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05080095 i 7 CITY OF CUPEwr[NO "�. �€�z;. T e "'�'£` BUILDING DIVISION pl;Rb19 'C�NTI2AG�TORaINFORi®N BUILDING ADDRESS: PARAGON SERVICES/RGM BUILEffArNO05080095 OWNER'S NAME: PERMIT ISSUE DATE LAKE BILTMORE APARTMENTS 2812 TRINIT 09/13/2005 ,ONE: SANITARY NO. CONTROL NO. (972) 478-2255 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 L00 LICENSED CONTRACTOR'S DECLARATION Job Description wp 1 hereby affirm that I am licensed under provisions or Chapter 9(commencing ito with Section 96fa0)ur Divisirn3ofthc Busines and Professions Code,and an,license is in full force and effect, Lucasc Class Lic.a REPAIR PLYWOOD CUTOUTS (1) 0�? Date Connector CONTRACTOR: PARAGON SERVICES, INC ARCHITECTS DECLARATION I arecrsund my plans Shall ba used as p.hire records to ;0� Licensed Pmfcssimeal S OWNER-BUILDER DECLARATION <f 1 M1emby alp. ff rm that I am exempt from the Contramm's License Law for the p o following reason.(Section 7031.5,Business and Prefessinns Code:Any city or county K m� which requires a permit to consumer,alter,improve,demolish,or repair any.amnu d ,;to prior m its issuance,also requires the applicant for such permit m file a signed statement e that he is licensed pursuant the provisions of notContrncmri Liceme Law(Chaptcf9 Sq.FL Floor Area Valuatio 425 pFo (commencing with Section 7000)or Division 3 of the Business and Professions Code)ur i that he Is exempt themfram and Or basis for the alleged exemption.Any violation of Section 7031.5 by any appliclum for a Permit subjects Our applicant o a civil penalty of APN Number Occupancy Type oat more than fisc hundred dollars($50al 36903008 . 0 0 ❑I.in owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(See.7014.Buttons Required Inspections antl Profusions Code:The Comsnemo License Law don not apply lf an owner of [� p r.�®q P tend PrYwboWilds or ns Code:improves antlwho does such walk not himself.,though his I'rdr� �J (///L/.tl�,� llgtlah�� own employees,provided that such impro tarena are not intended lir offered for sale.If, however,the building or Improvement is mid within one year of complction,line manor- builder will haus the burden of proving that he did not Wild or improve for purpose of Calc) OCT1,ruOwner ofOc aproperty,amexclusively contracting withlicensedconacereli- la 27 ZOOS cenewnthe pmjett(Sec.to a4.Business and ay who Wi Cade:)The vesdae on,Li- whocoswdoesnot apply manowner orproperywcensed ort improves mereon,or's �a. , I who contracts for such projects with aconuanorts7licenmd pvrsuam to the Contractor's p U {I�. tj /�:.'� (]LLA Law/ r1 flYd'llllll\\\\�Itl[�/�C�`/�' �A x�mpt under Sec. .B&P C for this reason V Owner �- Data KER'S COMPENSATION DECLARATION y affirm under penally of perjury one of the following declarations: 01 bare and will maintain a Certificate of Consent to self-insure for WrrkefsCompen- .lion,as provided for by Section 37W of the labor Code,fm dam Performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance,ss required by Senior 37M of the Labor Code.for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number art: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This secs on need not he eomplemd if thm permit is for onehundred dollars(SIM) m Ins.) I certify Nat in the performance of me work for which this Permit u issued,l shall not employ any person in any manners t terms tib, the a rkers'Compensation Laws of California.Date Applicant 1/' NOTICE TO APPLICANT.If,ift,r maks this Ccoificate of Exemption,you should become subject m the Worker's Compensation provisions of the Lobo Code,you must .Jz forthwith comply with such Provisions or this permilshall M deemed revoked. ZO CONSTRUCTION LENDING AGENCY [r E;), Ihereby aft m Nat there is a emisuuction lending apcnO fm the perturmaroc of Cd 1 the work fur which this peon it is issued(Sec.3097,Civ.C.) W Q Isndcra N. G Lender's Add V Q m.. 1 certify Nal 1 have read this application and