03040002 g }. B,. rwcn'
CITY OF CUPERTINO �.QrQ ,Id ,�"
BUILDING DIVISION PERMIT ,:°•, w-r
PERMIT N0.
BUILDING ADDRESS:
10169 S BLANEY AVE # 4B WALD TT rnmqTPTTPPERMrtsGEonTe
OWNER'S NAME:
LAKE BILTMORE APARTMENTS P 0 BOX 598
SANITARY NO. CONTRO N0.
(408) 377-8186
BUILDING PERMIT INPO
ARCHITEC IRNOINEER: BLDO ELECT PLUMB MOECH
j� LICENSED CONTRACNR'S DECLARATION Job Description
1 hetebY do UW 1 ser Ikenud under(OOvIs of Chapter 9(commencing
with Section 7IX10)OfD"Ion 3 ofthe BusincaA and ProfeWau Code.ud my licomm is
ij Infull tc &ad effect.
uumseCiant Cn
INTERIOR RENOVATION-KITCHEN & BATHR
MS REMODEL,
Dau vuwr WAHER/DRYER, WALL A/C, FL. COVERINGARCHRE9DECLARATION
3 1 understand my plena Nall W used se public mWoft
i
Licensed Professional
OWNER-BUILDER DECLARA71014
I hetehy efliw that I w eumIn from Uro CmNow ces License law far the
j ofollowing moon.(section 7031.3,Business rod pmfosalons Cmk Any city or county
I which requires a Permit w coalml,alter,bass v.&.011.111 m term,my nwerum
PAN on its Issuance.aim requires theapplicant for such pewlt to file a signed atatemenl Sq.Ft. Floor Area Valuation
Ethat he le licensed paramnt to Ne Provisions of the Comracu's Manse Law(Chapter 9
—� (commencing with Section 7000)m Division 3 of the Business and Fmfwwns Cade)Or
;.. duel he Is eumpl Uumrrom and the bull for the alleged eump0on Any violation Of ppN Number 0$B+DB�YJIyPe
Sudan 7031.5 by Aappnesnt fm a Permit w °u hlethe APPEC'm LO A N
AM vll Penally of
ml more than R.hundred dollars($50(l).
❑j.u Owner or Ne pnspany,m my wployces wIN w&ee u thetr role compsunuon,
wipe°the work and thawatime is not Intended mortered ror Wo(Sm.70M,Business equired Inspections
and Pwreeaiou Cude:The CoNNNN,'t Llctoom law does Out apply w An owner of p�n
pwpeny who builds m rc
Lmproslbereon.end whodmasmh wmthimulforllwughhls II\YI
ALED
am,onployces,prpaldnd that such imprmemenuare not Intended marketed far nln fr. 101 — FOUNDATION
holm,the building or improrcmenl lsuld within ore year ofmmplcdom the Owner- 102 — PIERS
Wilder will have the burden or proving that he did not build m imp.for purpose of 103 — UFER JUN 0 4 2003
alk..
u msmr Or the property,am"claurcly mmneswg with Ilcewd cunaacton w 104 - REBAR
oswet the project(Sec.7014.Business and Professions Cade:)The Cmincuh lJ- BUILDING who eoue Ymfor such apply
ru a Cann wRs)licensed pursrly he Wild,or uant to l°tau C°mrutoes 105 - ANCHOR BOLTS
License Law.
106 SEWER & WATER
Bk mason
❑tem axe das — UNDERFLOOR PLUMBING
Dwm (OW DaPCfu 203 - UNDERFLOOR MECHANICAL
WORKER'SCOMFENSATIONDECLARATION 204 - UNDERFLOOR FRAME
Immby alllwunderperultyofpenjuryane Ofdtefollowingdmlwumtc 205 - UNDERFLOOR INSULATION
an and will maintain aceNBcamorcmaomw ulbimu eforwmker'Acompen-
1310D,of
,sa provlded fm by Sudan 37M of the labor Code,Ire the Perromance Of the 301 - ROUGH PLUMBING
for which this Permuismued. 3O2 - TUB & OR SHOWER
nit
oe and will maintain Worker's Compewdon Insurance,u required by Sudan 303 — ROUGH MECHANICAL
the labor Code.fm theperfmcam of the wosk far which this Permit is Issued. 3O4 — ROUGH ELECTRICAL
oAmes CompensWon Inwratme caNar end Policy number ate:t Policy No.: 305 - FRAME -
CERrIFKATEOFE%EMPnoNVROMWORKERS' 306 — HOLDOWNS
COMPENSATION INSURANCE
(lTusecdon need notWcompluod Blhe Pewit b fmonehundmil dollar,(SIM) 307 - INSULATION
muga) 308 - SHEETROCK
I mnify that In the per(owanea Of th or or which Iwo pewit is Issued,1-hail not 309 - EXTERIOR LATH
Nor,Oy any PC., In y mMmr�Ubjmtl0 thewoArms Comperes"°" 310 — INTERIOR LATH
Laws of cabro9(f�l �j51r�u .--�..7.��
Applicant _
NOTICE TO A CAM:IL alum making Inds provisions
nnu Of Eumpwn,you should
SCRATCH COAT
bmomehcomly it wooers CaN,IEdnermitSuoftheLabor Godo,You resin 313 - ROOF NAIL
'O toMwith comply with such pmvwou mthh permit Nan be deemed mvnkrA. 501 — FINAL ELECTRICAL ENERGY
TJ. CONSTRUCTION LENDING AGENCY
Ihmany arrow that Neu ala ronstrectlon lending Agency for theperfmmsuceof 502 - FINAL PLUMBING ENERGY
he work IN which his pewit is lued(Sm.3097.Civ.Ca 503 - FINAL MECHANICAL ENERGY
W Lender's Name
O LemicesAddma, 504 - FINAL BUILDING ENERGY
Uleanlythatlhavereadthis ulonrodreterentheaborcinFormadanu 505 - FINAL ELECTRICAL
w rower.l Agree I9 comply with all city and county ordinances and sou laws relating In — GAS TEST
C building construction.and hereby Amanda,up ,,mWlrcs of this city w color upon sic
157 abM.,Mmflmmd property far inspection PNPOML O — F I
(We)agree to save.indemnify and keep hAwuss the City Of Cupertino agalw I CAL
" fd'g Ilabilitn,judgmuts,mass and expresses which may In any my accrue Agaiva said City
L)T in consequence or the&naming of this Permit. 17 DBLC
G7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 5
SOURCE REGULATIONS.
