplei ann permit is f nue hundred run
. ,
RI OR LATH .
($1000m -bas.)
`,
INTERIOR LATH °- -• "- -
in
I ml 61 in th fm to ba hchthspetmt kers
I centrlylaws
m subject
a to beco the
rma
311 -
SCRATCH "COAT
C oil ation of C hp( che en ,
Applicant .:t:_ _ 6'i.: .-.: .,-.........
313 .-'
ROOF NAIL .. t• ..
NOTICE TDcttube Warm' ❑ k'ion Gentette a mpl onm, .a pold
M ome subjccno the WarkeraCompensi povisions of Lbor Cade, you must
st
501 -
FINAL ELECTRICAL 'ENERGY
5 rain tncamplrwitnaennroisinnsortniAcermitsnaubeaeemadrevokm
SO2_ -
FINAL PLUMBING_ENERG]'
^ " "'!"'coNSTRUCrIONLENDINc'ACENCY ''e
503 -
FINAL MECHANICAL ENERGY -
Ihereby which that there Iso aonsim0 c, lending zg icy far the p`etformance
y of the work for which this p t s 3ved(s 3o9rciv.c) ;
504 -
'
BUILDING ENERGY
�'
-'Lender Nam _ :...:. : •I, r ::,
Leader',Add s:.' � •• 1.505
J
..
r
_FINAL _..
FINAL ELECTRLCAL,,,
506 -
GAS- TEST
I ntythimIh mad this application t dsmmthaun bo information
correct.Iagreeto comply man city and ,ty ordinances and site laws rlring
507 -
FINAL PLUMBING
to vid call.mction: and hereby anthl mpreseotatives of rots cirym enter upon'
me above-mentionedppp nr mi-inspectiogpmm�ses.
508 -
FINAL MECHANICAL
y' (W) g iii ea a demo fy and keep haml ssihe City f C pert b against
509 -
FINAL GRA DE
O Haid t 3 d m n¢ cot a d expens hid, may n any yagainst am
City n Fact of it timing f th Penn t
N NG
APPL A U4DERI P WT
Issuedl�iO
Date
/D/SA�NSDWILLCOMPLYWlALINO
SOrll CE TIYIe /uv is/P
t/
sign t fAsIss
ppf circ i t -. D t
'. HAZARDOUS MATERIALS DISCLOSURE ,
Re -roofs
-1
/
„.. W 11 m cant o f t Milding pant store br handl h idoas fr t n I
Type Of ROOF:
--. • . ..•. /- . U _ f .: ^ . - .... .-
as defied by the CupertinoMu c pal_Coca Chapter9.12, a d th Health aad Safety
255(72(1
CodeEd
5's I l'
t ji-I;• xT.
dNol
t
ift (
Yon
All,roofs shall be
inspected,prior to any.roofing material being installed
..
t will theapplicant o f t building occupant use equ pment or devices which
s
If a roof is installed without fust obtaining an inspection; I agree`to remove
an t h rarmaA at, cn t mimats as defined by he Bay Area Air Quality Management
all.new materials
for inspection. Applicant,understands and will, comply. with,
El :, ❑No
:,,.. . �-,; -' : • .
all non -point source
...
regulations:
:.
I mv'a read, the haia doa,,not enms mqu emenis finder Chapter 6.95 of the
foinHealth&safety Code, Sections 25505,25533 and 25534.-1 andemmod thatallgdoeA
lifflimbim],firtnot omedyhave at t that n is my responsibility to notify the
-
cc pP�t f A equirc t lu h must b met poor to s f 9 Cf tions e of
Dc / �/ � ,rJA�`y�' ' •' "' /C/=/DI
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Signature of Applicant Date
ow o a age t „
All roof coverings to be Class eB•' ml better
g