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02050033 CITY OF CUPERTINO BUILDING DIVISION PERM CONTRACTOR INFORMA N: BUILDING ADDRESS: PERMIT NO. 20100 RODRIGUES AVE # 9D WALDRON CONSTRUCTION COMPANY 02050033 'LAKE BILTMORE APARTMENTS P 0 BOX 598 APPLIC1ON05707Sy2002 PHONE: (408) 377-8186 SANITARY NO. CONTROL NO, q s Z "ARCHITECIENGINEER: BUILDING PERMIT INFO (°R BLDG ELECT PLUMB MECH < uS i " .LICENSED CONTRACTOR'S DECLARATION' Job Description :8 .LICENSED ly - I hereby affirm That 1 am licensed under provision of Chapter 9lcommencing �p wiTh Scotian 7000)of Division 3 of the Business and Professions Cade.and my license INTERIOR RENOVAVATION u«� IcisuaodeRCO' Lic.g KITCHEN BATHS REMODET, ..' WPI SHIR RYER fie o Date' Contractor WALL A/C/FLOOR u���`rQ" 13 a to ARCHITECT'S DECLARATION O g 1 undersand my Plans shall be used as Public mcONs 1 0 Licensed Professional - s JUL a 4 ZOOZ aF R OWNER-BUILDER DECLARATION to 1 hereby offlva that I oat exempt from the fesmContractor's License Law for she C?6 followingmassa ermitttocontrBusinessandmpr Professions Co de:Any oily or county BUILDING E O which requires n Permit reconstruct,pilar.improve,demolish,fie.Sig any sweater, Iv\.l g pdt he is l issuance,a 0.Ounal to the Th ortsio.of(he Contractors Li ,...Law pChmmrnt thor he ieci ntsed Ouduan m the provdons of She he Bu3m(s License Lew(Chapter) S Ft. Floor Area: $3 4 6� (c that he ing with lumf 7000)ofhe basis o T the Braid IsamI Professions Cotle) - q' ation or Shot he is exempt..any ap li and the burs for the alleged exempnioo Any l Pen Sty " of Section 7031.5 by any applicamfor apemdt subjects the applicant n°a evil penalty ,�p,pYv of not more Than love hundred doll...($500). 3 6 9V' 9I( Isttluo Occupancy Type °1,a owner of the Property,or my employees with wages ss Their Bole cu rpeastaiM, will do the we*.and the swmure is not intended or offemd for .In(sea.7044, - 101 - FOUNDAT t{ Business and Professions Code:The Contractor's License Law does not apply to M R&Nired Inspections owner of property Who builds or improves thereon,and who does such work himself 10 2 - PIERS or through his Own employees,provided Nat such improvements an not intended or offered for ale.If,however,the building or improvement is sold within one year of 10 3 - UFER ' Completion,the own,,-Wilder will have the burden of proving that he did not build or improve for purpose afsale.). 104 - REBAR iAh ve awn.Oahe o rt,am nmusWel -contracting 105 = ANCHOR BOLTS. . . .. .. - .... ..... ���vvvuuu Pr R Y y dPro ftithydamW contracts..ro Li atheoes no(sec. to an Business andertywhons Code:)Theves thereon, 106 — SEWER & WATER License Law does not apply man owns of a contr who builds or sed prow thereon, and who contracts for such projecu with o commctogs)licensed pursuant to the 202 - UNDERFLOOR- PLUMBING - Cantrano(s License Lew. _ .. °lam ex pT un cr Sce. B S,P C for this reason 203 - UNDERFLOOR- MECHANICAL owner ,eDam 204 - UNDERFLOOR FRAME 146a IT Rf- COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION I hereby affirm under Penalty of Perjury one Of the following declarations: 301 - ROUGH PLUMBING ° I have and will maintain a Certificate of Consent to MINOsure for Worker's 3 O2 - TUB & OR SHOWER Compensation, as provided for by Section 3700 of The Labor Cade, for she performance of the work for which this permit is issued. 303 - ROUGH MECHANICAL °1 have and will maintain Worker's Compensation Insurance,as required by Section 304 - ROUGH ELECTRICAL 7700 of the labor cad,.for he pertormonce of The walk Car which his permit is 3 05 - FRAME Issued.My Workers Compensation Insurance carrier and Policy number are: Cuvier. Policy 306 - :.HOLDOWNS ., ... - CERTIFlCATIONOFEXEMPTIONIONFROMWORKERS'. "'-307 - INSULATION COMPENSATION INSURANCE " ' 308 -""'SHEETROCK (g100)omr he section need not be completed if The permit is for one hundred dollars 309 - EXTERIOR LATH 1 certify that in the performance work for which This Penh is issued,1 310 - INTERIOR LATH shanot employ any person m any..none sa o a.S°become.object m the Workers' 311 - SCRATCH""COAT CompcCompensationLawss off Celifomia.Dau Applicant 313 - ROOF NAIL NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should 501 - FINAL ELECTRICAL ENERGY Z become subject to The Worke's Compensation provision of the labor Code,you must O p, ford1ovids Comply With Such Provisions Of this pCoolt Shall be esamed ronakod. 