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05080102 CITY OF CUPEwrINO �IaN BUILDING DIVISION p FO�"_< ON:, LRnnl xOL � vT�r ,�, _ z, BUILDING ADDRESS: PARAGON SERVICES/RGM BUILDIS"TNQ05080102 1 OWNER'S NAME: PERMIT ISSUE DATE LAKE BILTMORE APARTMENTS 2812 TRINITY SQUARE 09/13/200S NE: SANITARY NO. CONTROL NO. (972) 478-2255 ARCHITECT/ENCINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u00 LICENSED CONTRACTOR'S DECLARATION Job Description [u G 1 hereby affirm Nm 1 am li¢nud under provisions of Chapter 9(Commencing ?rte with Scction70(1).f Division 3.f NC Bisinnaand Professions Code,and my lion.is .„ inmBmro anaerr« REPAIR PLYWOOD CUTOUTS (2) t2 Zi License etre. Lie Dam Contractor CONTRACTOR: PARAGON SERVICES, .INC. .H p DECLARATION ARCHITECTS DECLARATION 1 unticrstlnJ my plans shall be used az public records I.Q ,N Licensed Professional g OWNER-BUILDER DECLARATION sE I berchy affirm that I am exCmpt from the Contractor's License Law for the _ct o following reason.(Section 7!111.5,Business and Millennium Code:Any city or county i m which.quires a permit Or consumer,alter,impmvc,demolish,or repair any struemm poorm its issuance,also requires the applicant for such Permit o rile a signed namment - ar that he is licensed pursuant to the pmvismnaofthe Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuatio$850 as (commencing wi ih Section 7000)of Division 3 of the S usinms and Professions Code)or i that he Is exempt On reform it for basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a Permit subjects the applicant o a civil penalty of APN Number Occupancy Type not more than rive hundred delta.(350(). 36903008 . 00 - OI,as Owner of the property,or my employees with wages star their sole compenaxtion, n n will aro the work,and theswctum is not ntended or offered for sale(Sec.7044,Business ��{ Required Inspections and Professions Code:The Conuacmr's License law data not apply if ri owner of property who builds or improves thereon,and who doessuch work himself..through his q P own employees,provided Nm re such improvements anet intended or offered fur sale.If. however.the building or improvement is sold within one year of completion,the owner. OCT 2005 builder will haw.the burden of proving that he did net build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors t. 1�as p /r rl p ///����,,, comma the out (Sec.70,41,a.,owner II and n,who h tom ds ce:)The Contracmr's Li I I '1 I' IIB ®�la1` 11 . who conwdoesnOapplymmoith a omerch bs wcobuedsorimproves themnr.and 1111111111JJJLAA(Illll Jll l' N�VN who contracts for such projects with a Conmemr(s)licensed pursuanuo the Crmranor's License L ev�empt,t nd�er Sec. .B&P C for this reason , Ohwt!" �—-/ '�i�--_ Dam WORKER'S COMPENSATION DECLARATION 1 hereby affum under penalty of perjury ore of the following declarations: 1 haw and will maintain a Ccnifiea a of Consent to self-insure for Works(.Compen- sation,m provided for by Section 31W of Ne Labor Code,for the perromanee of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as required by Section 37M of the tabor Code,for the pconormane,of Ne work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number art: Carrier: Policy No.: CERTIFICATE OF EXEM MON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completN if the permit is for one hundred dollars(S IID) m Its.) 1 Certify that in the performance of the work for which this permit is issued.I shall nut employ any person in any manner so�tu hccomg-ubjauo M Workers'Compenaimi Laws of Caliromia.Dom Applicant NOTICE TO APPLICANT:if,aficr makingd this Ceniftoate of Exemption,you should become subject an the Workers Compensation provisions or the tabor Code,In.must .JZ forthwith comply with such provisions m this permit shall M dccmcd revoked. zO CONSTRUC ION LENDING AGENCY E .N. I herchy affirm tial there is a Construction lending agency lot the performance of E 7 Ne.,it for which this permit is issued(Sec.3097,Civ.C.) W QLender's Name a, Lender's Addrrss U Q 1 certify that 1 have(cad this application and come that the above information is �(•' Correct.I agree to comply with all city and county ordinances and stem laws radioing 0U building conswnien,and hereby authorise representatives of Nis city to enter upon the W stu ve.menu...d property ter inspection pmlwses. (We)agree to save,indemnify and keep harmless the City of Cupertino against HN liabilities,judgments,costs and es penes which may in any way section against said City U Z in eonsequencc or the granting of this Permit. .. