02060202 CI'T'Y OF CUPERTINO
BUILDING DIVISION C0NTRAGT0RkINFORMATIQN�...:
:M;, ...•f"' --arab: .ism,.: 97 rr=
BUILDING ADDRESS: WALDRON CONSTRUCTION COMP
20100 RODRIGUES # 9E
NEWS NAME P 0 BOX 598 APPLICA11ON SUR DATIi
46
LAKE BILTMORE APARTMENTS 06/28/2002
ZONE (408) 377-8186 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
C 4-mvdo)t LL, 6 p O 98 BLDG ELECT PLUMB MPOCH
w� I hereby ufrrmlthatEI am IHemsed vont, DECLARATION
9(commencing `✓ Job Description
xeH provision n
with Section]qMB na Division]of the Business and ProlecainnaGde,and mylicense is
in 1.11 w
forceaeee". INTER.RENOVA�y���X,,��22yMODELED KITCHEN AND BATH (S)
zogb rotenmclass Lie." NEW WASHER/D �I 9, A/C, NEW FLOOR COVER
yr O Uatc Contactor
q a As shall LTS DECLARATION
oZ Iunderstand mypmnsshallMuscaospublic rcenNs AUG 1 6 2002
'apdU
w3u.t; Licensed Policies hat
rLL O� OWNER-BUILDER DECLARATION
My, a m I hereby affirm that 1 am exempt from the Contractor's License Law lin the
says oo fulloveingrcasm.(Sunion7031.5,Businuss and Preaessiou,Code:Any city or ecnmty BUILDING
K$ which requires a permit to cornball,.11C,improve,demolish,or repair any"menus N V
'°—�^ Pon it)its issuance.dist,requires the applicant for.mch permit in file a signed statement
�icn matM1eisuanteawRranurmepmvinnnsofbeContracmrsLicense Liw(Chapter 1) Sq. Ft. Floor Area Valuation
WN$ is
with Seciion7")ofDivision 3ofthe Business and PrnacssionsCndgrr $34660
y — Nat he u exempt therefrom and me basis fear the alleged exemption.Any violation of
section 703 L.5 by any applicant for a permit subjects the applicant o a civil Penalty of APN Number Occupancy Type
not more than five hundred dollars(S500). 36903008 . 00
0 I,as owner of the property,or my employees with wages as their side compensation,
will do the work,and the structure is not intended or offered for sale(Sec.]TWA,Business
and Pmfessions Core:The Commets's Licence Law does not apply to an owner of 101 - FOUNDAftb*d Inspections
pripery who builds or improves thereon,and who times such work himself or through his
Own employees,provided Nat such improvements e2 not intended or offered for sale.If. 102 — PIERS
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving Nat he did not build or improve for purpose of 103 — UFE R
sale.). 104 — REBAR
01,as owner at the property,am exclusively contracting with licensed Combustion h' 105 — ANCHOR BOLTS
Contract We project(Sec IIWA,Business and Professions Code:)no Contractor's Li
Cense law docs not apply in an owner of property who builds or improves Nemon.and 106 — SEWER & WATER
who contacts torsion projects with a conuanmpursuant(s)licensed pursuano Ne Contractor's
License law. 202 — UNDERFLOOR PLUMBING
0 l am exempt under Sec. .B&PC for this moon 203 — UNDERFLOOR MECHANICAL
ter Date 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION
IMrmy amrr tnor,papally of perim,ore of Ne following declarations: 301 — ROUGH PLUMBING
0 How and will maintain aCzrricam nrconsem toself-insure lin Worker'sCompen
saP302 — TUB & 0R SHOWER
tion,as provided for by Section p)of the labor Code,for the perfunnowe of the
work for which this permit is issued. 303 — ROUGH MECHANICAL
0 I have and will maintain Workers Compensation Insurance,as required by Section 3 04 — ROUGH ELECTRICAL
3700 of the Ichor Gude,for me performance of the work for which this permit is issued.
