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10090172 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10129 S BLANEY AVE BLDG 16 CONTRACTOR:DEVERA PERMIT NO: 10090172 CONSTRUCTION INC. VNER'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 Ij LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT I— PLUMB 1 10- License Class / Lic.#� r/ MECH r- RESIDENTIAL COMMERCIAL Contractnrl�F — t✓tZc�� i r�:� Date JOB DESCRIPTION: BLDG 16 APT L,J I hereby affirm that I am licensed under the provisions Uof Chapter 9 DRYER VENTS: (commencing with Section 7000)of Division 3 of the Business&Professions 16L-DRYER HOSE NOT VENTED CORRECTLY 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:36903008.10129.16 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.I 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 DAYS FROM I.�ST:CALLED INSPECT ON. indemnify and keep harmless the City of Cupertino against liabilities,judgments, r i C t'1 costs,and expenses which may accrue against said City in consequence of the - granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: 'iature--(aL 09& 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 Date: Signature of Applicant: I hereby affirm that I am exempt from the Contractor's License Law for one or the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,as owner of the property,or my employees with wages as their sole compensatior,, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE 1,as owner of the property,am exclusively contracting with licensed contractors to 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 1 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 25505,2553 25534. Section 3700 of the Labor Code,for the performance of the work for which this Date: Owner or authorized agent: 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,l become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued(Sec.3097,Civ C.) forthwith comply with such provisions or this permit shall be deemed revoked. 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 relating uilding construction,and hereby authorize representatives of this city to enter .i the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'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 INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: SylviaM Sec: Twp: Rng: Sub: Blk: Lot : APN 369C3008 . 10129 . 16 INVOICE DATE. . . . . . : 10/14/2010 REFERENCE ID # . . . : 10050172 SITE ADDRESS 10129 S BLANEY AVE BLDG 16 SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LAKE BILTMORE APARTMENTS ADDRESS 101 )9 S BLANEY AVE CITY/STATE/ZIP CUPERTINO, CA 95014 CONTRACTOR . . . . . . . : HENRY DEVERA LIC # 24605 COMPANY . . . . . . . . . . : DEVERA CONSTRUCTION INC. ADDRESS 941 D BERRYESSA RD CITY/STATE/ZIP SAN JOSE, CA 95133 TELEPHONE (40-3) 441-9598 FEE DESCRIPTION DUE FOR AMOUNT DUE ------PAID BALANCE --------------------------- ---------- ------ --------- CAL BLDG STAND COMMISSION F PRINTING PERMIT 1 . 00 1 . 00 0 . 00 VENT FAN SINGLE DUCT PRINTING PERMIT 42 . 00 42 . 00 0 . 00 MECH PERMIT ISSUANCE PRINTING PERMIT 42 . 00 42 . 00 0 . 00 TRAVEL & DOCUMENTATION FEE PRINTING PERMIT 42 . 00 4200 ------0_00 ----- 127 . 00 127 . 00 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- ----------------- - 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL 516 FINAL BUILDING CITY OF C UPERTINO 777 LUPE TING GENERAL BUILDING PERNIIT APPL][CATION FORM /W/0i %-CDate: APNi 13 e�'. /C)/2-9 , g�rS��O�o Building Address: I0I2.61 SOUT-PI BLANI✓y AVENUE / UNIT ILoL. lu Mailing Address (if different from building address): .ID15q SDUTH BLANEY AVFzNUE I CUPERTIND CA 85014 Are Hazardous Materials being used as part of this project? Yes No HOA: xterior work only) Yes ❑ No If ,es, provide letter from HOA Owner's Name: Phone#: ((ASS, 6131 34od PROM EINE US REAL ESTATE G ROUP Contractor: Phone:(408) 4q]-9598 DF-VERA OCNSTRUGTION, INC. Fax: (408) 4/1 -437$ Contractor License t &gC)g15 Cu ertino Business License#: x,4&05 Contact: Phone: Ctlp g) 4141 -958 g DEL TpL.AND Fax: Cllo8) 44 t- 93 Z g' Residential X Commercial Job Description: UWr 10 L : DRIVER HOSE NBT VENTED 2CRRECC7Ly UNrr ILOJ : MASTE(i BATH FAN 15 NOT �oNNECTED Building Permit Info: Bldg Elect ❑ ?lumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IT/TTT B, IV- , V-D ❑ < _ =- Valuation: Square Footage: Project Size: Express ❑ Standard ❑ Large [] Major ❑ Green Building: Please complete relevant portion of the Green Auilding/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. points Achieved: e or help, contact Build it Green at www.builditgreen.or Revised 07/14/09 3