15010171CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10159 S BLANEY AVE
CONTRACTOR: BYLDAN CORPORATION
PERMIT NO: 15010171
OWNER'S NAME: LAKE BILTMORE APARTMENTS
PO BOX 60970
DATE ISSUED: 04/24/2015
OWNER'S PHONE: 6509313457
PALO ALTO, CA 94306
PHONE NO: (650) 614-1149
JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
LICENSED CONTRACTOR'S DECLARATION_
BILTMORE; SITE UTILITY FOR FUTURE DEVELOPMENT
``��7 1 v 2
License Class /J Lie.#
Contractor 1-13 /iJ Date J
I hereby affirm that am liceed nder the provision of C pter 9
(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
erformance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $300000
and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 36903008.10159
Occupancy Type:
;Jthave
Section 3700 of the Labor Code, for the performance of the work for which this
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
180 DAYS F CALLED INSPECTION.
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
ed by: Date
granting of this permit. A dilionally, the applicant understands and will comply
with all non -point sourc egulations per the Cupertino Municipal Code, Section
9.18.
Signature ./Cl/1��(f� Date t
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
�T
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 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
1 have and will maintain a Certificate of Consent to self -insure for Worker s
should I use equipment or devices which emit hazardous
Additional) s
material. y,
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
with the Cuperti o Municipal Code, Chapter 9.12 and
which this permit is issued.
performance of the work for w pe
p
I have and will maintain Worker's Compensation Insurance, as provided for by
will maintain compliance
2 534.
the Health & Safety Code, Sections 2 and 5
Section 3700 of the Labor Code, for the performance of the work for which thisL
2 e —
Owner or authorized agent: �J / Datr. i
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, 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
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
to building construction, and hereby authorize representatives of this city to enter
upon 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 BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: 15010171
10159 S BLANEY AVE (369 03 008)
412 OLIVE AVE PALO
ALTO, CA 94306
OWNER'S NAME: LAKE BILTMORE APARTMENTS
DATE ISSUED: 04/24/2015
OWNER'S PHONE: (408) 255-8787
PHONE NO: None
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class CONTRACTOR - GENERAL Lic. #
Contractor Date 03/31/2016
—BLDG _ELECT —PLUMB
MECH RESIDENTIAL COMMERCIAL
1 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
_ _
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
BILTMORE; SITE UTILITY FOR FUTURE DEVELOPMENT
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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.
2. 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
Sq. Ft Floor Area:
Valuation: 5300000.00
permit is issued.
APPLICANT CERTIFICATION
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
369 03 008
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We) agree to save indemnify and keep harmless the
City of Cupertino against liabilities, judgments, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date
Issued by: Leeacv
Date: 04/24/2015
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. if a roof is
1. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date:
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 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.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date:
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
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed
Professional
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building()cupertino.orq
EX -1 i. rw rnm CTRI IrTInm F-1 AnnITIow I—I AT.TF.RATION / Ti I—I REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 10159 South Blaney Avenue
APNk 369-03-008
OWNER NAME Lake Biltmore Apartments, a California limited partnership
PHONE 650 931-3457
E-MAIL mducote@prometheusreg.com
STREET ADDRESS 1900 South Norfolk Street, Suite 150
CITY, STATE, ZIP San Mateo, CA 94403
FAx 650 931-3657
CONTACT NAME Michael Ducole
PHONE 650 931-3457 7
E -MAIL mducote@prometheusreg.com
STREET ADDRESS 1900 South Norfolk Street, Suite 150
CITY, STATE, ZIP San Mateo, CA 94403
FAX 650 931-3657
❑ OWNER ❑ OWNER -BUILDER OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME Michael Kaizoji
LICENSE NUMBER
LICENSE TYPE
BUS. LIC �-
COMPANY NAME Clarum Communities
E-MAIL michael@clarum.com
FAX 650 681-9521
STREET ADDRESS 412 Olive Avenue
CITY, STATE, ZIP Palo Alto, CA 94306
PHONE 650 322-7069
ARCHITECT/ENGINEERNAME Ray Welter
LICENSE NUMBER On file
BUS. LIC 9 On file
COMPANY NAME Studio T -SQ., Inc.
