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10090175 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10099 S BLANEY AVE BLDG 1 CONTRACTOR:DEVERA PERMIT NO: 10090175 CONSTRUCTION INC. `'NER'S NAME: LAKE BILTMORE APARTMENTS 941 D BERRYESSA RD DATE ISSUED:09/20/2010 OWNER'S PHONE: 6509313400 SAN JOSE,CA 95133 PHONE NO:(408)441-9598 (P( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r— PLUMB r— License Class I Lic.# �� L MECH I— r—RESIDENTIAL COMMERCIAL Contractor'J�� 'J1J1 �t fl a Date JOB DESCRIPTION: BLDG 1 APT B,D 1 hereby affirm that I am licensed under the provisions of hapter 9 DRYER VENTS: (commencing with Section 7000)of Division 3 of the Business&Professions 1 B-LAUNDRY FAN&DRYER VENT NOT VENTED TO Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$300 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36903008.10099.1 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.1 agree to comply with all city and county ordinances and state laws relating; WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAV3'" 60__T'I LASTLLED INSPETTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, kf , costs,and expenses which may accrue against said City in consequence of the Id by: Date: .-'-C, ssue granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: nature //ref a4__� Date All roofs shall be inspected prior to any roofing material being installed.If a roof is _ installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one(d the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensatio i, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I rm st I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relati�g budding construction,and hereby authorize representatives of this city to enter ,n the above mentioned property for inspection purposes.(We)agree to save ARCHTTECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 4 ITEMS OF 40 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk Lot: APN . . . . . . . . : 36903008 . 10099 . 1 DATE ISSUED. . . . . . . : 09/::0/2010 RECEIPT #. . . . . . . . . : BS000011498 REFERENCE ID # . . . : 10010175 SITE ADDRESS . . . . . : 10009 S BLANEY AVE BLDG 1 SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LAKE. BILTMORE APARTMENTS ADDRESS . . . . . . . . . . : 1900 S NORFOLK ST SUITE 150 CITY/STATE/ZIP . . . : SAN MATEO, CA 94403 RECEIVED FROM . . . . : DEVERA CONSTRUCTION CONTRACTOR . . . . . . . : HENRY DEVERA LIC # 24605 COMPANY . . . . . . . . . . : DEVHRA CONSTRUCTION INC. ADDRESS . . . . . . . . . . : 941 D BERRYESSA RD CITY/STATE/ZIP . . . : SAN JOSE, CA 95133 TELEPHONE . . . . . . . . : (4013) 441-9598 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- 1BCBSC VALUATION 300 . 00 1 . 00 0 . 00 1 . 00 0 .00 1BREMVENFA NO UNITS 2 . 00 42 . 00 0 . 00 42 . 00 0 .00 1MPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 .00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 .00 ----------- ---------- ---------- ---------- TOTAL PERMIT 127 . 00 0 .00 127 . 00 0 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: $300 R*PERMITTYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY Multi-Family Dwelling1(.1I°`�/ PENTAMATION 1RMAP8 USE: Y I ZU(112i', PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID UNITS BP FEES Ventilation Fan 1 BREMVENF �1� # $21 TOTALS: •�0 _T_T Mech.Plan Check 0.0 hrs $0.00 i'lur�;l>.1'r'nn C'hec, f.7��:. "'/"M('74%k Mech.Permit Fee: IMPERMIT Other Mech.Insp. FO.0 hrs $42.00 oo?,,>•11lurl2h 1rrsPLl _L_ Urher•�;'('(,Ir-y, 7—L— !Ucch. h?v. N l'r'r1nn,. Ii_��;. /:_,�- .. NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 09-051 E . 7% CITY OF CUPERTINO 777 OF CUPS TING GENERAL BUILDING PER1NUT APPLICATION FORM APN # Date: V cl 6 -:3 c • q/is/Zoio wilding Address: 100 Qq 5 _ t3L.AN Ev 1. N it ID uN►r 16 Mailing Address (if different from building address): ID1.5q SOUTI-I SLANEy CUPEi?r1N0 , L'A Q5014 Are Hazardous Materials being used as part of tl.is project? Yes No HOA: (Exterior work only) Yes ❑ No, Z If Yes, provide letter from HOA Owner's Name: Phone#: PR UM E T HFO S REAL_ ESTATE G RW P (050 q31 -340C Contractor: Phone: (409) 441 -gEgg D1=.VFRA CONST RUCr►01J, Wo . Fax: (14V9 LINI- g37S' Contractor License t 640 /15 Cupertino Business License#: 214&C5 Contact: Phone: (�08) 4N1—g5gfi' DEL TOLA&ID Fax: (4rg) 4yl —8378 .Zesidential 1K Commercial Job Description: UNIT 1D : I-AUNDR\1 FAN AND DRYER VENT- NuT VENTED To 01,r)sOF UN rr 10 : WAS 1-I ER DRAIN LINE VENT P PE - NOT VEN i ED -1-C Cum IDE Building Permit Info: Bldg ® Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ U=-A ❑ II/III B, rV-HT, V-B ❑ v_ Valuation: $ 300• DO Square Footage: Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green BuRding/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. "3oints Achieved: - or help, contact Build it Green at www.builditeen.or Revised 07/14/09 i