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05080103 CITY OP CUPERT[NO 0M DIVIs1oN PERM xCONTRACTOR INFORM ON r*� ,.� -,. _ _,re.>' r,:, te BUILDING ADDRESS: PARAGON SERVICES/RGM BUIL `ST NO.0508 PERMIT ISSUE DATE OWNER'S NAME: LAKE BILTMORE APARTMENTS 2812 TRINIT 3/20 ONE: SANITARY NO. CONTROL NO. (972) 478-2255 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 0 0 awz app LICENSED CONTRACTORS Job Description M iy 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing n2 y with Section")of Division 3 of the Businessand Professions Code.add my licenseis mfull faces too effect. REPAIR PLYWOOD CUTOUTS (1) Z License ClassLie.N trn Data Contract., CONTRACTOR: ' PARAGON SERVICES, INC a� ARCHITECrS DECLARATION i d< I understand my plans shall he used in public manna JtiU Licensed Pndcssional in, OWNER-BUILDER DECLARATION 4 g 1 hereby affirm Nal 1 am exempt from the Conha en's Licenit'aw for the D C fallowing mason.(Section 8031.5,Business and Professmon Code:Any City or county a' 4 which requires a permit in candract.alcor,improve,demolish,or repair any structure n�'^ inner it)its issuance,also requires the applicant faction Permit to file aligned statement that he is licensed minod a.the Previsions of the Contractor's License faw(Charter 9 Sq. Ft. Floor Area Valuatiot$425 yt (commencing with Section]WB)of Division 3 of the B usiness and Professions Code)or that he is exempt Osterman and the basis for the alleged exemption.Any violation of Section]W1.5 by any applicant for a Permit subjects the applicant o a civil penalty of � � rAPN'Number Occupancy Type not more than five handrail dollars($SW). a 3 6 9'0`3'0 0'8 . 0 0 ❑Luowner of the pmpcny,or my employcu with wages aslands sole compensation, a 1 Y:l h—:b—FNaIY� will do the work,and die auunure u not cautioned ser offered Board.(Sec.]U1A,Business if uu Required Inspections and Prafessions Code:The ConldacmYs License Law does tit apply to an owner of q P property who builds or improves thereon,and who does such work himself or through his own employees.provided Nat such improvements are not intended or offered far aide.If, V�I 2 LUl1J however,the building or improvement is sold within ate year of completion,the owncr- builder will have the burden of proving that as did oat build or improve for purpose of safe.). ONO 1.f ❑ 1.as owner of the property.,B exclusively Carousingficawith licensed conmaerors ta� 11 p'�� comes La the es not (Sec.nano Business and Professions dsoCode, The C s daemon.Li IlV1J cense caw dors oat apply je an owner of property slice builds or impmvu thereon,and who conlncm for such projects with a contncmr(s)licensed pursuant an one Contractors u exempt under Sec. .B&P C for this mazon Own f� Dal W/ORyE 'S COMPENSATION DECLARATION ' 1 cby'9lirm undcf penany of perjury ane of Ne following declarations: I have and will maintain a Cenificam of Consent to self-insure for Worker's Compcn- sation,az provided fm by Section 37W of the Labor Cada,for the performance of Ne work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 37W of the labor Code,far am performance of are work for which this permit is issued. My Worker's Compensation Insumned camicr and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section aced not he completed if the Permit is for one hundred dollars(SI W) to lest.) I comfy that in the performance of un,work for which this Permit is issued.1 to all not employ any peraan in any manner s,}�m W�e subject the Workers'Compensation Laws of California.Data _..._L Applicant 7 �� NOTICE TO APPLICANTk If.icor makingti This Ccnin s of of E Labor Cul you should become subject to the Worker's Coons or this provisions of the lahnr Code,you moil F forthwith comply with such provisions m this permit shall be deemed mvpkctl. CONSTRUCTION LENDING AGENCY Ei� I hereby affirm Nat then is a eouwctinn lending agency for did Performance of <, the work Por which this permit is issued(Boc.JW],Civ.C.) [Q �� Lender's Name - P. LcnJcr's Address f Ly i I certify Nal I pare rad This application and sum that the above information is g4� bunecL lagree to comply with all city yduavori repreounty sentatives nances escarats sum laws mlpingtom Ca U almVengeonstrvdi9gand hereby wthonp rposes. utivcs o!this oily to cote upon the Y I V ahovcmcmiunctl ProPcny for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupcnino against f%C,, Eabilities.judgmems,costs and expenses which may in any way accrue against said City �)j' in consequence of the granting of this Permit. Date a1 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. 