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12090080CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20030 RODRIGUES AVE CONTRACTOR: INTERNATIONAL PERMIT NO: 12090080 BUILDING INVESTMENT OWNER'S NAME: LAKE BILTMORE APARTMENTS 6117 GRANT AVE DATE ISSUED: 09/12/2012 OWNER'S PHONE: CARMICHAEL, CA 95608 PHONE NO: (916) 716-9565 ❑ LICENSED C NTRA TOR'S DECLARATION r r F INFO: BLDG BUILDING PERMIT ELECT PLUMB License Class Lic. # / r r r Contractor Date 3 MECH RESIDENTIAL COMMERCIAL 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: BLDG 7, UNITS A,B,D,F,H,J, & L-LIKE FOR LIKE (commencing with Section 7000) of Division 3 of the Business & Professions DRY ROT REPAIRS ONLY Code and that my license is in full force and effect. NO GUTTER/DOWNSPOUT REPLACEMENT(THIS INCLUDES BEAMS 1 hereby affirm under penalty of perjury one of the following two declarations: & FASCIA) OR CONSTRUCTION OF MISSING PATIO ENCLOSURES TO I have and will maintain a certificate of consent to self -insure for Worker's MATCH EXISTING ONES UNTIL DIRECTORS MINOR MOD IS Compensation, as provided for by Section 3700 of the Labor Code, for the APPROVED BY PLANNING performance of the work for which this permit is issued. 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 Sq. Ft Floor Area: Valuation: $4500 permit is issued. APPLICANT CERTIFICATION APN Number: 36903008.20030 Occupancy Type: 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non -point source regulations per the Cupertino Municipal Code, Section 180 DAYS F O LAST CALLED INSPECTION. 9.18. Signature Date ' / Issued b : C^ Date: 17 ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE -ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is I, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection, I agree to remove all new materials for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain Section 3700 of the Labor Code, for the performance of the work for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & permit is issued. Safety Code, Section 25532(a) should I store or handle hazardous material. I certify that in the performance of the work for which this permit is issued,) shall Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, I Health & Safety Code, Sections 25505, 25533, and 25534. become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner r rzed agent: Date: APPLICANT CERTIFICATION 1 certify that 1 have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. 1 agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's to building construction, and hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Civ C.) upon the above mentioned property for inspection purposes. (We) agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Lender's Address 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. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date Licensed Professional � CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: Ax,90 Lao teDATE: 0911112012 REVIEWED BY: suew/Albert Im APN: P#: ��Ql �80 'VALUATION: $4,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi -Family Dwelling USE: Buildina is 3 Stories © Yes ® No PENTAMATION 1GENRES PERMIT TYPE: 14 WORK LIKE FOR I-IKE DRY ROT REPAIRS GUTTER/DOWNSPOUT REPLACEMENT & CONSTRUCT SCOPE MISSING PATIO ENCLOSURES TO MATCH EXISTING ONES NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Diclrirl_ etc )_ Theco feoc are hosed an tho nroliminary infnrmnlinn availahlo and aro nn/v an octimalo_ Cnntart tho Dent for addn'l info_ FEE ITEMS (Fee Resolution 11-053 Eff 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F7 7 # $467.00 Deck / Deck Railing IDECKRAIL Deck Railing Suppl. PC Fee: Q Reg. ® OT 1 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-0 Reg. Q OT F0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 7 1 7;ij iYh',rlrt'r.0 E) Work Without Permit? © Yes (F) No $0.00 Advanced Planning; Fee. $0.00 Select a Non -Residential Buildin or Structure g E) Ir.t1 I�r7rl�l+rrirlalr,i; 1 r Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $467.00 TOTAL FEE: $468.50 Revised: 07/01 /2012