E-MAIL rwelter@studiot-sq.com
FAx 510 451-2850
STREET ADDRESS 304 12th Street, Suite 2A
CITY, STATE, ZIP Oakland, CA 94607
PHONE 510 2860
DESCRIPTION OF WORK We are requesting a utility only permit pursuant to the scope of work detailed in the submitted plans accompanying this application.
Work to include the installation of wet utilities associated with the new clubhouse and 7 units.
EXISTING USE
PROPOSED USE CONSTR-
TYPE
I X STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
5,000
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH ARE
GARAGE AREA: DETACH
❑ ATTACH
I
4 DWELLING UNITS: 7
IS A SECOND UNIT YES
SECOND STORY ❑YES
BEING ADDED? NO
ADDITION? ONO
PRE -APPLICATION []YES IF YJhaNp
COPY OF
IS THE BLDG AN YES
.RECEIVED BY:
TOTAL VALUATION:
PLANNINGAPPLO ❑NO PLAVAL
LETTER
EICHLERHOME? NO
$30,000.00
By my signature below, I certithe
following: I am the property owner or authorized agent to -act on erty owner's behalf. I have read this
application and the informationidedis
correct. I have read the Description ofWork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relati
construction. I authorize representatives ofCupertino to enter the above -identified property for inspection purposes.
January 28, 2015
Signature ofApp]icanUAgent:
Date:SUPPLEME0
ATI0N REQUIRED
PLAN CHECK TYPE ROUTING SLIP
❑ OVER-THE-COUNTER UILDING PLAN REVIEW
_ New SFD or Multifamily pply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS NING PLAN REVIEW
Bldgs: Provide a completed Hazardous Materials Disclosure
STANDARD PUBLIC WORKS
—Commercial
form if any Hazardous Materials are being used as part of this project.
❑LARGE FIRE DEPT
of Planning Approval Letter or Meeting with Planning prior to
❑ SEWER DISTRICT
—Copy
submittal of Building Permit application.
MAJORNITARY
❑ ENVH2ONAIENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
�---� CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addit 7 info.
FEE ITEMS (Fee Resolution 11-053 E . 7�
ADDRESS: 10159 s blaney ave
DATE: 01/29/2015
REVIEWED BY: Mendez
�e
APN:
BP#: /5 D/ 0/7
*VALUATION: $30,000-
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family Dwelling
USE:
Building is
>3 Stories 0 Yes (E)No
PENTAMATION 1 GENRES
PERMIT TYPE:
WORK
Bitlmore• site utility
SCOPE
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addit 7 info.
FEE ITEMS (Fee Resolution 11-053 E . 7�
ECh. / � iii t.'f;c'c:h
-.'7i . PCtit
MISC ITEMS
�e
Plan Check Fee: Hourly Only? () Yes (E) No
$0.00
® hours
$572.00
Phonb hasp,),her
Stec. In: p.
Suppl. PC Fee: (F) Reg. 0 OT0.0
lhrs
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addit 7 info.
FEE ITEMS (Fee Resolution 11-053 E . 7�
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? () Yes (E) No
$0.00
® hours
$572.00
Plan Check, Hourly
ISTPLNCK
Suppl. PC Fee: (F) Reg. 0 OT0.0
lhrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? Yes Q No
$0.00
Suppl. Insp. Feer Reg. 0 OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
orist-ruc,•tion 74-v:
F
0
G
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure 0
�
y
��r"edl�c'ir �)C3C'Iti78E'YdtC�LI£13i L`Q�$�S,
Strong Motion Fee: IBSEISMICR
$3.90
4.0 hrs
$572.00
Inspections
ISTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$5.901$1,144.00
TOTAL FEE:
1
$1,149.90
Revised: 01/06/2015