02050034 CITY OF
BUILDING ONpERMjv CONTRACTOR MORMAIW:
BUILDING ADDRESS: PERMIT NO.
20100 RODRIGUES AVE # 9I WALDRON CONSTRUCTION COMPANY 02050034
OW—Nj:R_ 9A BILTMORE APARTMENTS P 0 BOX 598
APPLICATION
PHf,O�(N�E�:(�s'
p (408) 377-8186 SANITARY NO. CONTROL NO,
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
z LICENSED CONTRACTOR'S DECLARATION
HI hereby ufrm that I am licensed under provisions of Chapser 9(commencing Job Description
'_t° with Section 7")ofDivision3o(theBusiness Rod PmfessimarCode, ad myhiens, INTERIOR RENOVAVATION
incCorea dnaefren.
WKITCHEN/BATHS REMODEL NEW WASHER/DRYER
< License ensecrose Lie.g DRYER &
R. DateContractor WALL A/C/FLOOR
I O rat ARCHITECT'S DECLARATION
w g 1 understand my plans shall he Road as public records s
7 a O Q Licensed Professional
7
OWNERBUILDER DECLARATION
—to1 hereby affirm that 1 am exempt from the Contractor's License law for the
t a< following rwson.(Section 7031.5,Business and Professions Cade:Any city or county 0�
p�S,Z❑ which requires a permit to conswn,alter,improve,demolish,or repair any swcmrt
e 3 m poor to its issuance,.iso requite the i pplicent f arsuchpem,m film signed vo¢ment
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 .Sq. F[. FIOOC Area $3 4 6�Iti3anon
Division(commencing with Section 7000)of Sof the Business and Protections Code) ,.
or thin he is exempt therefrom end the basis for the.])egad uemptlon.Any violation `
of Section 7031.5 by any applicant for o permit subjects the applicant to a civil Penalty
of not mom than eve hundred dollar,(SSW). 3 6 g Jt1070 - Occupancy Type
01,as owner of the propeny,or my employees with wages is their sole compensation,
r will do the work.and the'swnurc is not intended or offered for sale(Sec.7614, 101 — FOUNDAT'sS
Business and Profcssimts Code:The CommaK ror's License Law does not apply to an �lired Inspections
owner of property Who builds or improves thereon,and who does such work himself 10 2 — PIERS
or through his own however,t provided that such improvements is sol art not intended or
s, corned for sale.If,however,the building or imen of Prov n sold within one year of 103 — UFER
completion,the owner-builder will have the burden of proving that he did not build or
a improve forpuryoxotsale). 104 — REBAR
I.as owner of the propeny,. .exclusively contracting with licensedcontracton w 105 — ANCHOR BOLTS
on a the project(Sac.70/4,Business end Profusions Code)The Cantmnoh 10 6 — SEWER & WATER
License Low does oat apply to an owner of property who builds or improves thamon,
and who contracts for such projects with a convaaor(s)licensed pursuant to the 2 02 — UNDERFLOOR PLUMBING - -- - - - -
Cmarsomer License law.
❑lame em t oder Sec. ,B&P C for this reason 203 — UNDERFLOORS MECHANICAL
Ao/w�ner .aV care —q� 204 — UNDERFLOOR FRAME
/4v "reRa R'SCOMPENSATIONDECLARATI( 205 — UNDERFLOOR INSULATION
Ihereby afrat,under penmtyofperuryone othe following declarations: 301 — ROUGH PLUMBING
�41[1 1 have,and will maintain a Certificate of Consent to self-insure for Workers 302 — TUB & OR SHOWER
Compensation, as*pmvided for by Section 3700 of the Labor Cade, for the
performance of the work for whim this permit is Isxe,all. 303 — ROUGH MECHANICAL
01 have and will maintain Worker's Compensation Insumneca as required by Section 304 — ROUGH, ELECTRICAL
3700 of the Labor Cade,for the performance of the work for which this permit is 305 — FRAME
issued,My Workers Compensation Insmnce carrier and Policy nomination: 306 —" HOLDOWNS
Cartier. PolCERTIFICATION OF EXEMPTION FROM WORKERS' ' :'307 '- INSULATION ,
COMPENSATION INSURANCE -308 "-'SHEETROCK-
(This region aced hot hecompince!flue Permit is Insane hundred dollar
(SI00)mIcrs.) 309 — EXTERIOR LATH
I certify that in the performance of the work for which this pemsit is issued,I
310 -- INTERIOR -LATH
shall no,employ any person in any manner an as 10 become subject m the Workeri 311 — SCRATCH COAT
Compensation Laws of California.Dem
Applicant .313 .- ROOF NAIL
NOTICE uOAto the APPLICANT,.If.Compeer nsation
this Cenincme of Labor Code.youshould
st 501 — FINAL ELECTRICAL ENERGY
Z become subject to the workers Compcmetion provisions of the Labor Code,you must
0O. forthwith comply with such previsions or this permit shall be deemed revoked. - 502 — FINAL PLUMBING ENERGY
. . .. . ._ _
4 - CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY
ai1 hemby odifinn that there isa construction lending agency for the performance —