My Worker's Compensation Inaumnce carrier and Policy number um: 3 05 — FRAME
Carrier: Policy No, 306 — HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 307 — INSULATION
Min;section need nm w cnmplmea bsM Permit is forme hundred dollars n HkO 308 — SHEETROCK
1L59.) 309 — EXTERIOR LATH
1 ccNfy that in the performance of the work for which this permit is isund.I shall not 310 — INTERIOR LATH
employ any Noon in any manner an as to Income subun
jecthe Workers Compensation
Laws of California.D01e 311 — SCRATCH COAT
Applicata should 313 - ROOF NAIL
NOTICE TO APPLICANT:If.seta making this Certificate of Exemption,you
Income sobject mthe Workers Compensation provisions of the Lalun Calc,you must 501 — FINAL ELECTRICAL ENERGY
OZ forthwith comply with such provisions or this permit shall he deemed meaked.
z° 502 — FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
F Ihereby affirm Mai them isaconswrl construction tmmnf 503 — FINAL MECHANICAL ENERGY
aitimcfurwhicM1Nispermitisissued(Sec.JIy9],Civ.C.)
Lenderde, 504 — FINAL BUILDING ENERGY
1 0 'as Namc
= zLeader sAadreu 505 — FINAL ELECTRICAL
U O 1 Certify Nat I have read this application and state that Ne.*in information is 506 — GAS TEST
(, correct.l agree to comply with all city and county ordinances and state laws relating In
Q building mnswetinn,and hereby authnrivcrcprescmativcsofmisCity tenmrurymme 5 FINAL PLUMBING
W above mentionedpe
property for inspection purposes. 08 FIN L
(We)agree in save,indemnify and keep harmless the City of Cupertino against
tiy liabilities,judgments,costs and expenses which may in any way accree against old City 5 N D
U Z in consequence of the glaring of this permit.
^r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by51 - NG Date
SOURCE REGULATIONS.
Re-roofs
Si,mome of AppllcanUCommelm Date
HAZARDOUS MAIERIA1S DISCLOSURE Type Of ROOF
Will me applicam or future building omi part store nr handle ho.dnus material
as defined by the Cu,,romo Municipal fide,Chapter 9.12,and the Ilcalth and Safety
Glc.Sectia 25532(a)]
❑Ycv ❑No - All roofs shall be inspected prior to any roofing material being installed.
Will the applicant it mantra tui Wing by the B use equipment or device,which
If a roof is installed without first obtaining an inspection, I agree to remove
\ f-liel?NnusaircnntnminantsasJctincdM1ythcBayArcaAirQmlityManagmem all new materials for inspection.
L._tr'n?
❑VCs El No
I have scat me h....does materials tequit oncots under Chapter 6.95 of Ne Calife,
ria Ihealth.Safety Code.Sections 25415.25533 and 255M I understand dw if Me building
rocs not currently hole a tansy Nat it is my mspoadmahty to notify Me trapant of Ne
requirements which must be met prior to issuance of a CemucaW of Occupancy Signature of Applicant Date
Owner or antheri,.ed agent Date All roof coverings to be Class "B" or better
',CITY OF CUPERTINO
CONTRACTO
nuu,ntNcntvtsioN PERMIT R-INFORIVIATION
auM0"90DRIGUES # 9E WALDRON CONSTRUCTION COMPPffINb206O2O2
O1 NI� °MILTMORE APARTMENTS P 0 BOX 598 APrucATQNSvBpgTF2002
HONE. (408) 377-8186 SANITARY NO./ L CS/ CONTROLNO.
