05080093 CITyw CUPERTINO ^'
[BUILDING DIVISION PER _ CCINTRACTCIRINFOR ON
BUILDING ADDRESS: PARAGON SERVICES/RGM BUILT NO 05080093
OWNER'S NAME: PERMIT ISSUE DATE
LAKE B
ONE: SANITARY NO. CONTROL NO,
(972)1478-225S
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
_op LICENSED CONTRACTORS DECLARATION Job Description
;.5 1 herby affirm that 1 am licensed under provisions of Chapter 9(commencing
u with$Ccrc andefec Division3.f the eusincas and Prufessinns Codc and my licens is
t toll tune and conn' REPAIR PLYWOOD CUTOUTS (2)
�tj_ License Class LonN
`mow Dam c DECLARATION CONTRACTOR: PARAGON SERVICE [ �Q��p mak®
tpp ARCHITECTS larem, �J tau ILI6tL��
Y a I understand my plans shall he used as public records
3a.r, Licensed Pmfcssirrnal
I OWNER BUILDER DECLARATION OC I
I hereby affirm that I am exempt from the Comnnofs License Law Can the 1 2005
O O following ratun.(Section 7131.5.Business and Pmfcsxions Cade:Any city m county
awe m fi which¢quires a Permit to eonslmol.alter,improve,demolish,or repair any structure
ij- priorw its issuance.alsornsumas the applicantforsuch permiuo rile a signed statement
i< that he is licensed pursuant to the provision of the C.nlmctm's Lm,n ,law(Cbque,9 Sq.Ft. Floor Area Qf,�
ne l-� (commencing withScdi7lW
on )n(Division 3 of the B nations and Professions Code)or Iftl
i Nal he u exempt terefrom and the basis(or the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mare Inas five hundred dallara(s50)). 3 5903008 . 00
1,as,owner of the prpeny,or my employees with wages as their sole compensation.
will do the work,and the structure is not intended or offered for sale(Sec.7[14.Business
and Professions Code:The Contractors License Law docs not apply to an owner of Required Inspections
pmpeny who builds m improve rhemon,and who does such work himself.,through his
Own employan,provided that such improvements sm nal imenaed or offered for sale.IL
however,the building or improvement is sold within a¢year of completion.the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as be,of dee Poulson,run exclusively contracting wit licensed contractors to
consumer the project(Sec.7(344,Business and Professions Code:)The Contractor's LI-
ccnse law does not apply to an owner of property who builds or impmvas Shaman,and
who eontmeas or such projects with a(numsewr(s)licensed pursuant to to Contnetofs
Lkrnm on
r antler Sec. a h P C for this mason
W. Date
KER'S COMPENSATION DECLARATION
I here yaRrm under penalty of perjury orm of to following duluaaions:
1 M1im anJ will meinuin aCcnifare of Conserv to self insure fur W.rkcr'sCompen-
cation,a provided for by Section 3700 of Ne Labor Code.for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker]Compensation Insurance,as required by Section
37W of the labor Coda.for Ne performance of the work for which this permit is issued.
My Worker's Compensation Insurance artier and Policy number am:
Cattier, Polity N.,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rnru section aced not he complead if lbe Permit is for one hundred ilmh rs(310(3)
or less.)
1 cervi fy that in the performance of the work for which this Permit is issued,l shall not
a.day any person in any manncrso whcco csub' olbe,Workers Cimi,matimi
Laws of Cabfoodit.Data
Applicant IJ��
NOTICE TO APPLICANT:IL after making this Ccnirieatc of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Codc,you must
.J O forthwith comply with such provisions or this Permit shall bo deemed revoked.
Z CONSTRUCTION LENDING AGENCY
P.�.. I hereby affirm that there is a construction lending agency for the Performance of
a 7 the work fur which Of,pan it is issued(See.3[97,Civ.C.)
W Q Lenders Name
G Le dae,Addrns
U O I cavify that I have read Nis it,licuumn and state that the above information is
U, cormos.1 agree to comply with all city and county ordinances and stale laws relating to
0 building consuuclion,and hereby authorize reproommarivn of this city to enter upon to
G ahove-mentioned pmperly for impaction purPams
(We)agree to save,indemnify and keep harmless the City of Coauthor against
liabilities,judgments,costs and expenses which may in any way accrc against said City
U in consequence of me grand ng of this Permit. {-
APP RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 4 J
RCE REGULATIONS.
9��? f Re-roofs
Signature plicant(Contraaor I Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant.,(inure building occupant vme.,handle hazardous mammal
as defined by the Cupenino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section25532(.)7 , All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will thea licantor(clam buildin Occupant use t ordevicea which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air mm
nminan�6u defined by the Bay Arca Air Quality Management all new materials for inspection.
