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
•
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