502 - FINAL PLUMBING ENERG F: . CONSTRUCTION LENDMOAGENCY 503 - FINAL MECHANICAL ENE ENERGY ai I hereby flan than Than is a contraction lending agency for The performance Of The work for which Nis Permit is issued(See y 3097.civ.C.) 504 - FINAL BUILDING ENERGY q Leader's Name 505 - FINAL ELECTRICAL - a RL Lender's Address U'O�r 1 certify that 1 have real this opplicanion and state he,he above information is 506 - GAS, TEST U Pr. correct.1 Agree to comply with all city and county ordinances and sue laws reining 507 - FINAL PLUMBING V re building consmuction.and hereby emhcrixe re,ra,m rives of This city to enter upon >..W the abs e-mentioned property for inspection purimm. 508 - FINAL MECHANICAL t: L ( e)agree to save,indemnify and keep hamdesnhe City of Cupertino against IA liabilities,judgments,cats and expenses which may in any way seem,Against said 509 - FINAL G E U sal. City in consequence of the greasing of this perm. APPLICANT I�'iWERS�'TP((..4DSAND WILL COMPLY WITH ALL NON-POINT 5101 - N NG SOURCE RErgL'I„ATSlgJSt � Issued b3l Date till.... VVt�/lha r-9- ,�- Sig entre o(AppllcanUCmnmctor Re-TOOTS HAZARDOUS MATERIALS DISCLOSURE' Will the applicant or forum building Occupant atom or handle harmdous meMal Type of Roof as defined by the Cupertmo n Mum I Code,Chapter 0.12.and the Ha b and Safety Code,Section 25532(.)'I °Ye No All roofs shall be inspected prior to any roofing material being installed. Will The applicant o futurebuilding Occupanty A use aAirQu ordeviceswhich If a roof is installed without first obtainin an ins ection, I a ree to remove emitrict? sinus air wntammanu os defined by the Bey Area Air Quality Management g p g °i"nC7 all new materials for inspection. Applicant understands and will comply with °Ye Ir all non-point source regulations. I have read the Incurious materials requirements under Chapter 6.95 of the California Health&safety Code,Sections 25505,25537 and 25534.I understand That ifthe building does not currently hove a unnt.That it is my responsibility tostand Ne occupant of the .iumams which must be met prior to ismance of a Certificate of Ooc.PaneY. ,',Bd,I'� S�f I Signature of Applicant Date W -01 Owner m aulaorned agent Date All roof coverings to be Class "B"or better OFFICE 0 CITY OF CUPERTINO 1m 5 of 10 PERMIT RECEIPT OPERATOR: conniew COPY # 5 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36903008 . 00 DATE ISSUED. . . . . . . : 05/07/2002 RECEIPT # . . . . . . . . . 18251 REFERENCE ID # • . : 02050033 SITE ADDRESS . . . . . : 20100 RODRIGUES AVE # 9D SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LAKE BILTMORE APARTMENTS ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : SAN MATEO CA, CA 94403 RECEIVED FROM . . . . : LAKE BILTMORE APART CONTRACTOR . . . . . . . : WALDRON, ROBERT LIC # 21547 COMPANY . . . . . . . . . . : WALDRON CONSTRUCTION COMPANY ADDRESS . . . . . . . . . . : P 0 BOX 598 CITY/STATE/ZIP . . . : CAMPBELL, CA 95009-0598 TELEPHONE . . . . . . . . : (408) 377-8186 *E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL --------- - ------------- ---- ---------- ---- --- ------- --------- - BENERGYADD PLAN SETS 1 . 00 22 . 20 0 . 00 22 . 20 0 . 00 BPERMFEE VALUATION 34 , 660 . 00 380 . 00 0 . 00 380 . 00 0 . 00 BPFIXTURE UNITS 2 . 00 16 . 66 0 . 00 16 . 66 0 . 00 BPLANCKADD PLAN SETS 1 . 00 22 . 20 0 . 00 22 . 20 0 . 00 BPTRAP NO OF TRAPS 1 . 00 8 . 33 0 . 