a,Z ARCHIFECT/ENGINEER: BUILDING PERMIT INFO
O O BLDG ELECT PLUMB MECH
�so
Z LICENSED CONTRACTOR S DECLARATION T D
to In l,yafrrnm,1 ran,ea a p ' tsofCPpre,9tcomneneir, INTER.RENOVATIO�/HeEff9aED KITCHEN AND BA
ithS , 10W3 of Division l fthe Bu' dr' fevsime,Cadennd mylcmne
iainfall outdo:mderrae,. NEW WASHER/DRYER, NEW WALL A/C, NEW FLOOR
s e:z¢ tLicenm Class ❑c.#
O'y O Date Cantmcmr
ARCHITECTS DECLARATION
I undemmhd my plans shill he used as public records
i p O Lkensed profmsionnl
co v,
OWNER BUILDER DECLARATION
m—w i a' I bneby uffrm that 1 um exempt from Ine Comrunor'a License Lnw for tine '
!-z a following rcamn.,Section]0315,Business and Professions Code:Any city or county
ad I-O wh ch rcgn¢es a permit m ttmswn,alter np....h,nil sl p ' y t Imre
sate pro , t I q ' , idm tf an 'tt fl s,L a.rt m. 34660 .. ..._ ._ ._. ...._._
a3'� ,porta licensed' " p ngrhep ' n fm c t t L L (cher s S Ft Floor Area , ,
Valuation
-grt cogwnhSeO 1000)of Drvs' i rth l s aM Par,Any violation
Code) , ys �9 v ,♦ 1 .y p_.,`:
or S,,lie scornful poercfrom fna or ba.- f n alleged r x pf n.Any l penalty 3 6 9 0 3 0'0'8:`0 0
;ofn i "103156y mynppR dollars ay t- bJ cta,M1e vppl' a vcivilp elry
' Inr of m , than eve hundred amhrr(z,00) APN Number .._., - � , Occupancy Type
t ❑1,aaownzr�nnepropenr.ormye,npli,yeeawimwag<aaaroeiram<<on,p<naaaon, 101 - FOUNDATION
will do the work,and the structure is hot intended or offered for sale(Sec 10q4,
^Bu ess and P'f ssl C d TI Contractos Uce-e Law does not appll to an — Required Inspections'"
who,of property Who builds or polo rma poemor,and who doe, .on work himself 103 - UFER
d h h' n em l r,t provided th t t ,intended or
�rda 8 P > p
f ea f -sale.'Ir n men las.,'improvement' 1a m' " year r . 104— - REBAR"- -..- _ . _. _
i 'move mbald uhm tt b an rpro ogthatleea tbola 105 - ANCHOR BOLTS y
cm
in
o e f p rp oC 11 '
1 0 ' rine pip ny i,- 1 . ry o t dr g 'Ili d cultural,....t ---- --106- — -SEWER & WATER
the project(S 1044 Retailers d Professions c a d The Clariductorra202 - UNDERFLOOR PLUMBING if
License Law da,nm pply t f p pent who builds p i1bacromr, i -
_ . :. ..rad noaanins.foschpole<ta.whh. commaoe),I nedpmsuamtome -. . 203 - .UNDERFLOOR_.MECHANICAL
. .. ..... . .._
'c°'°' SLnse L
204 — UNDERFLOOR, FrRAME. .,
❑la, der - B&PCfonhis reason
�unDoo7 205 — UNDERFLOOR INSULATION
S (qn WORKERS COMPENSATION DECLARATION 301 — ROUGH PLUMBING
Ine ny IBrmuae penmr>rzrpel'ry, finernn ge Iamrions: 302 - TUB & OR SHOWER
11 d01have and dl'ra t Compound ofCluster to elf imumfar wa,ker'a 303 - ROUGH MECHANICAL
as_�P' ,Cop i' a' mvided far by Section 3700 of be Labor code, for he 304 — ROUGH ELECTRICAL
m
perforance of the work for which this pemmr is issued.
01 have and will uhad n worker's Comp r Insarone a�required by Section 305 - FRAME
i
3100 oLrne Labor Cade,for me performance of the-work(or which this permit is 3 0 6 - HOLDOWNS
"sad.MyW rkefs Competsat laum 'na Pory min rare: . 307 --" -INSULATION . .- -. .. -. .
