05080104 CITY OF_CU P_
BUILDING DIVISION PERMY INF,OR ION
BUILDING ADDRESS: PARAGON SERVICES/RGM BUTLE ffftItT NO.05080104
OWNER'S NAME: PERMIT ISSUE DATE
LAKE BILTMORE APARTMENTS 2812 TRINITY Q2/13/2005
ONE: SANITARY NO. CONTROL NO.
(972) 478-2255
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
ureZ LICENSED CONTRACTOR'S DECLARATION
00 lob Description
s u C 1 hereby affirm Out
1 am licensed under pmviuons of Chapter Y(mmmeneim
ZZw wiCSulion]OW7 of Division3ofdre Businevnd Profcssiuns Cmle,redmyliccrociie
in muforce and effect. REPAIR PLYWOOD CUTOUTS (2)
Vin? License ClassLie.#
Date Comment, CONTRACTOR: PARAGON SERVICES, INC
ARCHITECTS DECLARATION
SsI understand my plans shall be read az public records
>of
3 Licensed Professional
g OWNER-BUILDER DECLARATION
1 hereby affirm that I am escort from the Cnnvanm's License Law for the
p O fallowing acorn.(Section IID I.S.Business and Profcssinu Code:Any cily err county -
m l! which acquires a permit to consumer,alcor,improve,demolish.or repair any structure
or m is issuance,also require the applicant(or such permit to rile a signed sentiment
i2' mal he is licensedpursuttmvi
anothepeiouofCeContmcwr'sLicense Law(Chapter 9 Sq.Ft. Floor Area Valuatioi$8 5 0
y.n (commencing with Section 7000)of Division 3 of the Business and Profusions Code)or
y Nat he is exempt therefrom and be basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit Objector the applicant to a civil penalty of APN Number Occupancy Type
am meBe.r.wchundred delta.(s500). 36903008 . 00
❑1,az owner rf the properly,rr my cmplryca wish wages az Heir salt compensation,
will Pr Newons and e:ere Commissioner
Li km,c Law
do for or apply
an owner
of Re hired Inspections
end Profusions Code:Thc Contractors Licenu Law tlxs not apply so an owner of k[f Ir.,,..'1q q P
Property who builds or improves thereon,and who does such work himselfor though his 11 tf"y p
own employees,provided Nal such improvements are not intended or offered for sale.It, RNA[[foss°° tt1444..+ NsY/
however.the building or improvement is sold within one year of completion.the owncr-
builder ,will have the burden of proving That W did not Wild or improve for print of OCT
ale,. 12 7 2005
❑I.as owner of the property,am exclusively contracting with liceued contractors m
smistme,the project(Sec.7044,Business and Profusions Code:)Thc Contractor's Li. f�rg p f(77 n tpp+'�. p
who surfaces
wdoar such plymia with
a s fpropeny who builds to
Centra.and, II ]'I'1 ',�I,I ®pq� Ii
come Loncas not 2PPIY on a wirer onlrazmr(s)Iicensildsorarro Ce Contractors I)Ld�yl(I''1IVll'' IIIiIS ItM1,Irk1tI UVt,'_•ty`'Y_-/7.J_
Licenorc aw.
exempt under Scc. .B h P C for Cis moan
net :n Dale
WORKER'S COMPENSATION DECLARATION
I bercby sta tion under penally of pe jury one of dm following declarations:
❑I haw and will maintain a Cerdfatc of Consent m self-insure for Workers Co.,..
nation,as provided for by Section 37W of da labor Code,for she N normance of the
work for which On permit is issued.
I have and will maintain Worker's Compensation Insurance,u required by Section
37W of Ne labor Code,for the performance of the work for which this permit is issued.
My Worker's Compenost Laurance artier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissectirn recd not W completed it permit is(err one hundred dollars(Sl W)
or Ices.)
1 certify Out to the perfrrmance of Be work for which this permit is issued,1 shall nm
employ any persont n any manner}n af` eo the Workers Compensation
Laws of Califimm..Dam an4
Applicam
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Wmker's Compensation provisions of Ce L i or Code,you must
,JZ forthwith comply with such provisions or this Permit shall be deemed revoked.
ZO CONSTRUCTION LENDING AGENCY
, I hereby affirm Nat there is a consumctinn lending agency fm the performance of
!Yi > the work fur which this permit is issued(Sec.3097.Ci,C.)
W Lender's Name
I<nder's Address
V O 1 certify drat 1 have read this application and sure that he above information is
WE' Cramer.l agree to comply with all city and county ordinances and state laws relating to
O ,1 building consWction.and hereby authorize representatives of Nis city to enter upon Nc
Y' W above-mentioned property of inspection purposes.
(•"C. (Wed agree to ave,indemnify and keep harmless Ce City of Capetian against
In liabilitics.judgmenes.cases and expense which may in any way accae against said City
U Z in consequence or Ce granting of this permit.
