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05080096 CITY OF CUPERTINO �'="`+ � BUILDING DIVISION PERMF INFFOR ON BUILDING ADDRESS: PARAGON SERVICES/RGM BUILE EtIffT NO.05080096 OW NER'S NAME: PERMIT I5SUE DATE LAKE ONE: SANITARY NO. CONTROL NO. (972) 478-2255 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH +�+Oo LICENSED CONTRACTOR'S DECLARATION 5IOb DCSCrI hon I herchy affi (com rm In.,I am licensed under provisions of Chapter 9 mencing P W with Section 7000)of Division of the Business and Professions Code,and my license is h in ran roma and errert. REP PLyW•ODa gOgOUTS (1) o a, License clue Lic.p n a Dam TSDECL CO T I b P RALJ N SERVICES, INC ARCHITECTS DECLARATION �e IundcrsunJ my plans shall to uscJ as public records is 3 u G Localised Poorcssional 2 `03 OWNER BUILDER DECLARATION ocT 7 2005 aE 1 hereby affirm that 1 am exempt from die Contractors License Law for the 00 following reason.(Section 7031.5.Business and Prnfcssiam Code:Any city or county K m which requires a Permit ,,cnnstruo,alter,improve,diminish,or mpair any structum 't—'^ ptionn lts issuance,also requires the applicant for such permit to fleasignrd statement !'ice that he is licensedpursund,1.heProvisionsoftheContractor'sLicenseLaw(Chepmr9 D I 1 Valuatiok$425 p~$ (commencing with Section 7000)M Division of the Business and Professionals Chase)or i _ thml rte is exempt therefrom and Nc bum for the alleged exemption.Any violation of Section 7031.5 by any...he.,for.permit subjects the applicant to is civil pacthy of APN Number Occupancy Type not mom than live hundred dollars(5500). 3 6903008 . 0 0 - 0 I,as owner of the p opert or my employees with wages as their sole compensation, will do the work.and the stricture is not intended or offered for salo(See.7044,Business Required Inspections and Profession de Co :The Canuaetor's License Law does not apply m an owner of q P property who builds or improves maroon,and who doessuch work himsdfor through his tun employe.,provided that such improvements arc not immnded or offered for sale.IL however,the building or improvement is sold within one year of completion,the owner builder will have the burden of proving mat he did not build or improve for puM=of sale.). 0 I,as owner of the"Opery,am excluively contracting with licensed Commends,to construct the project(Sec.7044,Business and Prafession Code)The Conbacmrs Li- nes raw docs not apply Io an owner of pmpcmy who builds or improves thereon,and. who contracts for such preens with a eonaactaKs)licensed priandurn to the Contractors Lictns, x cempl under Sec. .B&PCf this maw 0 Dale9 ORKER'S OMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a CeNfieRc of Cement to self-insure for Wmkers Coni smion,as provided for by Section 37M of dm Labor Code,for lie performance of the work for which this permit is issued. 0 I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of Ne labor Code,for me performance of dte work for which this permit is issued. My Workers Compensation Insurance crier and Policy number am: Cartier: Policy No.: CERTIFICATE OF FXEMP ION FROM WORKERS' COMPENSATION INSURANCE (This section need not heco mplemd if the permit is for me hundred daltars(5100) or Icad) 1 certify mat in the performance or Ne work for which this Permit is issued,)shall not employ any parson in any marine Q u�ncco iubieLLUIhaworkcri Compcmauon Law.mf C.Iihrdia+Da C Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must .J O forthwith comply with such provisions or this Permit shall be deemed evoked. Z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a c0muuction lending agency for the performance of a the work fur which this pctmit is issued(Sec.3097,Civ.C.) fat Q Lcndcr's Name Lmak,'s Address U C) I certify that 1 have read this application and sum that the shout information is , W P correct.l agree to comply with ail city and county ordinances and suite laws relating to 0U building construction.and hereby authorim representatives Of Unix city to enter upon One �+U above-mankind properly for inspection PwPmea (~:1 (We)agree to save,indemnify and keep harmless the City or Cupertino against V3 liabilities,judgments,casts and expenses which may in any way scene against mid City U Z. in eof the UNDERAND Aanting of Ir ANTSTANDS WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. _ h aggi2 -P Re-roofs ignaturc o IcaHAZ Dam RDOUS MATERIALS DISCLOSURE Type of Roof Will des applicant or future building Occupant store or handle havardous material as drilled by fie Cupertino Municipal Code,Chapter 9.12,and the flailth and Safety Code,Section 25532h)? All roofs shall be inspected prior to any roofing material being installed.O Yea ❑N W mr a,'lieantnr future build occupant use e ,or devices which If a roof is installed without first obtaining an inspection,I agree to remove IP g p qui pmcn mit ha'eardnus air cOhio amu as defined by he Bay Area Air Quality Management all new materials for inspection. U'svicG 0 Ye: CR I have mad the hvardrms materials requirements under Chaplcr 6.95of Ne Califon in.Health&Safmy Cade,Secdom 25505.25533 and 25534.1 understand that if the building does not curcmlly haw a rano.that it is my tcspomiality in notify the cupant of the myub .hMrmast-bc.mpl prior wiaavanre ora cerdream orgocaperany. Signature of Applicant Date .,or C�� 'n ' �e ��'�/ All roof coverings to be Class "B"or better CITY OF CUPERTINO �m 6 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 # . . . : 05080096 SITE ADDRESS . . . . . : 10159 S BLANEY (BLDG # 6) 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 *EE 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 09 FINAL GRADE 510 FINAL PLANNING 14 FINAL PUBLIC WORKS A.S.E. 255 N. Market St . , Suite #220 San Jose, Ca. 95110 (408) 999-7441 Permit # 050800091 Thru 05080106 I 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. 1 . Project engineer to inspect all repair works and to • submit Structural Observation Report per note #7 of the plans . :G = CITY OF CUPERTIN# u� CUPEkTINO PERMIT APPLICATION FORM o S'v N# Date:. 67 Building Address: Mailing Aiadress (if different from building address): /0/59 YO0 it CA.vEr dPl•n��.✓a �aiy Owner's Name: �/t/fL= ,afLTmoit f}o�filTnr[ �i^s Phone#: .(•,/°. A N.O .SUNS[=c /�/OG A.Fv1 Lp/'sr1t:✓i> c. - O �,. ..�3c5� Contractw-S414 > License#: Mllded,t/ SX v c S nJ -elep&I S 3 Contact: Phone:9'7a Cupertino Business License#: L Fn/v co L Fax: d y7 Building Permit Info: R A Bldg 2' Elect ❑ Plumb ❑ Mech ❑ Job Description: 64404/ /��Y4,co%I Rr fi9ii(r To Pt ywca o cfir^o[ui S i9! (a8 tac�v Tia,vr To Residential l L Fy ✓ovTs ®t'/3 ATTAc HF/J i 7,eA14,4 r Commercial ❑ Sq.Ft. Floor Area: AS t xi r'TiN c $/Sq.Ft.: Cost of Project: od C Occupancy Group: Type of Construe on: J# Please check this box if the project is a T !9P .37' o-Jn,0 7-r-,O second-story addition: ❑ ro'ect Size: Standard 2' Large ❑ 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 <= 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 Iof3 � � , / �� f I { CITY OF CUPERTIN(p CITY Or PIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group AOL 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 13PCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Cbeck 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 InstaWAlter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfn MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> 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 2 of 3 r' STY 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 BSPECI. L Special Inspection 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" -PermifIssue -- -- PLUMBING- - PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Lone Range Residential PLANNING ZADDCHG Address Change BUILDING w 3of3