of theworkforwhichthiapennitisissued(Sec.3097.Civ.C.) 504 FINAL BUILDING ENERGY
0. Q Lender's Name — ... .
tp Z Lenders Address 505 FINAL ELECTRICAL
V Q 1 unify that I have read this application and state that he above information is 506 - GAS, TEST
...at.1 agree to comply with all airy and county ordinances and state laws relating 5 0 7 — FINAL PLUMB ING
O V mbuilding constmmion.mdhercbyeuecrion ur,weanmtiveso(tbiscirytoe,nmrupon 508 — FINAL MECHANICAL
y �] tna.bove,.me,naonee pmpery for inapectmn parpoaes. — I
Ltr,,. y (We,)sgrce to save.indemnify and keep harmless the City of Cupertino against 509. _FINAL G E
M liabilities,judgments,costs and expenses which may in any way.ante against said
V Xe, City in consequence of the Framing of this Permit' S 1 O N NG
APPLICA,TUgm-e4
D-RSTANDS AND WILL COMPLY WITH ALL N N-POINT (` Dale
souacE c - Issued lyl
. � e 1 5 �l-07i
Stgmmd fApplrcomCmtmcmr Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
W II the applicant or future Wilding occupant store or handle he74idous meudel Type of Roof .
as defined by the Cuperrno Municipal Code,Chapter 9.12,and the Health and Safety '
Code,Sorion 25532h)o `�RI/Q' r
0YeS All roofs shall be inspected prior to any-roofing material,being installed.
Will the applicant or future Wilding occupant use equipment or devices whim If a roof is installed without first obtainingan inspection,I agree to remove
emit hazardous air contaminants es defined by the Bay Ansa Air Quality Management P g
District? ( all new materials for inspection. Applicant understands and will comply with
0 Y " all non-point source regulations.
1 have read the hazatdons materiels requircments under Chapter 6.95 of the
California Health&Safety Code,Swoons 25505.25533 and 25534.1 understand that
if the building does net currently have a Manor.that it is my responsibility ro notify the -
occupant of the rcgw menu which must be ma prior m issuance of•Ccnirceu of
o.gRpat,.y Signature of Applicant Date
�• agent
owneror.Rtb.nae,aagent Date, All roof coverings to be Class"B"or better
.. .. OFFICE . ..
oZ3�
CITY OF CUPERTINO
BUILDING PERMIT APPLICATION FORM
uilding Address: x0/00 RDOQII�Ut:5 {iNC, # 9 =
Owne"001me: Phone No:
KK�E LTMDKE AQT'M� bS0 S416- 530
Contractor: License No:
L Mal CONSfQ.(,iGTl04 NG.
Contact• Phone No:
5 WEA1/ER ?"JFrT A60 G� Sgb-5308
Architect/Engineer License No:
S SINCWIR. KS$
Applicant/Contractor:
LAye 028 AfW ewS
Building Permit Info: (circle one)
Bldg Ele Plumb Mech
Description: IArfC2lm R6w vA nonl o4 RBP46DELBl7 W 8A
NEW WA6{I82/Deyee , NEW Weu..A/e. , NGW Rade CovBRa&JG
Residential: fn1A1.T1-FAM104 Commercial:
Sq. Ft. Floor Area: 1000 SF $/Sq. Ft.:
APN # (Must provide): Valuation
3l�-03-DO tf 3'f lobo
Type of Construction: Occupancy Group:
Qty. if Fee/D 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 Repeaffee 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
ookl
�6s 7• 70
CI BUILDING
OyON
PERTNO
IPERMIT CONTRACTOR.INFORMATION:.