.. APPLICA�S'1'-UAIDEgSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date f.2'6.
S NR ERCGULATIONS. /1
/!') �— 70 ��U� Re-roofs
Signature rfA t
amyContractor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ce appliam tar towed building oweepanl stare or handle hazardous material
az defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ycs
Will the applicant or rulme Wining oceupart use equipment or device whim If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air conaminann az defined by the Bay Area Air Quality Management all new materials for inspection.
District' /
Q Yes [�'u
1 have read the hazardous materials requirements under Chapter 695 of the Califor-
nia Health.k Sxfcty Code,Sections 25505.25533 and 2551L 1 understand Cal if the Wilding
dors not currently hate a mount.Cal it is my responsibility In noufy the,occupam of the
r races hmusltomeIpriortoissuanceofaCertifareofOcCopancy SignatureofApplicant Date
Owncr.uwJi orizcJ agent Dalee All roof coverings to be Class "B"or better
CITY OF CUPERTINO
om 14 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 # . . . : 05080104
SITE ADDRESS . . . . . : 10159 S BLANEY (BLDG # 15)
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 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 3.08 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
514 FINAL PUBLIC WORKS
Hca
® A.S.E.
255 N. Market St . , Suite #220
San Jose, Ca. 95110
(408) 999-7441
Permit # 050800091 Thru 05080106
t
PLAN CHECK NUMBER: 05318 .CUP September 341, 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.
II ® 1 . Project engineer to inspect all repair works and to
submit Structural Observation Report per note #7 of the
plans .
CITY OF CUPERTINP
cuPEi�F PERMIT APPLICATION FORM OS `l J
APN# Date: ,
.S✓ i
Building Address: Mailing Ac .tress (if different from building address):
1,0/59 .S'o0n .1,v,1c'Y Ir - �- '01 v
Owner's Name: (,g et= 11.4 7-"194Z7 4JP44 r1wZ.- lr-r Phone#:
(.�, A,✓q Su,vIs r 4/104br 10-evl '4ol mr✓ir c- O �5 �'3cJ V
0
Contractor-Sda > License#:
ben/ -V<rlf v c Z-S yope IS 3
Contact: Phone:97--Z y78ad.5'S Cupertino Business License#:
—14W,U con_ Fax: ,2 Y7 oZ
Building Permit Info: R;
Bldg 2` Elect ❑ Plumb ❑ Mech ❑
Job Description: .6• 6cl,S ^' YOco o Re Pisi,C.r To �1<yc✓uvo c6,Tou73 1rCe2J tou
Residential �e eFSP J00T r ®t ,4 .Q rri9ciyr--/J
Tt•XM.Z r Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
�v
Cost of Project: ou Occupancy Group:
,V4 /
Type of Construction: Please check this box if the project is a
Anik T xooe s, emu second-story addition: ❑
Pro-eet Size: Standard [a' Lar e ❑ Ma'or ❑
QuantityFee 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 Elee Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of 3 !^
K � ee CITY OF CUPERT
CITYC' OF PAZMIT APPLICATION FORM
CUPERTINO
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
BPINIERCEP 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 InstaWAlter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reins ection Fee BUILDING
BREMACOVER A/C Unit> 10,000 clip MECHANICAL
BREMAIRHAN A/C Units<= 10,000 cfrn 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/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
Ory OF CUPERTINO 0 - ' '.
CUP TYOF O PERMIT APPLICATION FORM
QuantityFee 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-_. Plumbin" Permit-Imie —"- ----PLUMBING" "
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
w
3of3
CITY OF CUPEWHNO
BUILDING DIVISION PERMIT CONTRA@T�ORaINFQRMA TION:
BUILDING ADDRESS: PARAGON SERVICES/RGM BUIL 'b'f`NG05080104
OWNER'S NAME: PERMIT LS5UE DATE
LAKE BILTMORE APARTMENTS 2812 TRIN 2005
E; SANITARY NO. CONTROL NO.