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date l/-/J-6(- SOURCE REGULATIONS. Re-roofs c Signature. ilicanUConoacmr Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Sarety Code,Section 25532(a)l All roofs shall be inspected prior to any roofing material being installed. El Yes P Nu i Will the applicant of future/building Occupant use equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Diarin7 / ❑Yes Q}N� I have mad the hazardous maarialarequiremenu under Chapter 6.95 of the Califon . nix Hcelth&saN yCade,Sections 25515,25533 and 25534.1 understand trot if the building does net currently have a tenant Nat it is my respunsibility to notify the Occupant of the requiumcn .ata:MCI p6OrtoiaruanccofaCertircate��i0,up er. Signature ofApplicant Dale �_ �Cz %� All roof coverings to be Class "B"or better Ohtnewr-sated agent m CITY OF CUPERTINO m 12 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 # . . . : 05080102 SITE ADDRESS . . . . . : 10159 S BLANEY (BLDG # 12) 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 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 509 FINAL GRADE 510 FINAL PLANNING 14 FINAL PUBLIC WORKS cao A.S.E. ® 255 N. Market St . , Suite #220 San Jose, Ca. 95110 (408) 999-7441 Permit # 050800091 Thru 05080106 1 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 1 . Project engineer to inspect all repair works and to submit Structural Observation Report per note #7 of the plans . ; t CITY OF CUPERTINO F cuPEr PERMIT APPLICATION FORM 03'� �°l /e2 0 6 N # Date:. . Building Address: Mailing Ad ress (if different from building address): /D/S9 S0& // [A.vFY /JfEiST�n/O c c5�lJ/ y Owner's Name: ,(�}/lL= /SitTmp2c-fIP�1/J?ry/t ✓Ts Phone#: �,�, -yivq S/NSFT ///OG .01 UttpP�r7r 0✓i/ c �S �S3�SS 0 Contractor:-sda , License#: Gd,t/ S/r U C L S' nJ - ype/Is 3 Contact: Phone: 9'7a y78-7a-3 Cupertino Business License#: 1Fn/v roti Fax: 9,2 V 7 a Building Permit Info: f; Bldg [' Elect ❑ Plumb ❑ Mech ❑ Job Description: .BSoc/S' /k Y&-W4 s To Oe ywono e6,o4,:J' ollr(to f -Zac�,a TQC/ � X- Tp Residential ED-e�F» ✓ovTs ®E /{S,47-; i�Car/v TPA/A<s' Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: cv Cost of Project:CIOoo Occupancy Group: Type of Construe on: Please check this box if the project is a T e S' ede,; second-story addition: ro'ect Size: Standard ©' Laze ❑ 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 Elee 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 of3 �� 41 *CITY OF CUPERTIN46 OF PERMIT APPLICATION FORM CUPEkTINO 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 BOVERTHVIE 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 InstatUAlter 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 BREMAIRHAN A/C Units<= 10,000 cfm 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/Platfonn Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BRENIREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 C IRTY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, 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 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 PPERMTTFEE—_ _ __—Plumbing-PermifIssue -"—,_ ----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 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTnR`�INFRMA'CION B UILDING ADDRESS: PARAGON SERVICES/RGM BUILE.PBRAHT NO.05080102 OWNER'S NAME: GPtEWIT ISSUE DATE LAKE BILTMORE APARTMENTS 2812 TRINITY 13 2005 NE: SANITARY NO, CONTROL NO. (972) 478-2255 ARCHITECDENGINEER: BURRING PERMIT INFO BLDG ELECT PLUMB MECH u0o LICENSED CONTRACTOR'S DECLARATION m 1 hereby affil.Nal l am licensed under provisions of chapter 9(commencing - lob Description to with Section 700)0)af Division 3 of the Business and Professions Code.and my license is =„ inhm0mrteand effCCL REPAIR PLYWOOD CUTOUTS (2) S,y,: License Class lie.• ; Dales Cement, CONTRACTOR: PARAGON �WSERVICES, sbc r I understand my planshal M used as public recordLED goUG Licensed Professional 3 OWNER-BUILDER DECLARATION <I I ncrchy alum that I am eat.ps from the Cmuectars Liccnee Law for the _ 20050 0 following mason.