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10090173 CITY OF CUPERTI NO BUILDING PERMIT BUILDING ADDRESS: 10149 S BLANEY AVE BLDG 13 CONTRACTOR:DEVERA PERMIT NO: 10090173 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 (gr LICENSED CONTRACTOR'S DECLARATION �L BUILDING PERMIT INFO: BLDG ELECT f— PLUMB License Class__ Lic.# QT r— r � 1 p C MECH RESIDENTIAL COMMERCIAL Contractor�IlC��t G� ���(`(`i.�G Date JOB DESCRIPTION: BLDG 3 APT H DRYER VENT:WASHER DRAIN LINE VENT I hereby affirm that I am licensed under the provisions of hapter 9 NOT VENTED TO OUTSIDE (commencing with Section 7000)of Division 3 of the Business&Professions 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 1 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:36903008.10149.13 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 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 relati rg 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 LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, 4 costs,and expenses which may accrue against said City in consequence of the Issued b a Date. granting of this permit. Additionally,the applicant understands and will comply y' with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: nature Date�,o O 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 I,as owner of the property,or my employees with wages as their sole compensate in, _ will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,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. 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,Sectio s 25525,5 33,,ind 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:Ylvttllo permit is issued. I certify that in the performance of the work for which this permit is issued,I sha 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, become subject to the Worker's Compensation provisions of the Labor Code,I tr ust 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 rela ing yuilding construction,and hereby authorize representatives of this city to ente on 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 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 369C3008 . 10149 .13 DATE ISSUED. . . . . . . : 09/20/2010 RECEIPT #. . . . . . . . . : BS000011498 REFERENCE ID # . . . : 100S�0173 SITE ADDRESS . . . . . : 1014:9 S BLANEY AVE BLDG 13 SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LAIC-, BILTMORE APARTMENTS ADDRESS . . . . . . . . . . : 1901) S NORFOLK ST SUITE 150 CITY/STATE/ZIP SAN MATEO, CA 94403 RECEIVED FROM DEV3RA CONSTRUCTION CONTRACTOR HENRY DEVERA LIC # 24605 COMPANY DEVERA CONSTRUCTION INC. ADDRESS 941 D BERRYESSA RD CITY/STATE/ZIP SAN JOSE, CA 95133 TELEPHONE (408) 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 - 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 1 . 00 42 .00 0 . 00 42 . 00 ------0_00 1TRAVDOC FLAT RATE -- -------- ---------- ---------- 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 vCITY OF CUPERTINO • ��=�-- GTY of CUPEKTINO GENERAL BUILDING PERMIT APPLICATION FORM APN## Date: Building Address: 1014q SDUTH 13LANEy UN IF 3H Mailing Address (if different from building address): ICY1567 SOUTH OLANEy CUPi=RTINCO , 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#: C CASo) Gj3{-3�op PRVk1FT-NEUS REAL. ESTATE 6RVOP Contractor: Phone: (409) 4W-6?5q$ ,DEL'ERA C0N5T'UCi IDN , INC Fax: 1108) N41 -'837$ Contractor License t &4ogj5 Cu ertino Business License* 214&05 Phone: ( 408 4141 "9sq fi Contact: SEL_ iOLAND Fax: ND$ 14t41--9378 Residential Commercial Job Description: UNIT 3A = WASMEP DRAIN vIENT - NGT VEWED 1D dlcrS1DE Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ IUIII/V-A ❑ II/VI B, IV-HT, V-B ❑ Valuation: Square Footage: % 300.00 Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ [Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet indez. 'oints Achieved: For help, contact Build it Green at www.builditgreen.or Revised 07/14/09 3