(972) 478-2255
ARCHITECTff NGINEEN: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u00
LICENSED COMEACTORSDECLARATION 7obDescri tion
mF I herebyat affirm thI am licensed under provisions of Chapter 9(commencing p
Zty with Sation]OfIU)ol Divixion3of NC Busismcs and Profcssiom Code.ane myliccnse is
dfull foreeand tritest. REPAIR PLYWOOD CUTOUTS,(,2)
S�z License ClaszIiax
,moo Dam Conuanar CONTRACTOR: PARAGON S yEsRVIC\ S'"\ (•INC Ir``,
fii sdy ARCHITECTS DECLARATION d AiL '\ t_—�,1—
< I understand my plans shall be used u public mem& J�
1.0
k u.f, Licensed Professional
g OWNER-BUILDER DECLARATION - Zt3�[
2 i P 1 bcrehy nfi.Nal I oro exempt frum the Conuacmr's License Law far the UU JJ
00 following moon.(Scetion 7(131.5,Business and Professions Cade:Any city or county
e m� which requites a permit to cnnstrum,alter.improve,demolish.or repair any structure 11 fl n 173 —
°zy prior at its issuance.itho requires the applicant far such permitto file a signed sutemem �� 1l 11 " , l
< Nat he is licensed pursuant the provisions of de Conlracmri limnse Law(Chapter 9 Sq. Ft. Floor Area l I❑I ILISV Xaluatio$850
yFG (commencing wi th Section TIDO)of Division 3 of the Business and Professions Cock)of �,
y $
Ban he Or esempt therefrom and the baso for the alegcd exemption.Any violation of
Semon7031.5 by am applicant four.permit subjects the applicanl to a civil pcnaby of APN Number Occupancy Type
......than five bundme delta,,($5001 36903008 . 00
Q 1,u owner of the property,of my employees with wages u Noir sole compenution,
will do Ne work.and she structure is notinten led or offered for sale(Sec.7066,Business -
. it Prefnssions Co lt:The Contractors License law does not apply toan owner of Required Inspections
property who builds or impmvrs thereon,and who coca such work himself or through his
awn employees,provided Nm such improvements are at intended m.ffesrd for uu.If,
however,the building or improvement is sold within one year of completion.Ne owner-
builder will have the burden of proving that he did not drib or improve far purpose of
sale].
Q I.as owner of the property,am exclusively contracting with licensed contractors to
constmm she pmjen(Sec.7064,Business and Professions Codi The Contractor's Li.
cense law does not apply to an owner of property who Wilds or improves themon,and,
who contractsfor such projects with a eontracmr(a)licensed puramm tothe Conuanors
License Law.
�mpt under See. ,B&P C for this mason
ar as Dale
WORKER'S COMPENSATION DECLARATION '
1 hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to sclbinsum for Workers Compton.
salion,u provided for by Section 3700 of Ne tabor Code,far Ne performance of the
work for which Nis permit is issued.
Q I have and will maintain Worker's Compensation insuranm,u mquimd by Section
3700 of dtc liber Code,for the pcdo...of the work for which this permit is issued.
My Worker's Compensation Iwrmrcc carrier,and Policy number M:
Cartier. Policy No.: _
CERTIFICATE OF E%EMPITON FROM WORKERS'
COMPENSATION INSURANCE
(This section need nut W completed if the permit is foranc hundred dollars(Sip))
Or less.)
I mnify Nal in the performance of the work for which Nis permit 4 issued,I shall nut
employ any person in any mannery ym bcco�subineefo the Wmkcrs'Compensation
Laws of California.Date a4�.i(�
Applicant Lk
NOTICE TO APPLICANT:If.after making Nis Cenifeatc of Exemption,you should
become subject to the Worker's Comicuation previsions or the Labor Code,you must
.J O forthwith comply with such provisions or this Permit hall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
'f^.
(Y' hereby affirm Nat Nem is a construction lending agency lot de,performance of
a 7 Ne work for which this permit is issued(Sec.3M,Civ,C.)
t[3 Landers Name
= z Lander'.Address
U 1 certify,that 1 have read this application and sum that the show information is
correct.1 agree to comply with all city and county ordinances and state laws misting to
pU Wilding construction,and hereby aumotim mp¢unatives of this city to enter upon be
above-mentioned property for inspecuon purposes.
0. (We)agree to save,indemnify and keep har fleas she City Of Cupertino against
I, liabilities,judgments,costs and expenses which may in any way accrue against said Ctry
U z in consequence of the gnarling of this permit.
'--' APPLIg6SM-UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /7-eir
SEREIIRC Gr ULATIONS. n
Re-roofs
SignstoreofA anVC.nrraemr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum building Occupant store or handle mese ous material
u defined by the Cupertino Municipal/Code.Chapter 9.12,and the Health and safety
Coe.section
25532(a)? tom✓ All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding..,a,use egi ipmtin or devices which If a roof is installed without first obtaining an inspection, I agree to remove
It haiardi ns air cormaninanu n defined by the Bay Area Air Quality Management all new materials for inspection.
Disui<t? /
Cl Yea Sty/
I have read the hxrardous materials requirements under Chapter 6.95 of the Califor
nix Hcalth&Safety Coes.Sccumu 25505.25533 and 25534.1 undeumnd Nm if de building
dao not currently haw a tenant that it is my responsibility On nouly the cocupent of the
mrnts ynusrWmet P60TLUissuarmcofaCcruricamofaoapancy/ Signature of Applicant Date
94--ld J All roof coverings to be Class"B"or better
Owncrur-aeffcaircn agent v Date