tum that the above inrOmoolmn Is W F" tracer.I agree m comply with all city and county ordinances and state laws relating to pU building construction.and hereby authentic representatives of this city to enter upon Ne ,W ahovomentiOmd property for ox,cetirnpurposes. (We)agree to save,indemnify and keep harmless dm City of Cupertino against Fi,, liabilities.judgments.costs and expemes which may in any way accmc against said City U in consequence of Ne granting of this Permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUICC=.aE_fYCA'MN Re-roofs Signature O pplicanlCrrdmdor / Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant smm or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(.)7 All roofs shall be inspected prior to any roofing material beim installed.EI Yes Lt✓Will the applicant or future Wilding occupant use equipment air devices which If a roof is installed without first obtaining an inspection,I agree to remove emit haiardous air mnmminana as defined by the Bay Arca Air Quality Management all new materials for inspection. D'xvicl7 �/ ' ❑Yes �Fu I have read Or huN vanus materials rcq.im..a.under Chapter 6.95 rf Loc Califon ria Health A Safety Cwfe.Sections 25505,25533 and 25534.1 undersand Nat BNe building drcs not currently have a neural,Lord it is my responsibility m ondty the occupant of the requirementswhich mntxMet Prior it)issuanecoraCertiOateoffkcupsney. Signa tore of Applicant Date amo -. All roof coverings to be Class"B" or better o n m .gem Date i CITY OF CUPERTINO em 5 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 # . . . : 05080095 SITE ADDRESS . . . . . : 10159 S BLANEY (BLDG # 5) 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 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 425 . 00 83 . 16 0 . 00 83 . 16 0 . 00 BSEISMICOM VALUATION 425 . 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 0-09 FINAL GRADE 510 FINAL PLANNING 514 FINAL PUBLIC WORKS e A 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 30, 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. 1 . Project engineer to inspect all repair works and to submit Structural Observation Report per note #7 of the plans . CITY OF CUPERTINO q CITY OF PERMIT APPLICATION FORMAs �S �S CUPERTINO • .; APN # 36Date:, — � d'ay s Building Address: Mailing Address (if different from building address): /o/S9 sov a .r�.vG-y d��•isT�,✓a �: _ �s'"cri y ' Owner's Name: 6,IXL= ,a�tTmo�t['ifs'�ti!?mc ✓fs Phone#: Z,/d, ,I.uO Sun/ t=r 61,urolizuo9ioc r AFUL tp/ rr/r ✓j c O � �$3c5� o ✓ . ContractorTSd,3 > License #: Contact: Phone: 97-Z y78.7d.5' Cupertino Business License#: L.Fyv to.t Fax: 9 9,g y7 Building Permit Info: i4 Bldg [' Elect ❑ Plumb ❑ Mech ❑ Job Description: ,BSOC/S 1�eY06,94 .r To ccuioUTS T.ICY~r To Residential [�ctFra ✓ouTs ®r'/; /o77-lci>r TPAIA.[s Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: od Occupancy Group: Type of Construction: Please check this box if the project is a T /w.c S' second-story addition: ❑ Project Size: Standard 2' Large ❑ Major ❑ Quantity Fee ID Fee Descri tion Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM 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 1 of 3 �� 72 nlCITY OF CUPERTIN �' °F "RMIT APPLICATION FORM 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 clm MECHANICAL BREMAIRHAN A/C Units <= 10,000 c8n MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Mise 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 BRETARESAPP Remodel Res Appliance ELECTRICAL 2 of 3 r a � OTY OF CUPERTINO • - CUCITY TYOF O PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Grou • BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL BRF-Tv=ATR Theatrical Lightmg 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 Bsvam 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--- - --Plumbing-PermifIssue — --PLUMBING PPLBG IPlumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential I PLANNING ZADDCHG Address Change BUILDING • 3of3