10090167 CITY OF CUPERTINO BUILDING PERMIT
BUILDIN;'ADDRESS: 20100 RODRIGUES AVE BLDG 9 CONTRACTOR:DEVERA PERMIT NO: 10090167
f ' CONSTRUCTION INC.
VNLR'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
K I LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# MECH r RESIDENTIAL F COMMERCIAL r
Contractor A- 0r,Date_ lib 'J
JOB DESCRIPTION: BLDG 9-APT A DRYER VENTS-2 DRYER VENTS NOT
I hereby affirm that I am licensed under the provisions of C apter 9 VENTED 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 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:36903008.20100.9 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 FI�jf1A4 BAST 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 all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
/� RE-ROOFS:offing
nature Date__��1� 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(f
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 compensatio i,
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. 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
1 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: —Y, Date: Z
permit is issued.
1 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 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
building construction,and hereby authorize representatives of this city to enter
m 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 nor.-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: Blki: Lot:
APN . . . . . . . . : 36S�03008 .20100 . 9
DATE ISSUED. . . . . . . : 0920/2010
RECEIPT #. . . . . . . . . : BS000011498
REFERENCE ID # . . . : 10090167
SITE ADDRESS . . . . . : 20:.00 RODRIGUES AVE BLDG 9
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LAKE BILTMORE APARTMENTS
ADDRESS . . . . . . . . . . : 1900 S NORFOLK ST STE150
CITY/STATE/ZIP . . . : SAT1 MATEO, CA 94403
RECEIVED FROM . . . . : DEITERA CONSTRUCTION
CONTRACTOR . . . . . . . : HENRY DEVERA LIC # 24605
COMPANY DE`TERA CONSTRUCTION INC.
ADDRESS 94:. D BERRYESSA RD
CITY/STATE/ZIP . . . : SA]1 JOSE, CA 95133
TELEPHONE (41)8) 441-9598
FEE ID UNIT QUANTITY AMOUNTPD-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
j .
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: $300
FPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY R)7;11: PENTAMATION
USE:
Multi-Family Dwelling F1.00R.r ;1„ : PERMIT TYPE: 1 RMAP
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Ventilation Fan 1BREMVENF 1 # $21
TOTALS: $21.00
'_T_F
Mech.Plan Check 0.0Fhrs $0.00 PlwnbChe<,ti F.i&C_ c.h"A k
FMech.Permit Fee: IMPERMIT Phi nb. Pertnrl Fce: 1:'1`tl . Permit Fe"',
Other Mech.Insp. 0.0 hrs $42.00 t?ri��, Plumb Irt.r1> oifwr A"(C(. Iny1j.
C( Lisp. 1"'C
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 09-051 Eff 7%7110' FEE QTY/FEE MISC ITEMS
P/an C;he(:k Feu:
suppl. PC
PME Plan Check: $10.00
Permit Fee:
Suppl. hasp Fee
PME Unit Fee: $21.00
PME Permit Fee: $42.00
(7onsfruction T ix _t'
Acoustical Rcview Fee:
Work Without Permit? 0 Yes 0 No $0.00
Planning-F e cs:
Travel Documentation Fee: ITRA VDOC $42.00
StroniMotion Fee: $1 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.0 L�
SUBTOTALS $1011 $0.00 TOTAL FEE: 10;761
Revised: 9/14/2010
CITY OF CI -PERTINO
carr a> B TILDIN G
cu rrY Of O GENERAL
PERNUT APPLII�ATION FORM
--iDate:
APNLt 1 G Cab o2G1 CJ(; . q ql i5/200
Building Address: �' _
2DID0 RD'DRIGUES ,4VENUE r q
Mailing Address (if different from building address):
ID15q SOUTH BL.ANEy �PERTINC� CA a50�'�
Are Hazardous Materials being used as part of this project? Yes No
HOA: xterior work only) Yes ❑ No (� If es, rovide letter from HOA
Phone#: )
Owner's Name: l(Ifi50 q31 3�DC�
PRDME.?HEUS REAL. �STo GROUP e: 408 441-450$
Phon ( )
Contractor: Fax: C408 NNS - 8378
DEVF.RA CCN STRLAO-MN , ►NC
Contractor License* &µ0µl5
Cupertino Business License#: 2,4&vf Phone: (408) U4I-�15q g
Contact: Dp_t- TDLAN-D Fax: ��Gg
Residential Commercial
Job Description:
LjNIT 61 2 DRYER VENTS NOT VFNT1rD oUTSIDE
Building Permit Info:
Plumb ❑ Mech ❑
BldE-A, l
Elect ❑ Occupancy Type:
onstruction (Usage Class):
_A ❑ II/VI B, 'T V-B ❑ R '
❑ Square Footage:
Valuation: 4- 30o DU
Project Size: Express ❑ Standard ❑ Large ❑ Major ❑
[Zir7eenBuildlng�: �omplete relevant portion of the Green Buildin&�Ee sheetChecklist & attach it
pplication or if applicab le, include in plan se
Points Achieved:
For help, contact Build it Green at www•buildit�:-een.or
Revised 07/14/09
3