BUH DING ADDRESS:
20100 RODRIGUES AVE # 9I WALDRON CONSTRUCTION COM
PANYMIT ° 02050034
W'NER'S NAME: wPPLIC TIONS IB DATE
LAKE BILTMORE APARTMENTS P 0 BOX 598 05�07j2002
(�• PHONE:
(408) 377-8186 SANITARY NO. CONTROL NO.
Poo O ARCHITECT'/BNGLUEER: BUILDING PERMIT INFO
�,d� BLDG ELECT PLUMB MECH
tnaa. I'—1 I_ I
-5 v 3 LICENSED CONTRACTOR'S DECLARATION
Z= I hereM1y uffrm Thai 1 am licensed und<r provision of Chapter Y(commencing Job Description
NanSecan 7000)ofDivission3nflneB.Im"sandPrnfessmnscoee.and mylicense INTERIOR RENOVAVATION
,In fullhassLic.x
and
z License KITCHEN/BATHS RFI�A�MMkSHER/DRYER &
6 eCClass
3 H y Dam Cmnraemr
ARCH ITEC T'S DECLARATION WALL A/C/FLOOR
yO s I understand my plans shall boo,used as public meorisJUL 2 4 2002
j a4O O Lmonsed Professmnal
o OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contmaors License Law for the
following reason.(Section 703 1.5,Business and CodeAny cor county
which ts Permit t T h mpm,r,drmmlifsn p ...Ysum,ture
BUILDING
3
m 'rimm its' r - pDBursars pemuu ii,pedstatement
thinno 1 Yepursuantt -Provisions nme ContractorsLis Ip renain,,9
(cum g 'mst00nothe BusiepProfessionscle
ar unit he 11 axe opt thenfordandhe asisfor
S pptFloor Area
'l^s, $3_4_ _(_�
ation:'k9shifted mpuon.Any violation
of Senion 903 LS by any applicant for a pemdt subjects the appli<em m a civil penalty-
of notoo
rm man five buanred dollars(SSW). 3 6_06W21131ftbpr0 . . Occupancy Type
❑1,as owner of the limleny,or my employees with wages.,Meir sole compenntion,
will do the work: wa
and thersu,is not intended or offered for sale(Sec.7614,' 101 — FOUNDAT
'Business and Professions Code:The Contmaror's License Law does not apply o an TZQ1#Tlired Inspections-
r of properly Whn build,or improves thereon,and who does inch w'O,k himself
owner -
onnrough his own employees.provided mat such improvements am not intended or 102 — PIERS
Offered for 011e.1f,however,the Isoldieg or impFo-vemem,s sold within one --" _
yearor- 103 UFER._.
completion,tire ownerbuilder will have the harden of proving thin he did not build or
Impmvemrputpose"faale.l. _ 104 — REBAR
.: : Las owner onme property,am exclusively contracting with licensed contractors to
m t Sec 7614,Business and Professions Conw)no Completion,
T"05- _ ANCHOR' BOLTS
,. rc tact the p lac ( -. ._ ..
Liaise Loxdra:s not apply to an owner of property who builds or improves thereon 106 — SEWER & WATER
w
and
_ who contracts for such Dn
ro3es win m
a eancmgs),Ic se-0.D aeon" he
Commotion's License Lew. 202..__..UNDERFLOOR -PLUMBING --
and it " "
s – — -.