0/J Re-roofs Signator pinion.s looter Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Wilt the applicant or future building occupant store or handle havardous matenal as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety code.seetionzss32(a>] All roofs shall be inspected prior to any roofing material being installed. ]Y Nu Will the applicant or cera a adding occupant ate equipment or devices whien If a roof is installed without first obtaining an inspection,I agree to remove omit hazardous air cnnmminant,as defined by the Bay Are,Air Quality Management all new materials for inspection. Dlsuia, ❑Yes lJsaa✓ 1 have lead the hazardous materials requirements under Chapter 6.95 of the Califon .in Health&Safety Code Sac imu25505,25533 and 25534.1 understand thaif the nuildag docs not currently have a mount,Nat it is my res manihility las nntily the mournat or the .quit which mu;t_Windt pd.,to issuance ora Carol of Oce er. Signature of Applicant Date c `��— 0,7-cy� All roof coverings to be Class "B" or better Otaiier ser aulaah. sem 0 0 CITY OF CUPERTINO om 13 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 # . . . : 05080103 SITE ADDRESS . . . . . : 10159 S BLANEY (BLDG # 14) 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 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 09 FINAL GRADE 510 FINAL PLANNING 14 FINAL PUBLIC WORKS e 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 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 . Project engineer to inspect all repair works and to S submit Structural Observation Report per note #7 of the plans . t CITY OF CUPERTINA , CITY OF PERMIT APPLICATION FORM CUPEkTINO Ad 1h Al" /S/ �ooSo APN # Date: 97 6 Building Address: Mailing Andress (if different from building address): Owner's Name: 1119Xk A,1,4 OitE-i9 olmPmt>✓Ts Phone#: 4,4, lAnN.O SUn/S'FT fJodE' .OPvtc°✓ �nr.✓; �- O <5 �53�SS o „i . ContractorrSda , License #: blylilf"O'Ll yope>S'3 Contact: Phone: -77-Z Cupertino Business License#: 2.F4/,u to.L. Fax: 99.1 7 a Building Permit Info: R Bldg 2' Elect ❑ Plumb ❑ Mech ❑ Job Description: BSoc/S /�e Y40e,0,0 T To Pt ye✓uvo curTou:s fr(a& LOC,4 %icl~r 71,1 Residential [jj'Cz 'JO 01- - i TPAbfL r Commercial ❑ Sq.Ft. Floor Area: AS < XisTin/G $/Sq.Ft.: Cost of Project: od Occupancy Group: Type of Construe on: Please check this box if the project is a T yloe .5' ve r.° second-stn addition: ❑ W_ roject Size: Standard 2' 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 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 /� tJJ �� CITY OF CUPERTIN CITY CUPE{�TTINO PERMIT APPLICATION MRM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING IN r BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOM2vIE 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 StomVRain Water PLUMBING BPTRAP Kitchen Trap PLUMBING 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 BREMAIRHAN A/C Units<= 10,000 cfln MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT 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 BRENU RAPP 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 BRENI ESAPP Remodel Res Appliance ELECTRICAL 2 of 3 +ITY OF CUPERTINO . CITY OF PERMIT APPLICATION FORM CUPEkTINO 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-PermifIssue --- --PLUMBING - PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC PI ning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 1p • 3 of 3 CITY OF CUPERTINOas BUILDING DIVISION PERMIT '�',CONT,iiA"CTij'l"�"]'NVOI�M'AT�10 BUILDING ADDRESS: PARAGON SERVICES/RGM BUIL IMTNO 0 5 0 8 0103 01 -39 S RT-ANRY (RT.DC If 14) OWNER'S NAME: PERMIT ISSUE DATE * LAKE BILTMORE APARTMENTS 2812 TRINITY SQUARE DR 09/13/2005 I E: SANITARY NO. CONTROL NO. (972) 478-2255 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PM MECH tic p LICENSED CONTRACTORS DECLARATION I louct,affirm that I am licensed under provisions of Cluiplior 9(commencing Job Description �g with Section 7")of Division 3.d th,Be..and Professions Cock,and my license is i=_ infiflIfinuatmidiflfifict. REPAIR PLYWOOD CUTOUTS 'r"z Lic.macclies Lic.N N CONTRACTOR: PARAGON SEkVL IC �Cr ��S%L r J) ARCHITECTS DECLARATION I understand my plan shall W used as public records D d U