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05080100 CITY OF COPER'1'INO � BmLuwc DfvlSION PRRtaa CONTRACTn,R INFO$ �ION.�.. BUILDING ADDRESS: PARAGON SERVICES/RGM BUILD �"fTN005080100 OWNER'S NAME: PERMIT LSSUE DATE LAKE BILTOE MRAPARTMENTS 2812 TRINIT 2005 N6 SANITARY NO. CONTROL NO, (972) 478-2255 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 000 LICENSED CONTRACTOR'SDECLARATION Job Description w❑ I hereby affirm that I am licensed under provisions of Chapter 9(commencing iW with Scaion 7(n))of Division 3 of he Business and Professions Code,and my license is Z„ in full root. REPAIR PLYWOOD CUTOUTS (1) .,v27 License ClassLie.# =mac Dam C.mamor CONTRACTOR: PARAGON SERVICES, INC °YY�i ARCHITECTS DECLARATION C< I understand my plans shall be used as public..,its >nU #off LittnscJ Pmrexxional S OWNER-BUILDER DECLARATIONeCmitnew 1 henchy tlrirm on 1 1. exempt Gum Uro COntraetCod License Law for the a following mason.(Seedon 703 ousho Business and ve esiol Code:Any city or county E nt v which lets sura permit re conxwet,alter,improve,demolish.or repair any structure uia priore IS ienadpairalso 2yo the theapplicantfor such Commurmi0aiensele Lw(hod SholCha mem that he is licenssJ pursuanunthc provisions of the Conw<mr's License law(Ciapmry Sq. F[. Floor Area Valua[io$425 yFG (commencing with Section 7000)of Division 3 of the Business and Pmrcssimis Code)ser Q that he is exempt Boerefmm and the basis for Boa alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjccs me applicanuo a civil penalty of APN Number Occupancy Type not mom than fire hundred deltas(55001' 36903008 . 0 0 I,as owner of the property,or my employees with wages.Neir..mle compenaation, will do the work.and the structure is not intended or offered for sale(Sec.7W.Business i. Required Inspections Te 8Y, and Professions Cade:The Contractor's License Law docs not apply to an owner of yyv d n v e f I i7 r q P property who builds.,improves thereon,and whodues such work himself or Borough his 1 bgs yyd 'j•,v, s ,r) awn employees,provided thal such improvements are not intended br.Bered fur sale If. however,the building or improvement is sold within one year of completion,the owner. builder will have Ne burden of proving Nm he did not build or improve for purpose of �l•I /y j�t'� sale.). 1. 1 L {I ❑1,as owner of due property,am exclusively contracting with licensed contnemrs to cone a the project($eco o an wner o.end Professions Code:)The co ',S Lid Ccnselaw does hot apply c manowncress ad rtywho iamera dsorimprovco Bocreon,and 1'pll�l�J��/pJU \\`V`t,Jtt who convects for such projecu with a Commercials)licensed pursuant b the Conaachers LLaima Law L}unrexcmpu undo,Sec. .B&P C for this..on Dam S ' \y0 CER'S COMPENSATION DECLARATION by arnrm under Penalty of perjury no,or the following declarations: I have and will maintain a CeNfiom of consent to scB.insure for WorkersCompen- ration,.provided for by Section 31M Of the labor Code,for due perfmmance of due work for which'is prmit is issued. I have and will maintain Workers Compensation Insurance,.required by Section 37M of the labor Cod,ra the performance.f has work for which his permit is issued. My Woder's Compensation l.vance canner and Policy number are: Carrier: Policy No.: CERTIFICATE OF EXEM MON FROM WORKERS' COMPENSATION INSURANCE (Thu section need not becanpletcd time permit is for one hundred dollars(5100) or less.) 1 certify that in the performance of the work for which this Permit is issued,1 shall nut employ any Person in any manners-/.bac%ubjeuvhe Workers'Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:If,after mnsati Nis Certificate or h Eatior o d you should become Subjecttothe Workers Coons or this pmvisimal of themied Code,you must .J 0 forthwith comply with such provisions or this pc,mil shall be deemed revoked, z'o CONSTRUCT]ON LENDING AGENCY re. 1 hereby affirm that there]s a co.vuctinn lending agency Ior