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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 1 of 3 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 • 2 of 3 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 • 3 of 3