t7, Licensed Profinsammil 2005 "'n OWNER-BUILDER DECLARATION a. I hereby affirm fast I..exempt from the Contractors License Law for the Hfollowing reason.tSecid 7031.5,Business and Professors;Code:Any city or county no sex,� gi; which requires a cramitch construct.alma minnow,demolish.or repair any structure Is poor to its issuance,also ner,idires ffic applicant for such Permit 10 Ole R Signed susermon that he is licensed pUrtalmal to the pmvimons of the Conlr=tor's License Law(Chapter 9 Sq.Ft. Floor Area LJu=11L=Vull Valuatio$425 (commencing With Section 7000)of Division 3 of the Business and Professions Cotic)or 2 that In is exempt dicrefirm.and Be basis for But alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more door fin hundred dollars($S(sy. 1 36903008 . 00 C]l.mwncrofthepmNny.ormyempl�c=with�geuftirwlccomPnsatiDn, will Ni the work,and the fracture is motimendied or offered(.risk(See 7044.Business and protrusionsCalc:The Commuctior's License Law dors tut apply to in owner of Required Inspections property who Wildi improve flacrear,and whodoes suchworkhmaccifor through his own employees.provided that such improvements are not intended or offered for wric.If. however,the building or improvement is sold within one year of completion,the owner, builder will ban the burden of proving that W did not Wild or improve for puma of sale.). C]1,as owner of the pro,axrty,am exclusively contraefi,with licensed contractors to consumer the project(Sec.7044,Business and Professions Code:)The Contractors Li come,Law does not apply to in owner of proorty who Wilds or improve thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's Lice.6� 0.4exempaunderSec. _,H&PCfor this noccon Date WOR L11,1T=dIr "and under ! S COMPENSATION DECLARATION WOR I tire under penalty of Noyn,one of the following dectuationse I Ins n and will maintain a Certificate of Consent to self-insure for Woolair's Compon. sound,a provided for by Section 37M of the Labor Code,for the penumenturec of the work for Which this Permit is issued. o Fol I ban and will maintain Worker's Compensation Insurance,as reported by Section 371 of on Labor Cradle,for But peRormanee of the work for which this Permit is issued. My My Worker's Compensation Insurance carrier and Policy number me Cartier.ame,. Policy No.; CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ins mootom need not loccompicied if the Permit is forodc hundred dollars(SI00) or In,,.) I certify than in use performance or Be work for which this"no,4 heated.I"I no employ any'pers..I.an, 1.that Wmkcars Compensation Law,of California Dm. Applicant— NOTICE TO APPLICANT.If,ifter making this Certificate of Exemption,you should become subject in the Worker's Compensation provisions of the Labor Code.you mum fcon1vivion comply with such provisions or this Permit shall the decreed icinfland. 4 0 CONSTRUCTION LENDING AGENCY I hereby ixffirrb that there is.construction loading.9oney In,do Peirfarronce of the work par which Bus permit is issued(Sec.3097,Cin.C.) fA lender's nan'a Nemc Ri Lcomt,2 Address I ccnify that I have mad this application and mate that the alien information is - ------------ m m comply with ail city and county oNinaruca and sum laws C) U building conebruction,and hereby authorize repeamentatins of Nis city to under upon Ric "how-rocartioned property for im,pection purposes, (We)agree a.saw,indemnify and keep harraless the City of Cupertino gains, ;,0 liabilities,judgments,costs and expenses which may in my way ascetic against said City U %r in consequence of the granting of this remain. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. 9&31"= Re-roofs Signor pplicauntiConowntar code 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 9.12,and the Health and Safety Crude.Section 25532(.)? cy" C�Na All roofs shall be inspected prior to any roofing material being installed. Will to applicant or i1doug occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it h..,d.ca air comiummants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yea - Ih na Hcoldal;Safety C.M.Scelicant 25505,25533 and 35534.1 understand that if the Wilding does not currently haw a tenant that itiaboy resminsihifily in nouly the occupant ofthe 7quiremems which matiLixe met prior to issuance of a Composite of -y Signature of Applicant Date Y4 Oe �31�z All roof coverings to be Class "B" or better ummot'sinetrigno tbac—