Carter
3CERTIPICATION OF EXEMPTION PROM WORKERS. a Y,1 3:O B'� ,'iSH'EETROCK (P p,.sl '
309._...,.-.EXTERIOR...LATH._._....,__. ...._... .-__. --------___
erbaaedt oda a o,be�ompinee fm pe mn ram enanarea aouare 310'1 "I-NTERIOR LATH
, capon) 1 ) 311 -.—.. .SCRATCH .COAT
I cert that i
y n m p f rmance of the k f whim rM1 perm is iss ed;l
shall m n innemployL'any person n any Date . o as to become subject to the Workers'
313 — ROOF NAILt:r-
cop ton wa left Date n,ptlon,youfioulJ 502 FINAL ELECTRICAL ENERGY
Applicant . . 501 — FINAL ELECTRICAL
NOTICE TO APPLICANT.If.after this C ices.re tof he - MBING 'ENERGY
become n campy the WorkersComn,or pcarall hubfthe Labor Code,you man
O C .min m comply will np i.rmna onhis p iunull be discredrevokee. 503 - FINAL MECHANICAL ENERGY
Ihereh RrmCONSTRUCTION
ONther UCTI eOinstLENnded DING AGENCY
nc for the rformanre -. ... -.504 FINAL BUILDING ,ENERGY. .`�.�' ... .-,
A �po kry- n-nm p t 'aea(s 3091 avgc)y ° -' 505 FINAL ELECTRICAL"` -
orad N .506 — GAS TEST ..
;D Z ae Ara 507 — FINAL PLUMBING""y ' '
U p
1 gme a comply
a this 11city 'ad a adte that mium, no information is 508 — FINAL MECHANICAL
0- 1.1. t 1 g . a comply th II city re ordinances d state laws relating
'02U to buildingconswciinn,andherenyaoMoiizerepresenmtivesofthiscitymen¢rayon 509 — FINAL GRADE
ty (� Ne rho e t V p pent'm 'aspect on pu,pose
Ea,6; (we)asreetosae demifyand k pa IssiheCty fCaperton iijanst 510 — FINAL PLANNING
rw V1 libt cs judgment,, t and expenses which may in any y against said 514 r'�— N WORKS
U z City co '9eofm journal,of thi pc n
AVP,(CANT//QQNDF�S��ANDS AND N'ILL COMPLY'WRH ALy N(]�N fBOIf,'T
SO ORCERYQOLq�pN1�.,is•.. " JL F- Issued by: to t
S;i�,,,mo e YfApp^lidliataicllottr((OOa.TT//YY.. 'handle
a-' -Dole,
ale,.,. _
HAZARDOUS MATERIALS DISCLOSURE
. Re-roots.
0FP ,of future building occupant tore oha dle hazardousType
Roof..
as der ooy m e pen M p oil CnPt 912 adthH Health Safety
Code Section 255020 t
as
tproofs shall beinsPected prior. u..any r.o
ofing.material being
g installed.
Will the appl t f t building
. _„.
bla g < p t eqa p nt devices rich If a roof is installed'without first obtaining an inspection;I agri remove
thaza d A y agement
opo t q1 ,c.by Ih 'B yA Quality Man
Dirt ct /,aJ'�/t all new materials for inspection Applicant understands and will com_ply with
qYe eat.una<,cne ter es all non-point source regulations
1 have read he mam
llas.do., r al. y mp 5 or the
Caloorm.Been&-Safety Code:Sections 25505;25533 and 25534.1 understand that
6cou'ailding do frour curzemly have am t,tharmarmi,marnsibltytanorify the - '--
c Pam f th egu/emi, h must b t p 'r to iss f a Cen fc t of
°` °°y �' !I-S-QZ, Signature of Applicant Date _
own rarantnoa.eaage t All roof coverings to be Class"B"or better '
�: " - , i. . Dote: