05080106 CITY OF CUPERTINO ��'s' a ms« r "' p' f`
BUILDING DIVISION PERK. CCINTRAC'PORINFORM �JN
BUILDING ADDRESS: PARAGON SERVICES/RGM BUILD 4C!5T NOU5080106
10159 S BLANEY BLDG # 17
OWNER'S NAME: PERMIT ISSUE DATE
LAKE BILTMORE APARTMENTS 2812 TRINITY "SQUARE I7R 09/13/2005
NE:
SANITARY NO. CONTROL NO.
(972) 478-2255 .
ARCHITEC V ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u00 LICENSED CONTRACTOR'S DECLARATION lob Description
C I hereby affirm Nal I am licensed under provisions of Chapter 9(commencing P
U with Sir 7000)o17Division Sof Us,Business and Professions Code,and my license is
_may intlanmrceanderbct. REPAIR PLYWOOD CUTOUTS (1)
>>p: License clxx Lir.• CONTRACTOR: PARAGON SERVICES, INC.
's-W Dam Contractor
ARCHITECTS DECLARATION
Sx a I undersand my plans shall be and as public months
>yU
t o
Licensed Professional
g OWNER-BUILDER DECLARATION .
1 hereby.(Teat that I L. exempt from the Contractors License Law for the
,v O followwhich residues
duesmason.($f=iat 703 L.5,construct.alter, and Prourvs,,de io li Code:Any City s county
ctum,
Km whichmquircsnparent to requiresthe
improve,demolish.Fit t orrepair
asiranytatement
0
priorlo i0 issuance,also requires the apPlicam for such permiuo nlc.LawdsLammcm
< (commencing wit parsmnt mth)of Division(of the Stactur's Liccnu Law lch"Pmr9 Sq.Ft. Floor Aiea VaIDahO
x r$ (coatis is exempt
Scnfterm and the
basis for
of the aged nous andexempt Proon.Any
lotionCruic)or
y�_ mat he is exempt Jmmfrom and J¢bazis far the alleged exemption.Any violation of
Section 7031.5 by any applicant for a mount subjects the applicant to a civil penally of A NNNumbber Occupancy Type
not more than r hundred dollars(s50o). pp 03fOOf8":�00 -
pl,az owner orris,property.or my employees with wages az their sole compensation, �Il JQt �h
will do the work and Saturations,is notimanded oroReed forsafc(Sec.]Oa4,Businas t� r�-:tY� Required Inspections
and Pmfevipns Cods:The Contncto's License Law dots not apply m an o est of
property who builds or improve thermn,and who docs such work himself or mmugn arts
own employees.provided that such improvements Us not intended or offered for sale.If, O�1 � � ZOU5
however, is sold within one year of completion,the owner- .t
builder will have the burden of proving that he did not Wild or improve for pmpou ofowever,he building or improve �t`ltjj��/�JJf
soled.
❑I,as owner of the properly am exclusively contracting with licensed contracma to (,���11
come La the es not(Sea tooaM.n Business and rty who rai Code)The Contractor's Li- 1'6ru�'(/,' IILi'7 .
cense taw docs not apply m an owner orpmperty who sed p of ant to the Norton,and.
lw/hco eso�nJlreac�u(or such proj<cu with a contractor(s)licensed pursuant to the Conaactori
fpm exempt under See .B&P C for this moon
fps. r �d>` - Date
l/`-F CER'$COMPENSATION DECLARATION
rtby efErm under penalty of perjury one of me following declarations:
,]1 hsrc and will mainain a Cenifieam of Consent m self-insure for WortrYs Compcn
cation,as provided for by Section 3700 of the Labor Code,for she performance of me
work for which this permit is issued.
❑I have and will maintain Workers COmPtimiHion Insurance,az required by Section
3700 of the Labor Corl for the performance of the work for which this permit is issued.
My Wm aCompensation Inaurane,carrier and Policy numberase:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION MOM WORKERS' '
COMPENSATION INSURANCE -
rod,section need not W uomplemd if the permit is fortune hundred dollars(S 100)
or Ical
I certify that in me perrormance of the work for which this Permit is issued.I shall not
employiny person in any m nn uazt�ccomc�bjih m "rkcrs'Compensation
Lawson California.Dam cr�5r�7%�
Applicant
N came sa j APPLICANT:If,atom making_Cen provisions of of E abor o d you shaum
become subject to it Wosh ri Compensation ernLml of J e Labor r Ctde,you maw
.J O forthwith comply with such provisions or this permit shall W deemed tevokeJ.
z CONSTRUCTION LENDING AGENCY
F+ � I hereby affirm that there is a construction lending agency for the performance or
a > he work fur which this permit is issued(Sec.301 Ci,C.)
V]Q Untier'e Name ,
Dz Lender's Address
U O 1 ratify that I have read this application and sate that me above information is
LL F-' =ovecL.l agree to comply with all city and county ordinances and sate laws relating to _
0 U building construction,and hereby aumorun,tepreeentatizes ofthis city to enter upon the
r w above-mentioned property for inspection purposes.
CL (We)agree to save,indemnify and keep harmless the City of Cupertino against
tiliabilities.judgments,costs and espenscs which may in any way see=against said City
U in consequence of the granting of this permit.
t—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURC - UtATIONS.
—' 26/3 (; Re-roofs f�
Signaturc of Ap anUComramor
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ill the applicant or(Muse building occupant store or handle hwarcous material
az defined by the,Cupetino Municipal Code.Chapter 9.12,and the Health and Safety
Calc,section 2$532(x)?
❑tioqi All roofs shall be inspected prior to any roofing material being Installed.
Will thea pram or rehire building t use equipment or devices which 'If a roof is installed without first obtaining an inspection,I agree to remove
rap gby thenitQu
emit District? s air conaminants az JcOneJ by me Bay Arta An Quality Management all new materials for inspection.
District?
❑tics
I have mail the hvmJnus materials requirements under Chapter 6.95 of the Califon
nia Hcolth&Solely Code,Studious 25515.25533 and 25534.1 understand mat if me Wilding
Joe not currcn I have a mnam.that it is my responsibility to amly me occupant of the
require cern t emmpnottoiasuan=eotocerdremor =up�nry. Sign All
Date
war-� g /��k� All roof coverings to be Class "B"or better
Ocr or ser annuo a�L / seam
CITY OF CUPERTINO
m 16 of 17 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36903008 . 00
DATE ISSUED. . . . . . . : 09/13/2005
RECEIPT 4 . . . . . . . . . : 31168
REFERENCE ID # . . . : 05080106
SITE ADDRESS . . . . . : 10159 S BLANEY (BLDG # 17)
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
WEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
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
514 FINAL PUBLIC WORKS
A.S.E.
255 N. Market St . , Suite #220
San Jose, Ca. 95110
(408) 999-7441
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Permit # 050800091 Thru 05080106
I
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
submit Structural Observation Report per note #7 of the
plans .
•
z,. _
CITY OF CUPERTIN#
cTM°F PERMIT APPLICATION FORM
CUPEI,TINO
N # Datq-
Building Address: Mailing A6dress (if different from building address):
/o/S 9 Sov Jr cp,vt'y dP�.is r�,✓a r �5 CJ/ y
Owner's Name: 4¢.e[= o,,4 7- rWC`NfS Phone#:
t,..�, A IO SUNSc o /�/OG AFut tp! mr ✓; �- O X5`9 z �S3�S ,5
ContractorfSva > License#:
Gen/ .S,<rifV c Z-5'. nJ c ylee 1,S3
Contact: Phone: 9?a Cupertino Business License#:
Fax: 9 9a ,I? v;
Building Permit Info: R
Bldg [' Elect ❑ Plumb ❑ Mech ❑
Job Description: .9SOCA' 0`4YUooio RePi9iR.r To PGywtn0 cur^ouT.r io.vr 7e
Residential P-Set f VXvTS ®6�> .grriturr-/�
w T!Ri 4 t r Commercial ❑
Sq.Ft. Floor Area: ,9s rxi r7iN c $/Sq.Ft.:
Cost of Project: ou Occupancy Group:
AL 9616z4ial�s
Type of Construe on: Please check this box if the project is a
T we S' second-story addition: ❑
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> IM 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
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7xz-
!' CITY OF CUPERTIN
°F PIT APPLICATION FORM
CUPERTINO
Quanti Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
41 BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTMlE 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 Storm./Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain & Vent PLUMBING
BPWATER InstaWAlter Water Pie PLUMBING
BPVv EATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfin MECHANICAL
BREMAiRHAN A/C Units <= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Fumace MECHANICAL
BREMFURNOV Relo Furnace> I 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 Devi ce/A aratus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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1/0 nan--
ISTY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM.
CUPER.TINO
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 BUII,DING
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" Pe>=mifIs"sue . - ----PLUMBING -
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Chane BUILDING
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