the perfurmvme of the work for which this permit is issued(Sec.3097,Civ.CI !y Q Lender's Namc a Lender's Add. U O 1 Certify that I have read this application and sum that the above information is B. P correct.]agree w comply with all City and county ooinrocca and sat,laws relating to QU building Construction.and hereby aulhorim«posentalives of Bois City to enter upon dm LU above-mentioned property for instruction purposes. gy (WC)agree to save,indemnify and keep harmless the City of Cupenmo against N liabilities,judgments,Cosa and expenses which may in any way accmc against said City , U z COr the ANDanting of s pinall. APPLICANT UNDERSTANDS WILL COMPLY WITH ALL NON POINT Issued b Date SOURCE REGULATIONS. y� &ADam Re-roofs r Signa Appliczo On HA'LARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building accvpant sora or handle hazardous material .defined by the Covent no Municipal Cafe.Chapter 9,11,and the Health and Safety Code.Section 25531(-)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes IY!+yi, Wise mea Ileum or future buildin occupant use e t or devices which If a roof is installed without first obtaining an inspection,I agree to remove •mit hazardous air Contaminants az defined by the Bay Arca Air Quality Management all new materials for inspection. Dismi<tl ❑Yax I have read the hazardous materials antro mens under Chapter 695 of the Cal ifor nice Health&Safety C.&,Secuu.25505,25533 and 25534.1 understand that if Ne huiWing does not Currently have a¢nano Nal II is my re,ponsibil ity 10 mej fy the Occupant of the herinimmenaLi whichmust xmet poor toiaxaaMcof.CCnlEemofa PPantry Signature of Applicant Date 10 r_ G/] �--- ���` All roof coverings to be Class "B"or better ser ramh.o,Cd agent Dam CITY OF CUPERTINO m 10 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 # . . . 05080100 SITE ADDRESS . . . . . : 10159 S BLANEY (BLDG # 10) 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 OEE 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 509 FINAL GRADE 510 FINAL PLANNING �14 FINAL PUBLIC WORKS oe - A.S.E. e 255 N. Market St . , Suite #220 San Jose, Ca. 95110 (408) 999-7441 Permit # 050800091 Thru 05080106 f PLAN CHECK NUMBER: 05318 .CUP September 3,0, 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 . a 1 C OCITY OF CUPERTINO• 6 o c� CITY Of PERMIT APPLICATION FORM `� / CUPERTINO 4.4 N # Date:, Building Address: Mailing A,. rens (if different from building address): /,016-9 X00 1W &fAIZ-Y , el;-9- s'ai t/ Owner's Name: ! x,tz ,6/,1 d.o447-mc.✓rs Phone#: 141161 .11 1.o Su.v r- o�ioaa �otv�-cos int ; G- O �S5 �53�55 Contractorf,S'd-s License#: Gen/ Sx- v e'S nJa ,?&JS'3 Contact: Phone:99.2 Cupertino Business License#:. 4�'tl to.L Fax: a y7 Building Permit Info: 4 A Bldg CY Elect ❑ Plumb ❑ Mech ❑ Job Description: .B40C1S PeY0604 To Ptywcno cvioaTs i9l (a6 tac v %icy�r To 0 Cz '�Ouj S ,AFA AT7--IcHt'/J Residential TPA/ALT Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: oo Occupancy Group: Type of Construction: Please check this box if the project is a T /o,,� -S' CJD r o second-story addition: ❑ Pro'ect Size: Standazd G�' Lar e ❑ Ma'or ❑ 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 lof3 6L 72, � lit ITY OF CUPERTIN OF PEIT APPLICATION F CUPEI�TINO 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 BPINfERCEP 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 InstalUAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 chn MECHANICAL BRENLUUiAN A/C Units <= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFD{T Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace> 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 s 40ITY OF CUPERTINO* CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Sigris 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 EPERNUTFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE—_"__ --Plumbing-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 i BUILDING • 3of3