00 8 . 33 0 . 00 BREMAIRHAN NO.UNITS 1 . 00 8 . 33 0 . 00 8 . 33 0 . 00 BELEC200 METERS 1 . 00 22 . 20 0 . 00 22 . 20 0 . 00 BREMFIXT NO. FIXTURES 8 . 00 8 . 88 0 . 00 8 . 88 0 . 00 PPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 BREMINHOOD NO UNITS 1 . 00 8 . 33 0 . 00 8 . 33 0 . 00 BREMRECEPT NO. OUTLETS 8 . 00 8 . 88 0 . 00 8 . 88,,x'. 0 . 00 BREMVENFAN NO UNITS 1 . 00 41 . 63 0 . 00 41 . 61 0 . 00 BSEISMICRE VALUATION 34 , 660 . 00 3 . 50 0 . 00 3 . 50 0 . 00 EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 MPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 TOTAL PERMIT 657 . 70 0 . 00 657 . 70 0 . 00 • 0 0 -2,vS?"' 33 CITY OF CUPERTINO BUILDING PERMIT APPLICATION FORM uilding Address: d d QD2l(sllES 9D Owner's N�1ame: Phone No:, b50 S`1(o- 5300 LAKE t-TMORE A21"M� Contractor: License No: 9. CogsTkIwrog me-. Contact Phone No: 5—gb-5308 s WG�/E2 Pr2or aC G Architect/Engineer License No: SUBM SNCLAIF tZ55 Applicant/Contractor: LAKE B" ORS APPer c�rr5 Building Permit Info: (circle one) Bldg Ele Plumb Mech Description: imlMoz 99WVA'n64 W RBmoDEtC-V W BA NEW WA6peejl7eYee , W-w Wnu,Ale- , NGW Fe0ae covEWiJG Residential: MuLT1-FANUW Commercial: Sq. Ft. Floor Area: 1000 Sr- $/Sq. Ft.: APN # (Must provide): Valuation 3l�1-03-Do re 3�f Gbo Type of Construction: Occupancy Group: R I •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 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 4s-�• 70 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDINGADDRE.SS: " PERMIT NO. 20100' RODRIGUES AVE # 9D WALDRON CONSTRUCTION CO PANY 02050033 A9ftWNER'S NAME APPLICATION SIJB DATF. LAKE BILTMORE APARTMENTS P 0 BOX 598 05/ 07/2002 �•• PHONE_ (408) 377-8186 SANITARY NO. CONTROL NO. wl0 o °ARCHITEC(ENGINEER: BUILDING PERMIT INFO F O BLDG ELECT PLUMB MECH o.H= .LICENSED CONTRACTORS DfCI:ARATION' Job Description to 11 mnymnr d tlotrl tta ern onsof sionsCde.anomylicense INTERIOR RENOVAVATION m with Secuon.and effect. nJnf the Business and Prolessinnx Code,and my license 'stm^md1Clasceanderfea' Li<a KITCHEN/BATHS REMODEL, NEW WASHER/DRYER & •is Date contractor WALL A/C/FLOOR 3 nc- vii ARCHITECT'S DECLARATION .u-O g 1 mulareard my plans shall be used as public records a,r �0 a Liced Prof C O ensessional ltT II /� rte, a OWNER-BUILDER me the ORATION p���� 11W�i•yasy. 4�= 1 hemby off ect tbat 1 ran exempt from the Conuomo o License Low,(or the a++� t' D fall g n ]O315B .m nd P'f..' .Cd An, ysrc ty €O which 4 alai n t i p d I t p y sir t < a37 that t tsTrequiresP. applicantf chpc a issigned,Chstatement. Not _licensed p rs a n the p vi f the Count L to (OM1 pt Y - _- -- (commencinghathesexemSecoefromadthe isootthcBusn eiProfessionscouel F. i,_5 k ;Sq.EI-iFloorArea ,q,� 5' f;ts,; $346 �aDott or that io is exempt zany applicant and or basis for the alleged exemption.to Any l Penalty of Section he.5 five applicant fora permit subjoin the applicant m a civil penalty 'ornm more man fve nmarea aouars issoot. 3 6 9Wj](j`btgtbp'0 Type 111,as owner of the i o my employees with wges a 'as their sole compensation, will do the work,and the structure isnot intended or offered for sale(Sec.](144, 101 — F',OUNDArI:g Business and Professions Code:The Contractor's License Law does not apply to an RQNIred In Spectlons u ' mer of property Who builds or improves thereon,and whit does such work himself 102 - PIERS or through his own employees provided that such improvements are not intended or offered for sale.If,noweved the buildingt is soldwithinone 10 3 -- UFER .. .. ._ ., .. ._.... . .. . . . _. _... er norms pro your of .... completion,the owner-bullae,will have the burden of proving Net he did not build or - improverorpatpoaenrsale), 104 — REBAR f 105 =—ANCHOR"BOLTS — — -- '- of property am exclusively commcung with contractorsta .. ` 1 con as therprojem(see.]ow,Business and Professions code:)The Contractor's 106 — SEWER & WATER ' License Law does not apply to an owner of property who builds or improves thereon, an Deno s for such projects with a commcmrts)licensed pursuant to the 2 02'-— UNDERFLOOR- PLUMBING and .