10090174 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10139 S BLANEY AVE BLDG 2 CONTRACTOR:DEVERA PERMIT NO: 10090174
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
wr LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG� ELECT[_ PLUMB r-
2 D qi[ Z�le- r
License Class bLic.#�
,}- RESIDENTIAL COMMERCIAL
Contractor L1 A. Date l
MECH
I hereby affirm that I am licensed under the provisions of Chapter 9 TOB DESCRIPTION: BLDG 2 APT E-WASHER DRAIN LINE VENT NOT VENTED
(commencing with Section 7000)of Division 3 of the Business&Professions OUTSIDE
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declaration.,:
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:36903008.10139.2 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 relatiu ig 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 F�ROIlC�I"EAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ow
costs,and expenses which may accrue against said City in consequence of the Issued by: Date: SCJ {
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.
►) ^ C., RE-ROOFS:
iature� 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 of
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 compensation,
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 t)
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. I 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 �i
Owner or authorized agent: 1�l � Date:
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shal I
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 must 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
1 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 relat,ng
luilding construction,and hereby authorize representatives of this city to enter
n 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
CITY OF CUPERTINO
4 ITEMS OF 40 PERMI" RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blh: Lot :
APN . . . . . . . . : 36903008 .10139 .2
DATE ISSUED. . . . . . . : 09,/20/2010
RECEIPT #. . . . . . . . • : BS000011498
REFERENCE ID # . . . : 10090174
SITE ADDRESS . . . . . : 10:139 S BLANEY AVE BLDG 2
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CU:?ERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LA*CE BILTMORE APARTMENTS
ADDRESS . . . . . . . . . . : 1900 S NORFOLK ST SUITE 150
CITY/STATE/ZIP . . . : SAN MATEO, CA 94403
RECEIVED FROM . . . . : DE'JERA CONSTRUCTION
CONTRACTOR . . . . . . . : HENRY DEVERA LIC # 24605
COMPANY . . . . . . . . . . : DEVERA CONSTRUCTION INC.
ADDRESS . . . . . . . . . . : 94L D BERRYESSA RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95133
TELEPHONE . . . . . . . . : (4 )8) 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 1 .00 21 . 00 0 .00 21 . 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 106 . 00 0 . 00 106 . 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: TDATE- REVIEWED BY:
APN: BP#: "VALUATION: $300 —�
*PERMIT TYPE: Mechanical Permit PLAP CHECK TYPE: Alteration /Addition / Repair
PRIMARY Multi-Family Dwelling l cel' . PENTAMATION 1 RMAP8
USE: � ��!tCZlF'l- PERMIT TYPE:
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Ventilation Fan 1BREMVENF 1 # $21
TOTALS: $21.00
Mech.Plan Check 0.0 1 hrs $0.00 k
Mech.Permit Fee: 1MPERMIT Fcc.
Other Mech.Insp. 0.0 hrsL!! .00
NOTE: Thesefees are based on the preliminary information anrilable and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (Fee Resolution 09-051 Elf. 7/1/10) FEE QTY/FEE MISC ITEMS
Phos Che uA Fcc
Supp/- 1'C/"(c
7_
PME Plan Check: $0.00
Pc l-11,1 t Fcc:
Stapp/ li p;
PME Unit Fee: $21.00
PME Permit Fee: $42.00
Work Without Permit? 0 Yes 0 No $0.C10
Travel Documentation Fee: I TRA VDOC $42.00 A
Stroniz Motion Fee: "W., Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00 X�p
SUBTOTALS: $106.50 $0.00 TOTAL FEE: $1
Revised: 9/14/2010
S
-' a
�c rr OF CITY OF CUPERTINO
CUPEKTINO GENERAL BUILDING
PER UT APPLICATION FORM
APN #
c' C 13 f � Date:
g115 12010
wilding Address:
ID13� SOUTH &LANE\/ IMIr 2E
Mailing Address (if different from building address):
1015q Sf)UT-H &I-ANF-\I , (;UPFRT IMG , 04 o15Dlq
Are Hazardous Materials being used as part of this project? Yes L No 2
HOA: (Exterior work only) Yes ❑ No If •es, rovide letter from HOA
Owner's Name: Phone#:
PRGMETHELAS REAL ESTATE GRC14 'o 650031-- 314Cn
Contractor: Phone: (40S) 44i - g5gg
DI✓VF=RA O-Cl,.STRUOMCK , INC. Fax: (,4Og) 14,41 - q37$
Contractor License#: (o40415
Cu ertino Business License#: 24(Dp5
Contact: DEI-. TO L A N D Phone: (4p 8)14y I -gggq g
Fax: C N-DS) 44► -4379
Residential E Commercial ❑
Job Description:
UNIT 2E = WA5HER DRAIN LINE. VENT - NOT VENTED 7Z) oUrsIDE
Building Permit Info:
Bldg I$ Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): E. 1 �( Occupancy Type:
1-A, 1-B ❑ E/ V-A ❑ II/VI B, -HT, V-B ❑
Valuation: 3Do. DO Square Footage:
Project Size: Express ❑ Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green B'uilding/LEED Checklist& attach it
to the application or if applicable, i;iclude in plan set& the sheet index.
oints Achieved: _
For help, contact Build it Green at www builditgreen-or
Revised 07/14/09
3