❑lame em t oda sen. Ba'rPemr this ren„p 203 — UNDERFLOORS' MECHANICAL
204 — UNDERFLOOR FRAME
�Q .R'S COMPENSATION DHCLARATIOIJ 205 — UNDERFLOOR INSULATION
Inerenr arrte,unser penalty of pegary one nine ronnxing eeclar.lion: 301 - ROUGH PLUMBING
t0. ❑ I have and'will maintain a Coli"Bcate of Cars"' to self-insure For worker, 3 02 - TUB & OR SHOWER
Compensation, as provided for by Section 3900 =f the Labor Code, for the
padormaneeoftheworkmrwhichmispennbisi.ssued 303 — ROUGH MECHANICAL
111 have and will maintain Worker's Cdilipensmlbn Imran.,as require)by Section 3 04 — ROUGH ELECTRICAL —'
37x1 of the Labor Code,for me pe,farproce of the wore for whirh nits venin is 3 0 5 - FRAME
issued:My Worker's Compensation Insurance cornier and Policy number are:
,'i. l - Policy
- ... 306 'x - HOLDOWNS -:
Carr e : 'Policy Nn. _ 1
CERTIFICATIONONSATIO'TIONFRNCE-v ERS t '. : t _3 b,'� 1 'LJ!INSLTL`ATIONc
stool files,.) 309 EXEETROCK-----
_ COMPENSATION INSURANCE '"
-308
This t heel nO6eannplemJ ftnepernl smro,ennnamdaona" TERIOR LATH 'p
-310•--: .INTERIOR-LATH
1 venify that in the performance of'he work f r h h('his p rrti i s issue),I
_snag O "ply any p rs y es 1"nccome uht a ro me WOrkcri 311 — SCRATCH COAT
Compcnsm on Inxs or Calibration.Dei,: ve
-Applo t ' - _._ _313. .-__ ROOF NAIL .. _
NOTICE TOAPPLICANT If ft k gIl IC nT ore of Ex pro You dumb, - -
z becones bj nnd,ew rk c Ipe t pm n:onneL tp c de ydumusl 501 — FINAL ELECTRICAL ENERGY
forr,with comply witsuch p is
z in-'Or this Peron shallIs,dee edre ke. 502 — FINAL PLUMBING ENERGY
F+� cONSTRUobemp LENDrNCAOENCY 503 - FINAL MECHANICAL ENERGY'
tea.' wr mildly IBrm mal here wet Bing agency f the p rmmmnce
Len lelafgrwmnnm,panto„is,uee(see.3B9znv.c.) 504 — FINAL BUILDING ENERGY, '
4.z Lender.Name v- :... ....... . .. .
LendmsneI is --- 505 = FINAL ELECTRICAL' - t�V_L,)le”iify0dulhavertedthisappl0cationwdstamthntme.hoveinrormainis506 - GAS, TESTcoma.I agree o comply with all city nd county ordinances and stale laws mlating 507 — FINAL PLUMBING
0:' m building conwcron;and hereby authorize representatives of this city to enter upon>. theabouememiopedpmpenyfarinspectionpurposes. 508 — FINAL MECHANICAL
4 (We)agce to save,indemnify and keep hamllesithe City or Cupertino against
W liabilities,judgments,costs and expenses which.may in any way mane against slid 509 — FINAL GRA E
t Z' City in eonsequome of the gmmir,el p,man,
APPI_ICA,gqT UN RSTANDS AND WILL COMPLY WITH ALL NPOINi 510r N NG
sotfkcErrµcT v -Q� Issued hyl _ Date
sg.:.me//ef•Applmamumoractm DateRe-roofs
IfAZ RDOUS MATERIALS DISCLOSURE -
- Will the applicant Imo Nodding aecpal sore 61 handle hrmation,material "
a,defiled by the C pertn M p I Code.Chapter 9.12.told 11H alis d Safety Type Of Roof ._. ,.. .. ..
Code sea on 255321 )^ . tet Is, r a 9,<''(r a ,1 .� S r .. .... .. .. .......
l
❑Yes — , , .
All roofs shall,be inspected prior to any roofing,material being installed,
Will th_ ppl' Of future building r p I use equipment d es which - - -- - . -
mithazardousAir contaminants asdefnedbytheBay Area Air QualityManagemern If a roof is installed without first obtaining an inspection, I agree-to'remove
j °`tncOall new materials for inspection. Applicant understands and will comply with
!, - ore " - - all-lion-point source regulations - -
1! 1 have read he happladibis mate als req name m under Ch.,upe 695 of the
Cahfo heit&Safety Code,Sections 25505 it 25533 d 25534 I de sand that
foo aHeal ottlamnam tht li .,iclyt nfy the -- - - _
mieursom of the rest m t h It -ust be and poor 1.is...fe of a Certifcam or
Occupy y
�• aU�l _q DY _.- Signature of Applicant . - ,., -._. Date
Owner or authorized.gem Date All roof coverings to be Class "B" or better
OFFICE .. ... ... _ ..