05080094 CITY OF CUPERTINO
BUILDING DIVISION PERKCONTRACTnR INFORM�ON
BU I LDING ADD RESS: PARAGON SERVICES/RGM BUIL gra K0 05080094
OWNER'S NAMC: PERMIT ISSUE DATE
LAKE BILTMORE alDAPTIVIENTS_ 2812 TRINITY
ONE: SANITARY NO. CONTROL NO.
(972) 478-2255
ARCHIIECr/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
°00 LICENSED CONTRACTOR'S DECLARATION Job Description
w 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing P
�i� with Scmitin]0(IU)afDivision3ofhc Rusin.s and Profcuinna Codc,end myliccnx is
in full force and erred. REPAIR PLYWOOD CUTOUTS (3)
o z License Clan: - Lie.u
Dam Cunlmaer CONTRACTOR: PARAGON SERVICES, INC
ARCHITECTS DECLARATION
1 understand my plana shall be used.public records
oats
;u.� Limmadd Professional
o OWNER-BUILDER DECLARATION
.'� 1 hereby affirm that I am exempt Rom the Convector's License,Law far the
a-
p o following mason.(Section 703 1.3.Busineas and Professions Code:Any city or county
x which requires a permit to Construct,alu,improve,demolish,or repair any stmnare
prior to its issuance,also requires lhcepplicmn for such permit to file a signed statement
that he is licensed pursuant In the provisions of the CommcluYS License Law(Chapter 9 Sq. Ft. Floor Area Valuatil$tt 2 7 5
(commencing with Section 7000)of Division 3 of the Business and Professions Cow)or
a that he is exempt therefrom and he basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
net mere than five hundred ddhua($SW). 36903008 . 0 0
01,As owner of Ne pmpcny,or on,employ,.with wag.az their.1.compensation, _
will mth,woak,Cade heCoreuno0mmnaede Lawitare.alcpply Tons. wner or /n� ��� Required Inspections
and Pmfwh ons Cade:The wAnvacm..License Law does rant apply to an owner of �r=r� q P
ownemploym.provieed dommmeacomandwhti doe souehwork oroffeedthroughhu // U
employees,provides m improuch vement
is sold
wit arc not ear dedofe or ochre.AM noun-
however.the building or imprevemcnt is sold within titre year of compleunn,me owner- _
builaer will have the burden of proving mat he did not Wild or improve for purpose of (q(a I / 200[
imIC.), til, sl
0 1,as owner of the p,.p,,,,am exclmivcly mourwim,with licensed cno memor Or
Construct Law
the.not (Sec.706q Business and Py who i Code:)The Convaaor's Li� Tian p��®�I� TI /�'�
ttnse Law do.not apply to m owner of progeny who Wilds or improv.Contra.and. II UJJ U t�tY\\v\I fll/�/``�//�]
who commacsfor such projects wish a eontractor(s)licensed pursuant t the Ctinua-Mh
Lie eaLaw.
[g-Panst�cxc mpt under Sec. .e 6 P C for this reason
Own Dare
RKER'SCO PONSATTONDECLARATION
clacm�y efface under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's Compact-
-tion,as provided for by Section 3700 of the Lit or Code,for the peafromnnce of the
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as reclaimed by Section
3700 of he Ube,Code,for he Performance of me work for which this permit is issued.
My Workers Compensation Insunnee carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORK ERS'
COMPENSATION INSURANCE
(Thu section need not W completed if the permit is foronc hundred dollars(5ltltp
mer less.)
I certify ma in the performance of the work for which this permit is issued,I shall not
employ any person in anyas ubecomesubjcct to the Workers Compensation
Law,of California.Date
Applicant ((''
NOTICE TO APPLICAN:If,after makorj Ks Qenifcam of Exemption,you should
became Wbjcct m the Worker's Compensation provisions of me labor Cole.you must
.J Z forthwith comply with such provisions or this permit shalt be theistical notified.
zOCONSTRUCTION LENDING AGENCY
[-. I hereby affirm mat mere is a Construction lending agency for LW performance Lir
IYa 7 dm work fur which this permit is issued(Sec.3197,Co.C.)
