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05080098 MY OF CUPEWN 0 " BUILDING DIVISION PERN><_ ..0®NTp2ACTOR BUILDING ADDRESS; PARAGON SERVICES/RGM BUILD FB5 "'05080098 PERMIT LSSUE DATE OWNER'S NAME: LAKE BILTMORE APARTMENTS 281.2 TRINITY SQUARE MPNE: SANITARY NO, CONTROL NO. 972) 478-2255 ARCHITECT/ENGINEER: BUILDING PERMIT INFO RCHITECT/ENGINEER: BLDG ELECT PLUMB MECH J00 LICENSED CONTRACTOR'S DECLARATION tp I hemby afrrm that I am licensed ander provisions Of Chapter 9(Commencing Description tW with Scclimn7BMpofDi,ei,m3ofO.Busincsxand Pmrcwiens Cadc.md ory li=ens is in fell REPAIR PLYWOOD CUTOUTS (2) ? 'zeawCl. Lie. DCONTRACTOR: PARAGON SERVICES, INC. 7 t.w Dam 7SDECL r.y; As shall rocs DECLARATION IundcrstanJ my plans shall he uacd as puhli<rtcnrds i o..f, Liccnsd Pmressional '1L+g OW NER:BUILDEADECe CimorDN y�0 I hereby affirm that 1 1. exempt(rum the Cssion c License Law for the i q D follwhich rayon.(Secunerrit i ID3str t.situ and ve de nm h.nu Any city Or county "w' which mquires a Pertain m ennmmcl.alms improve,demolish,nu repair any structure 'or to Its iauanec,also requires the applicant for such permit to file a signed statement prior Ft. Floor Area Valuatio 850 lis that he is licensed pursuant to the Provisions nRhc Connector's License Taw(Chapter Sq. >`I (commencingwiOSection?")nf Division 3 n(the Business and Prorasiom Code)or ?"S$ thrt he is exempt Jex" and the buffs for me alleged exemption.Any violation or Section ?031.5 byany appliLL(Or a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type not mare than r hundred delta.($50o). 008 . 0.0 ❑I,a mve., fthe property,CO my employees with wage as their rete compensation, 1 t rl* rxi will dote work,and cm,moerme isnot Intended mofrered for sale(See JO14,Business LS II fide Ulred inspections and Processions Code:The Connector's License Law docs not apply to an owner of IL19R 9 P property who builds or improves theme,and whodoes such work himself or through his own employcu,provided that such improvements arc not Intended ortRcred for ale.ir. OCT however.the building or improvement is sold within one year of completion,the owner- 2 7 200[ th builder will hawe burden of proving Nat he did not Wild or improve far purpose of (.. .t sced. ❑1.n owner of the property,am exclusively confessions with licensed contractorstor'si- D (I n ®�(:V D 0 1.feet the project(S¢.AWG,Business and concessions Code:)The d to U \\\\\H�J . cove law does not apply to an owner of props.who milds ar improves thereon,and who contracts for such projects with a emurac nO)licensed pueuanuo the Contractors Liccnsc lay/ �Ja,rfC m B&P C for this reason Dam /ya KERS COMPENSATION DEcLA5ATio t' cby affirm under pcmLLy of perjury anc of the following declarations: 10 1 ham and will maintain a Certificate of Consent to self-insure for Workers Compm- union,as provided for by Section 37W of the Labor Code,for the performance of the work for which this permit is issued. 1 have and will maintain Wmau's Competuation htsuraret,as tequimd by Sccuon 3700 of One labor Code,for the performance of the work for which this Permit is issued. My Worker's Compensation Insurance carrier and Policy number as: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE mere section need not be completed if the Permit is far anc hundred dollars(SIM) M Icss.) I ecnify Thal in the performance or the work for which this permit is issued.I shall not employ any person in any manners tobccoNesub�'r O the WOrkcor Cconfamation Laws of Califami Dam —<1 /.— / F Applicant NOTICE TO APPLICANT:If,after roodiiii,this CCNrcme of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. '-' CONSTRUCTION LENDING AGENCY I hereby affirm Nat there is a coostmoma lending agency for the performance of (: J Ne work for which this pennon is issued(Sec.3M.Civ.C.) L.endcr's Name I': 2 Lenders Address t �)V 1 agree Nan 1 hare read this application and start thin the aW ve information ng is I conch.l agree to comply with all city and county nonows of and stain laws testing e C} U shove-gcraosenion,arty fohereby amhonp rpows. tatiws of this city c0 cnmr upon the anove.