(Sttuan 7031.5,Business and Professions Cade:Any city of county a 21 which requires a p.it m construct,alter,improve,demolish,or minor any structure prior w in issuance,also requires the applicant for such permit to rile a signed ataement 6 that he is licensed pursuant to the provisionsofthe Contractor'sLincese Law(Chapter 9 Sq. Ft. Floor AreaVI' e aluatiHh 0l$'8'50 xss-$ (commencing with Section 7000)of Division 3 of the 9 usincees and Professions Code)Lir ��Ft�I\\ y _ Ne h at he is exempt therefrom and thee for the alleged exemption.Any violation of 1lJ I \\ 5I- Section7031.5by any applicant for aPermit nubjecesNeapplicanitoacivil Penalty of APN Number Occupancy Type no,.a.Nan five hundred dollar.(M). 36903008 . 00 L a the work,she p e structure uneof my cmployco wish Bred for (Sec, 7W lgrarno a will Pr the work and the awcturoru not intended Leconse a w do formate(Sec.7049.Business and Ptlywh ons Coda:The Contnc,our ndwho law docs rot apply,e an owner is Required Inspections Incipiently who,i,provided that such imps and who ma not himself er though his own employers,provided Natovenent I. to wtarenm eaf.fCtended erroffered formicdin.-.I- hander.the building Or improvement issoldwithinone)earofcompletion,Neowrcr- builder will have Ne Wrdcn of proving Nat he did not Wild or improve for puryosc of sale.). ❑1.as owner office prepeny,am exclusively contracting wit licensed contractors to construct the project(Sec.7049,Business and Professions Cade')The Contractor's Li. CO.law does of apply Of an no,of property who Wilds or improves devices,and. who Contracts for such projects;with a eantraener(n)licensed pursuant in Ute Commemes Liana LBw- CI.I.ni'Eamp,under Sec. .B h P C for this reason Dale WORKER'S COMPENSATION DECLARATION 1 nvmby a(fnv under penalty of perjury ore of the following dedanuom: I have and will maintain a Confliction of Consent to scl6insu.for Worker's Compere cation,as provided for by Section 37M of the Labor Code,for the performance of Ne work for which Nie permit is issued. (]1 have and will maintain Worker's Compensation Imuran¢,as rcyuimd by Section 37W of the labor Code,for the performance of fie work fa which Nis permit is famed. My Worker's Compensation In....carrier and Policy number are: Co. policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Inks section need not the completed if the permit is forest,hundred dollars(51000 or less.) I cenifv Nat in the performance of the work for which this permit a issued.I shall not cmploymy person in any manrerW�lo hecomesubjectm Workers Compensation Laws of California.Deme Q_,�praf%//,_q.� Appli NOTICE - is NOTICE TO APPLICANT:If.Compensation previsions of the, Exemption.you should become h comp to it Worker'.Comes or its pmvit hal ob the labor CMC,you mug .JO foMwith comply with such prnvisinm or deli permit shall Wdeemed revoked. Z CONSTRUCTION LENDING AGENCY I hereby affirm that than is a Construction lending agency for the performance of D.' the work for which this permit is issued(Sce.3097,Co.C.) W Q Lender's Name z Lenders Address V O 1 certify that 1 hale read Nie applicasian and$laic that the above information H r coned 1 agree to comply with all city and county ordinances and sum laws misting to p V building construction.and hereby gRofire mpmamauves of this city to enter upon the y W hove-mentioned property for inspeccon purposes. e)agree to save.indemnify and n the ty of rtino habilitici udgmcnts.cera ands pcnma whhiiich may in my way accsuc against said Ci fly /+ Of the granting V z APPLICANTCUNDERSTANDS AIND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs ignawrc o pi'aHAZARDOUS MATERIALS DISCLOSURE Data Type of Roof Will Ne applicant or future building occupant store.handle havaNaos maasial as defined by the Cupertino Municipal Code,Chapter 9.12.and tbo Health and Safety Calc.Section 255J2(a)? All roofs shall be inspected prior to any roofing material being installed. Yes Ne Will mea lice.or future building Occupant Lies equipment or device.wmm� If a roof is installed without first obtaining an inspection,I agree to remove pp g p quipmen it hvardous air contaminants as defmcd by,he Bay Area Air Quality Management all new materials for inspection. District' OYcs Nw I have mail Ne levasdous materials requirements under Chaper6.95 of the Califor Iia HalNgt Safety Code,Secuom 355(15.25533 and 25534.1undersmnd t.ifthe Wilding does not currently hoc a lepant that it h my responsibility m notify the Weeper,of the requircmc umbemetpriarhlissuapcom"C' inaeaf aeup esu Signature of Applicant Dale Mop 0 nvedagent �"--�-�,� All roof coverings to be Class"B"or better