- ---- Contractors . ...-._ .. .._ ... " Co t� t s L cense Law, - �---- of ptmer9 B&"renrmseeaaon 203 — UNDERFLOOR MECHANICAL o' liars-�-Oa- 204 — UNDERFLOOR FRAME `( D7. confPENsnnoNDECLARAn°N 205 — UNDERFLOOR, INSULATION Ikmny amr,rnnder penahy or perjary one Done mnnwing aeclaraaona 301 — ROUGH PLUMBING t$I(( ❑ 1 have and will m atit. a Certificme of convent to self-imure for Worker's 3 02 — TUB & OR SHOWER ' F Ca r. as provided for by Section 3]00 of the Inbar Cotle, for the perfarman<i:of he avink far which this permit is issued, 3 03 — ROUGH MECHANICAL ❑1 have end will'meirtem Worker's Compensation Insurance,as required by$,Chun 3 04 — ROUGH ELECTRICAL 37al or5ne Labor Code,for the performance of the work for which this permit is 3 0 5 — FRAME issued.My Workers Co rpe tsar on Insurance came,and 1'01 cy number are _. 306 HOLDOWNS Cart - •+ "Policy No.. - CERTIFlCATIONUFE%EMPTION FROMWORKERS"' , t f 3O7'. — •- INSULATION(€ a• COMPENSATION INSURANCE n �::-.• . . . .-- :miisscmionneed not be'completedifth¢permit isforone hundred dollars 309 — EXTERIOR LATH 31.0 ' — INTERIOR..LATH _. 1 eemfy mut in the performance of the work for which this peon is issued,1 I- 'shulfnm employ any pi in any manner su as m become subject to the Workers' 311 — SCRATCH COAT ' a,mpensafien Lows of California Dal` .313 ROOF NAIL '.Applicant - - NOTICE camesuOAPotheWT.ILaflerme,alimng hlrvisinsmfcate fExemptioda.yenhmain 501 — FINAL ELECTRICAL 'ENERGY become suspect such Compensation provisionsof the Labor Code,you must Z � rornwaw comply with acorn provismna or this aomit snail he deemed revoked. 502 -FINAL_ PLUMBING ,ENERGY CONSTRUCTION LENDING AGENCY - 503 — FINAL MECHANICAL ENERGY' I hereby effort th, here is - wet end ng agency for the performance ' of me workfor which this jannat is issued(Sec 30 97,Cis C.) 504 — FINAL BUILDING ENERGY, W Name 'm c d Address 505 - -FINAL .ELECTRICAL • �G 1 ermythminvareaatham,l atlonanaa,.athartn n ainfmommimik 506 — GAS. TEST •" Gil'H co i l agree to comply with all city and coomy ordinances and state laws relining 507 — FINAL PLUMBING - O V robuildingconsumption;aridrarelyauNmozerepresentativesofthiscitytoenterupon 508 — FINAL MECHANICAL Ina above-memioned property for inspection purposes. , ainst �.o,: (We) reetosavaindemnifyaadkeephearr _ the citiofevpiame.ng509 - FINAL GRA E Lit) liabilities,judgments.costs and expenses which may in my way accrue against said V.z city in consequence of the granting of this sainit. 510 — N NG t� ^' APPLICANT I' ER$ N'DS AND WILL COMPLY WITH ALL NONPOINT souace RE AT 't 'a —q—Ga— Issued byl Date Signature of A,Tliemu,Cmmvim­ i. nate Re-roofs HAZARDOUSMATERIALS DISCLOSURE' Will the pplicani prorate building occupant stem or handle Weardous mmenal Type of Roof - - ,- asdefndbythCapon M iced Code Chapter912,and he Hath and Safety Cod OYsn 2553211 sNo .- f' - l t, j4.. •4..': . - - - I :_ _ I. Al] roofs-shall be inspected,prlor to-any roofing.matenal.being installed., Win me applicant t future building- occupant use equipment or devices which If a roof is installed without first obtaining an inspection;I agree to remove ra t hazardous air contaminantdefined by the Bay Area Air Quality Management Di t t all new materials for inspection. Applicant understands and will comply with all non-point source regulations: ' 1 have read the hazardous materials soca remenis under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if ma building does not curendy he,.a tern[that d is my responsibility to notify the orcupam of the re uiremems which must W ran prior to issuance of a ce tifcam of o"oP'n`y ..- - Signature of Applicant Date owner oraumadaea agent. Data All roof coverings to be Class "B"or better ,, , . . . OFFICE