Districts icl? T
0Ycs
I have read the harardnus materials scquiremems under Chapter fi.95of the Califor.
iia Halth 6 Safety Cork,Sections 255(15,25533 and 25534.1 understand tat i(Ihe Molding
does notcumemly have a cement,that it is my responsibility to notify the nxupant of the
rquircmcn¢which must be no Pnono issuance oIs CcNfiJc w or gapxmY' Signature of Applicant Date
°�2 eq �'-'- 9UTC/ e D 1 All roof coverings to be Class "B"or better
CITY OF CUPERTINO
Sm 3 of 16 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36903008 . 00
DATE ISSUED. . . . . . . : 09/13/2005
RECEIPT # . . . . . . . . . : 31168
REFERENCE ID # . . . : 05080093
SITE ADDRESS . . . . . : 10159 S BLANEY (BLDG # 3)
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LAKE BILTMORE APARTMENTS
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : LAKE BILTMORE APART.
CONTRACTOR . . . . . . . : BRYAN BROWN LIC # 27131
COMPANY . . . . . . . . . . : PARAGON SERVICES/RGM BUILDERS
ADDRESS . . . . . . . . . . : 2812 TRINITY SQUARE DR
CITY/STATE/ZIP . . . : CARROLLTON, TX 75006
TELEPHONE . . . . . . . . : (972) 478-2255
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FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------- --- ------------- ---------- ---------- ---------- -------- - - ----------
BENERGYADD PLAN SETS 1 . 00 34 . 86 34 . 86 0 . 00 0 . 00
BPERMFEE VALUATION 850 . 00 83 . 16 0 . 00 83 . 16 0 . 00
BSEISMICOM VALUATION 850 . 00 0 . 63 0 . 00 0 . 63 0 . 00
BPLANCKADD PLAN SETS 1 . 00 34 . 86 34 . 86 0 . 00 0 . 00
- - -------- ---------- ------- --- ----------
TOTAL PERMIT 153 . 51 69 . 72 83 . 79 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----------------------------
101 FOUNDATION 102 PIERS
103 UFER 104 REBAR
105 ANCHOR BOLTS 106 SEWER & WATER
202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL
204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUB & OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 306 HOLDOWNS
307 INSULATION 308 SHEETROCK
309 EXTERIOR LATH 310 INTERIOR LATH
311 SCRATCH COAT 313 ROOF NAIL
501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY
503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY
505 FINAL ELECTRICAL 506 GAS TEST
507 FINAL PLUMBING 508 FINAL MECHANICAL
�09 FINAL GRADE 510 FINAL PLANNING
514 FINAL PUBLIC WORKS
® A.S.S.
255 N. Market St . , Suite #220
San Jose, Ca. 95110
(408) 999-7441
Permit # 050800091 Thru 05080106
PLAN CHECK NUMBER: 05318 .CUP September 34, 2005
PROJECT: The Biltmore
Structural Repair Details
10159 South Blaney Ave .
Engineer: John Clinton
510-2360-7435
-------------- ----------------------------------
DOCUMENTS ATTACHED: VIA•
1 SETS OF DRAWINGS HAND DELIVERY
-------------- ---------------------
Dear Sue: .
The attached document were reviewed and cleared by our
office .
O 1 . Project engineer to inspect all repair works and to
submit Structural Observation Report per note #7 of the
plans .
..............
a
G� CITY OF CUPERTINOO-
cuOf
PEriNo PERMIT APPLICATION FO7 �"
. 3 ion 9
APN # / �� Date
b Y. 5'
Building Address: Mailing Address (if different from building address):
/9159 Sbv // r,1- �U/ 1/
Owner's Name: Li?k<= 4/t7-7 v1tz, 19s,44r;»sPhone#:
,C./°, .11Nq Sl/n/.Se-)—/OG<•� A.[tU,C=Lp/'�rltiJ�� c– - O -5;„ '-�3cS•V
ContractorrSd, License#:
Contact: Phone: 9.7--Z y78.7d 5S Cupertino Business License#:
4FW4i to L Fax: ,2 y7 o:
Building Permit Info: 4
Bldg [' Elect ❑ Plumb ❑ Mech ❑
Job Description: 946'CIS /eYOc o -F To PLycrono ct r^ouTs Al (a8) 1oc.v r To
Residential [� Cl '�Ovi s ®[ i4 .orri9riyr—/�
rtAio cr Commercial ❑
Sq.Ft. Floor Area: .vs xi rTiNc S/Sq.Ft.:
Cost of Project: 1 O. Occupancy Group:
Type of Construction: 10, Please check this box if the project is a
T yloe S' eel e-.o s cond-story addition: ❑
Project Size: Standard LY Laze ElMa'or ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
ra .Qot a. sr�s� t? O V Q• p 7
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- lCITY OF CUPERTIN
PE IT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTUVIE Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool' PLUMBING
BPERMFEE Bldg Permit Fees _ BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trip PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER InstaWAlter Water Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BRENUHU AN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Fumace MECHANICAL
BREMFURNOV Relo Fumace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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61TY OF CUPERTINO
cuP TYOF PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Insection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
" – — PPERMITFEE -"--Plumbin -Permit Issue —_ _----PLUMBING" - -"
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Pla ning LR Commel Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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