(We)a gree to save for inspection emnify a keep hs. (We)agree m ave,indemnify and lith harmless the City ove a omit id City I Z in of the gratsing ex of this cs permit. may in any way acetas against said City �) I APPLICANTCUNDERSTANDSnArND WILL COMPLY WITH ALL NON-POINT Issued by: Date -7-� 1 URel•REGULAHONS. �h S 7� Re-roofs Sig pplicaDate HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicom or future building occupant amre or handle h..dous material as defined by the Cupertino Municipal Code.Chapter 912,and the Health and Safety Cade,Section 25532(.)? m��� � All roofs shall be inspected prior to any roofing material being installed. ❑Yes "a Will the appii=ant or future building occupant ore equipment Ordeviees which If a roof is installed without first obtaining an inspection,I agree to remove emit ha.ardnas air curnmincres az defeat by the Bay Area Air Quality Management all new materials for inspection. District? Cl Yea 1 have mad the haardevs materials requirements under Chapter 6.95 of the Cali for ria Health&Safety Code,Sections 25505.35533 and 25534.1 undersuml Out if the building does not Currently hoc a¢nam,that it is my ragotmihility to nouly the cumot Of me mya;run;; whichmuscMmctpnoitros'umeco(ac E . 'upas Signature of Applicant Date G, — All roof coverings to be Class "B" or better wnsr or truth rued agent Date - o 0 CITY OF CUPERTINO �m 8 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 # . . . : 05080098 SITE ADDRESS . . . . . : 10159 S BLANEY (BLDG # 8) 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 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 14 FINAL PUBLIC WORKS eo 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 3U, 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 e submit Structural Observation Report per note #7 of the plans . *CITY OF CUPERTINO* 9 cuP TYOFwo PERMIT APPLICATION FORM Ah o APN # 3 G o3 �� Date: Building Address: Mailing Address (if different from building address): /0i59 4i) tA.v!--Y e _ VW v' Owner's Name: IAkk= ,d1Lr_A171X Phone#: S'UNS'FT 41,0a LrA.t U.t=Lp./'7rlt%✓J� c. _ O e o Contractor-Sua > ' License#: Ge.i/ S C% v c r"S' nJ pe"'S'3 Contact: Phone: 999 Cupertino Business License#: 1E.r/v toL Fax: a 9,,7,r- Building 7Building Permit Info: R,1 Bldg [' Elect ❑ Plumb ❑ Mech ❑ Job Description: ,BSoc/S' f,e YOcalJ r To P<yireno cu7-oz1Ts A! Cb7,f Loc,v T.�o�r To Residential p'Ce FP ✓°uTs ®�ii .o rTi9riy Commercial ❑ Sq.Ft. Floor Area: As .4^,r. 6 $/Sq.Ft.: st of Project: I oo Occupancy Group: Type of Construction: Please check this box if the project is a T Xve S' -Jn r1-7 second-story addition: ❑ Project Size: Standard ©' Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BB01LERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> IM 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 d CITY OF CUPERTIN CITY OF PECIT APPLICATION F15RM 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 BOVERTME 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 Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER IustaWAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cim MECHANICAL BRENLkMiAN A/C Units <= 10,000 cfln MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Ligbting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREN MISC 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 *TY OF CUPERTINO ' CITY OF PERMIT APPLICATION FORM CUPEI,TINO Quantity Fee 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 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---" " —Plumbing PerihifI§"sue -- ---PLUMBING - - PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING • 3of3