U7 A Linda's Name
]z Lender's Address
U O 1 certify that I have read this application and sun that me above information is
ly H conecL.1 agree 10 comply with all city and county ordinances and sum laws relating to
�U building conswction,and hereby aummire mprcxnl31ivCS of his city to enter Upon be
.how-henmadd property for impccuen pugwses.
(WC)agree to save,indemnify and keep haamlcu the City of CoWnino against
F'(n liabiliti.,judgments.casts and expenses which may in any way accrue against mid City
(�Z in consequence or she granting of this permit. ` q
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
signawm ppfi.HAZARDOU Date
HAZARDOU S MATE RIALS DISCLOSURE Type of Roof
Will the applicant Lir future building eaptsanteof handle afdpnsmaterial
az
defined by the Cupertino Municipal Code,
Chapter Hc
r 9.12.and the Health and Safety
Code.Section 25532(a)T All roofs shall be inspected prior to any roofing material being installed.
❑Y.
Will me aMhcanLor future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ort ho andous air contaminants az defined by 1W Bay Arca Air Quality Management all new materials for inspection.
victT
Oyes gsw/
I have read he hmardnmmamrials requirements under Chaptit of he Calder .
nia Health A Safety Code.Sections 25505,25533 and 25534.1 undeasund that If he building
docs not Cuvcntly have a tenant.that it is my responsibility in nouly the Montano or the
ie,must W mei,nurin is,....ra Crodia, m Oc
fa *24ccupany.r__ Signature of Applicant ab
rte amhmacdagent �� All roof coverings to be Class "B"or better
CITY OF CUPERTINO
�m 4 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 # . . . : 05080094
SITE ADDRESS . . . . . : 10159 S BLANEY (BLDG # 4)
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
WEE 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 1, 275 . 00 83 . 16 0 . 00 83 . 16 0 . 00
BSEISMICOM VALUATION 1, 275 . 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
509 FINAL GRADE 510 FINAL PLANNING
�14 FINAL PUBLIC WORKS
ea
A.S.E.
255 N. Market St . , Suite #220
San Jose, Ca. 95110
(408) 999-7441
Permit # 050800091 Thru 05080106
r
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 DRAWING$ HAND DELIVERY
-------------------------------------------------------------
Dear Sue :
The attached document were reviewed and cleared by our
office .
1 . Project engineer to inspect all repair works and to
® submit Structural Observation Report per note #7 of the
plans .
Zalb, OCITY OF CUPERTINO* 9 c�
cuPEYOF PERMIT APPLICATION FORM
N #
Building Address: Mailing Address (if different from building address):
/1,159 Sbv /I Z*,L Z-Y dP1 iSTn✓d G - SCJ/ q
Owner's Name: �f}k�= ,6/tTma2�B.0447-nv[-, l1^s Phone#:
L./°. ANA Si/N,fET iJ/OG o' i0.1=I/L=Ld✓'»7t%✓i�0 - O �' --1513c515
0
Contractor:(-S'da , License #:
,4401M,re't'l S C% v c crS' nJ 41 -elope J S"3
Contact: Phone:9'7a Cupertino Business License#:
1 F,i/v roti Fax: ,2
Building Permit Info: R;
Bldg 2' Elect ❑ Plumb ❑ Mech ❑
Job Description: ,BSocA /'eYOoo/J To Pty,4dz a cUTe[iSs To
Residential [a cz nJouTs ®r ii .Q7'rivc/rF/J
/ rix t 4<s Commercial ❑
Sq.Ft. Floor Area: AX c $/Sq.Ft.:
Cost of Project: oo / Occupancy Group:
CIOType of Construe on: Please check this box if the project is a
T /9P S' e,9 ro second-story addition: ❑
roject Size: Standard 2' Laze ❑ Major ❑
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 <= IOOOA ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of 3 417
7 �-
' •CITY OF CUPERTIN
CITY OF PERMIT APPLICATION F�RM
CUPERTINO
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
BOVERTIME 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 rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain & Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BRENUHUiAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Fumace> I 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
2 of 3
(aimCITY OF CUPERTINO �
CUP TYOF O PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs 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
BSPECLU 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 Planning LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
3 of 3