Re-roofs 514 INAL PUBLIC WORKS
SI&nawreolApplleuVComncwr Data Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the a C-Plnl m fuwm building occupant pare orhandlethe
hvudou material
u dented io Olo 32(4)7 o Mumct 1 Code.CNpter 9.13,and the Health and Safety
GodC.Section l!!37(e)7 '/,Ra All roofs shall be inspected prior to any roofing material being installed.
❑Yes �[
/ If a roof is installed without first obtaining an inspection,I agree to remove
WIII the=1.011.
pplicant or furore building by the B NMequipmentAirQ m dcMana which
n M1aurdnm sir conuminAnp y,dc0ned by Oar Bay Am Air Quality Management all new materials for inspection.
Td�mnmc=c
❑Yes
limnMW LhehaurdmsmucdalsrequimmonuundeChepw6.95oftkCalifor-
ulthlyC . udons25305.3!!73 pusibl4.1aro notif tthulfthe Wilding
a e man4 that h h 55 ruponsl 34.I u ne��df)r sicpppcOOc��them il dtcirements Ic kc etjtit�totauuceohCCNO �cJpattj'. SignatureofppplicantDale
(iAll roof coverings to be Class 'B"or better
ner or authodud agent Dote
Cts- CITY OF CUPERTINO •% i s
CITY OF PERMIT APPLICATION FOCUPERTINO o
AP # Date:
. 369-
Building Address:
Owner's Name: Phone#:
B�rrntoeg Av�+ern�>?,rrs 6s� 5�6-5300
Contractor: License #:
R.WAtoQo�l �ovs�urno,J (uc. ���93�
Contact: Phone #-
UP5 W9AU0Z h6jT MA#,Ac-e. -53o8
Applicant/Contractor: Fax #:
LAKE aamoae APAP_Tme T
Buil ling Permit Info:
Bldg_---) Elect Plumb KMech
Job Description: N irtp�v np�t+ p wrWL�l r uew wqs �¢/DWet.?
Residential: MtALn- FLFnt11 ' Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
I D00 SF.
Architect/Engineer: Valuation:
k4ftm)o, 4/34,6(00
Type of Construction: Occupancy Group:
A P, 1
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances 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> I OOOA ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BNEWMULTI I New Multi-family Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMIvl New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
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7783
1
CITY OF CUPERTINO
Cno PERMIT APPLICATION FORM
CUPERT1NO
I
Fee ID Fee Descri tion Fee GrouNUMULTI New Multi-famil Res PLUMBING
OVERTIME Ins ection Overtime BUILDING
PBACKFLOW Atmos heric Vacuum PLUMBING
PCESSPOOL Cess ool PLUMBING
PERMFEE Bld Permit Fees BUILDING
PFIXTURE Pbl Fixture PLUMBING
PGAS Gas Pi in S stem Fee PLUMBING
PINTERCEP Ind Waste Interce for PLUMBING
PLANCHK Plan Check Fee BUILDING
PLANCKADD Plan Check Add Multi BUILDING
PLANCKREP Plan Check Re eat Fee BUILDING
PREPIPE Re i e Of Fixtures PLUMBING
PSEWAGE Sewa a Dis osal PLUMBING
PSEWER Sewers PLUMBING
PSPRINK Lawn S rinklerBackflo PLUMBING
PSTORM Storm/Raln Water PLUMBING
BPTRAAP Kitchen Trap PLUMBING
I BPVENT Alt of Drain & Vent PLUMBING
I BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reins ection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
I BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL
3 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
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS 1 Remodel Signs,Marquee ELECTRICAL
BREMTHEATR I Theatrical Lighting Fix ELECTRICAL
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'G CITY OF CUPERTINO
CITY F PERMIT APPLICATION FORM
• CUPERTINO
M
ee ID Fee Descri tion Fee GrouREMVENFAN Vent Fan Sin le Duct MECHANICAL
REMVENSYS Ventilation S stems MECHANICAL
SCBLVD Scb S ecific Plan BUILDING
SEISMICOM Seismic Commercial BUILDING
SEISMICRE Seismic Fee Res BUILDING
BSF&2FAM Single & 2 Family BUILDING
BSFNA Single Family New Add 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
1 EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
I MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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> 1.75 M Btu MECHANICAL
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