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10090170 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20050 RODRIGUES AVE BLDG 14 CONTRACTOR:DEVERA PERMIT NO: 10090170 CONSTRUCTION INC. ',WNER'3 NAME: LAKE BILTMORE APARTMENTS 941 D BERRYESSA RD DATE ISSUED:09/20/2010 ..•WNER'S PHONE! 6509313400 SAN JOSE,CA 95133 PHONE NO:(408)441-9598 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r— PLUMB r � � License Class Lic.# _ MECH RESIDENTIAL COMMERCIAL Z Contractor _— � _ Date— I�— - -- JOB DESCRIPTION: BLDG 14 APT A,F,H I hereby affirm that I am licensed under the provisions of hapter 9 DRYER VENTS: (contmencing with Section 7000)of Division 3 of the Business&Professions 14A-DRYER VENT NOT VENTED TO OUTSIDE 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:36903008.20050.14 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.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 DAYS FR WL CALLED INSPEC ION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Date: { granting of this permit. Additionally,the applicant understands and will comply Issued by: with ah non-point source regulP tions per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Date L if All roofs shall be inspected prior to any roofing material being installed.[f 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 of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,&s 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) HAZARDOUS MATERIALS DISCLOSURE 1 as owner of the property.am exclusively contracting with licensed contractors tai cons.ract 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. [will 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 he Health&Safety Code,Sections 25505,25533,and 25534. I have and will maintain Worker's Compensation Insurance,as provided for by t *_// — Section 3700 of the Labor Code,for the performan,:e of the work for which this Owner or authorised agent , � _ vats:. permit is issued. I certify that in the performance of the work for which this permit is issued,I shall I-lot empiov any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws.if California. It,after making this c..rtifrgate of cxeurption I become subject to the Worker's Compensation provisions of the Labor Code,I m-ist I hereby affirm that there is a construction lending agency for the perfonnance of work s for which this permit is issued(Sec.309',,Civ C.) forthwith comply with such provisions or this permit shall t+e deemed revoked. Lender's APPLICANT CERTIFICATION Lender's Address ----- I certify that I have lead this application and state that the above information i� correct. I agree to comply with all city and county ordinances and state laws relating io buildieg construction,and herebN authorize representatives of this city to ente! the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECI.ARATLo—N, mmfy and keep harmless the Cit of Cupertino against liabilities,judgments costs,and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records. granting of this permit.Additiona.1y,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional_------ 9 rofessional ---9 18. Signature—_ _— Date-_ CITY OF CUPERTINO 4 ITEMS OF 40 PERMIT' RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: B11;: Lot: APN 36903008 .20050 .14 DATE ISSUED. . . . . . . : 09,/20/2010 RECEIPT #. . . . . . . . . BS1000011498 REFERENCE ID # . . . : 10 )90170 SITE ADDRESS 20)50 RODRIGUES AVE BLDG 14 SUBDIVISION . . . . . . : CITY CUPERTINO IMPACT AREA OWNER . . . . . . . . . . . . : LAKE BILTMORE APARTMENTS ADDRESS . . . . . . . . . . : 1900 S NORFOLK ST STE150 CITY/STATE/ZIP . . . : SALE MATEO, CA 94403 RECEIVED FROM . . . . : DEVERA 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 . 00 1BREMVENFA NO UNITS 3 . 00 63 . 00 0 .00 63 . 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 148 . 00 0 . 00 148 . 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: I DATE: REVIEWED BY: APN: I BP#: *VALUATION: $300 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY R77.I PENTAMATION 1 RMAP8 USE: Multi-Family Dwelling 1/{ l?,' ., il<?, PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Ventilation Fan 1 BREMVENF # $21 TOTALS: $21.00 Mech.Plan Check 0.0 hrs $0.00 7r . t'rC.',a:<ck Mech.Permit Fee: 1MPERMT �'�t erb. x'errn t T'cc': 1ilr.c. P�;, riit I.r Other Mech.Insp. 0.0 hrs Other t>��.Iras; NOTE: These fees are based on the preliminarqy in ormatiojr available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 09-051 Eff. 7/1;10) FLE QTY/FEE MISC ITEMS Plo)l Check Supp/. PC 1•cr PME Plan Check: $0.00 Permit Fee: Suhpl. Insp Fee PME Unit Fee: $21.00 PME Permit Fee: $42.00 (7onswuction Ta ,,Ic:ous(icul Rc vier i Fee: Work Without Permit? © Yes E) No $0.00 Travel Documentation Fee: ITRAVDOC $42.00 Strong Motion Fee: $ Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $106. $0.00 TOTAL FEE: 0 Revised: 9/14/2010 CITY OF C UPERTIN O C]Tf OF CUPEKTINO GENERAL BUILDING PEPMT APPLICATION FORM N # j Date: AP ` � �����; r �f ��ls/2o�n L3 Building Address; 20050 f�ODR1C�UES AVENUE UNITS IUA IFF , 14 H Mailing Address (if different from building address): IOI5a Sc)u-rH ei-ANY 0,L.PF_RTINO , CA 675014• Are Hazardoug Materials being used as part of thi. project? Yes No HOA: xterior work onl ) Yes ❑ No If es, rovide letter from HOA Owner's Name: Phone#: ( (o6D) LI31- 34M PRnM ETHF-US RI✓AL- ESTATE C-iRMAP Phone: 0408 441 -G15q 8 Contractor: --q37 g �EVE1"A 0 TRUC-"UnJ, 1NC Fax: (4c) 4N Contractor License#: 040416 Cu ertino Business License#: Phone: (408)44 I-q5 9 g Contact: 4111 `437 8 DEL TOLAND Fax: (408) rZesidential Commercial Job Description: UNIT" 14A : DRVF-R VENT NOT VENTED TO DUT51DI✓ UNIT 14F: DRYER VENT UNHOOKED UN►T 14N: PIASTER OATH FAN NOT 4FNTED TO OUTSIDE Building Permit Info: Elect ❑ Plumb ❑ Mech ❑ Bldg K Occupancy Type: Type of Construction (Usage Class): p( E/EVV-A II/❑B, N-HT,V-B ❑ 1-A, 1-B ❑ Square Footage: Valuation: Project Size: Express ❑ Standard ❑ Largf- ❑ Major ❑ Green Building: Please complete relevant portio-.i of the Green B senEED& the sheet eck xt & attach it to the application or if applicable, include in plan points Achieved: r'or hel , contact Build it Green at www.builditEreen.or Revised 07/14/09