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05080099 I CITY OF CUPERTINO BUILDING DIVISION PERK - C®NTRACT,OR NFORM ON:, BU ILDING ADDREss: PARAGON SERVICES/RGM BUIL EST"°05080099 PERMIT ISSUE DA OWNER'S NAME: TE LAKE BILTMORE APARTMENTS 2812 TRINITY SQU RE DR 09/13/2005 ONE: SANITARY NO. CONTROL NO. (972) 478-2255 ARCHITECTIENGINGER; BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 opo LICENSED CONTRACTOR'SDECLARATION Job Description U F 1 hereby affirm Thal 1 am licensed under provisions of Chapter 9(commencing �Zw with S(lctlon 7")of Division 3 often Business and Profusions Crob.and my licenm is mfullforceandeffec. REPAIR PLYWOOD CUTOUTS, 3) ' = Lice" Class uex CONTRALTO RADON.{o-SER ICES INC 'i to Dale coo`TS D ClOf hS(/� {IZ W r ARCNITECI'S DECLARATION FRA I �a I undersand my plans shall he used as public records �' a It, A ,a0 s C.t;; Licensed Pmfessional `O� OWNER-BUILDER DECLARATION snr� .�a 9 1 2 1 hereby affirm that 1 oto exempt from the Contractor's License Law for the OC,) /, / �Lv o O following reason.(Section 7031.5,Business and Prufesxlur¢Code:Any city ar county 5$ which inquires a permit m crop ,alcor,improve.demolish,or.pair any structure _ = 1I rior m its issuance.also mquiru me applinm for such permit 1.tilt a signed stalemem a isc mel he islicensed pursmnnothe provtsonsnfmcCnnvacwrsLianslaw(Chapmr9 Sq.Ft. A're •,• 4{y. ,,� ValuatiCr31275 yl-m (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y _ Nat he is exempt thonfrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant m a civil penally of APN' umber Occupancy Type a.,.om man Eve hundred dollar:(5500). 36903008 . 00 I,as owner of the prepeay,or my employees with wages u dochrole compensation, will do the work.and the strucwm is not intended or offered petiole(Sec.7G,W.Business Required Inspections and Professions Code:The Contractors License law does not apply to an owner of q p property who builds or imprnven thereon,and who does such work himself.,through his own employees,provided mat such improvements us not intended or offered for sale.If, however,me 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 purpose of sale.). . ❑ 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(sec.71W4.Business and Professions Code:)The Contractor's Li cave law does not apply 1.ad own,of property who Wilds or improvss thereon,and who contracts for such project/with a eontncfor(s)Itceread pursuant to the C.nlracmra License Law. pt under Sec. .B&P C for this reason Dale' ORKER'S COMPENSATION DECLARATION �d ereby affirm under pe.try of perjury n ve or the followidg declarations: , 1 have and will maintain a Cerificaat,of Consent to self-insure for Worker's Compen- eager,as provided for by Section 3700 of the labor Code,for the performance of the work for which this permit is issued. 1 have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this rennins issued. My Werkcri Compensation Insurance carrier and Policy number a.: Commit: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need n.hecompleteJ if the permit is for.ne hundmd dollars($100) ,or less.) I certify,mat in the performance of me work for which thia permit is issued.l shall not employ any person in any manner eryu to become subject t.the Workers'Compensation Laws of California.Dale—{rte Applicant fe 'i'— NOTICE TO APPLICANT:If,after making Oda Cenific.e of Exemption,you should become subject o the Worker's Compensation provisions of the labor Code,you must .J z forthwith comply wire such provisions or this fermllshalt W deemed revoked. ZOCONSTRUCTION LENDING AGENCY 'r- I hereby affirm mat there is a eonnroction lending agency for the performance of W 7 the work fur which this permit is issued(Sea 3097.Civ.C.) W n^- Undcrs Name z Lcoder's Address C)O 1 eeNfy mal 1 have read this applic.im,and state that me above information is W t— Correct.1 agree to comply with all city and county ordinances and sate laws relating re 0 r.) building construction.and hereby suth.rine representatives or mus city to enter upon the W ahove-mentioned property for inspection purposes. (~ 1 (We)agree to save,indemnify and kccp harmless the City of Cupertino against V3 liabililies,judgments,Cuv and expenses which may in any way acct against said City U Zin emsr,arrc.of the gmefir,of this permit. y APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. ' O7 _ 5�e' Re-roofs aW _-,_ mhCmugachr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle bvardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Cale Section 25532(a)+ All roofs shall be inspected prior to any roofing material being installed. oYcs No Will me applicant or Tulare building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hardnux aircomaminana as defined by the Bay Area Air Quality Management all new materials for inspection. District? El Yeses 1 have read the hanedous materials requirements under Chapter 6.95 of the Cali aro pia Her b&Safety Cade,Sections 25505,25533 and 25534.1 undersand mat if the Wilding d« of comedy have a report.mal h is my responsibility to notify the we upanl of the requirements which must W met prior to issuance eta CeniEca.of OOccupancy. Signature of Applicant Date owner or authorized agent Dam. All roof coverings to be Class "B" or better CITY OF CUPERTINO !m 9 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 # . . . 05080099 SITE ADDRESS . . . . . : 10159 S BLANEY (BLDG # 9) 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 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 K09FINAL GRADE 510 FINAL PLANNING 14 FINAL PUBLIC WORKS • A.S.E. 255 N. Market St . , Suite #220 San Jose, Ca. 95110 (408) 999-7441 **tt*+���rt��***x*�**tit+t*tt**•r��r**,t*�***t**ttr*�t,t,t*:t,t*,tt Permit # 050800091 Thru 05080106 r PLAN CHECK NUMBER: 05318 .CUP September 3O, 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 CUPERTIN# c CUPEI�TTM TINO PERMIT APPLICATION FORM - Alk Q[•0IN do/oo APN # Date: - z 3 ( 6-3 � � � � Building Address: Mailing Ad ress (if different from building address): /OIS9 S007-11 6411AACY I < _ ,S'G/ y Owner's Name: llgt tt= QitTmaa[--B1,,44rmc ✓rs Phone#: ,e,ld, .11ANO SfJn/S'F T 41 OG<'- A.YUtLOJ'n1 r%✓it e_0462W e"d O X5'"9 e ✓ ContractorrS'va � License#: Mwzfed,tl SC% v cc S' nJc- VGIS'3 Contact: Phone: `t 9a Y'>8-;W-YS Cupertino Business License#: 2AFtl,u co.t Fax: Building Permit Info: i4 Bldg 9' Elect ❑ Plumb ❑ Mech ❑ Job Description:.B4ac/S 1'e 5,0604 r To Ptywcno cuTouTS i9l (a6 Zac�a .,Iv yr To Residential P-CtF 9n�ouTS 0 r 4 ATj-Ac N TlRIA<s Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: C40 )Cost of Project: od r Occupancy Group: Type of Construe on: Please check this box if the project is a T e second-story addition: ❑ Project Size: Standard L' Large ❑ Major ❑ Quantity Fee 1D 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 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 I of ,� � 7 4,,ME 1. CITY OF CUPERTIN °F PIT APPLICATION MRM CUPERTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMTTIGATC 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 Ad k BPVENT Alt of Drain &Vent PLUMBING BPWATER InstaWAlter 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 BRENLkMiAN A/C Units<= 10,000 clip MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> IOK 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 O "' * &YY OF CUPERTINO�, CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee rD Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREI T=ATR 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 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__.._ ---Plumbin -PerniifIs-sue -- ------PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Ran a Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3