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05080092
CITY OF'CUPERTINO g -_' $'"" 4 ` BUILDING DIVISION PER �C®NTRACTOR=INFORN�'IQN " 4., ;?tib.,IP.� BUILDING ADDRESS: PARAGON SERVICES/RGM BUILEM9"No'0S080092 OWNER'S NAME: PERMR LS9UE DATE Ahk LAKE' BILTMORE APARTMENTS 2812 TRINITY SQUARE DR2005 14 ONE: SANITARY NO. CONTROL NO. (972) 478-2255 ARCHITECT/ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 0 0 0 0 u00 LICENSED CONIRACfOR'SDECLARATION Job Description tau G gyJ 1 Mmby affirm that 1 am licensed under provisions of Chapter 9(Commencing _fiat with SeDivision 3 of the Business and Professions Code,and my license is e<n, inmRfame and effect. REPAIR PLYWOOD CUTOUTS—HARDY BOARD t,u, License Class Limp i DaL Contractor PARAGON SERVICES, INC ARCHITECTS DECLARATION ¢ 1 understand my plans shall W used u public records Dau ;u.t; Licensed Pmfcssimet =0s OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from due Contractors License Law for the p o following reason.(Section 7031.5,Business and Professions Code:Any city or county K$iei which requires a permit to consumer,alter,improve,demolish,or repair any structure Fzy prior in its issuance.also requires the applicant for such permit to Glc a signed statement at he is licensedpm9uanuon to ItheCuacwr'sLicenselaw(Chapter9 Sq.Ft. Floor Area Valuatio$850 ��a N,s (commencing with Section 7")of Division 3 of the Business and Protestant Conti)or a,�' that M is exempt do mfrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a Permit subjects the applicant to a Civil penally of APN Number Occupancy Type not more than Five hundred dollars($5DB). 36903008 . 00 L os he work,the t uopeny,or is emntendedwitn wages u Nei(See.Compensation, andPtnework,andd¢9WCWRI9mo1s Laded arawdos rot apply to a A.Bu91rof Required Inspections ponand snywsis bis Code:The Convector,License Law does not apply to an owner of /J �r- q p own employ b,pomids rimproveudurcogandwho we not idoes ntended work ormlemrthrough his IY LED own cmploycns,provided that such impmrcmcnu are not intended oroRcrcd for sale If. �y I'�' however,NcbuildingorimpmsementissoldwiJinoneyearorcompledon,Ncowncr- (� r, "tF9 Lam® builder will have the burden of proving tom he did not Wild or improve for purpose or sale.). ��n...ssa t- I,as owner of Ne property,am exclusively contracting with licensed contractors to (✓ + �.-/ 2005 conswct toe project(Sec.7(l Business and professions Cade:)The Contractors Li- —I o cmue Law does not apply in an owner of property who Wilds or improves themon,and who contracts for such pmjccss with ecamractor(a)licensed pumuanuo the Canvanors sell 1 as � �9 L®.IS ycrept un ,B&PC for this on Ow crDate ER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury ons:of toe fallowing declarations: ❑I have and will maintain a Cenificmu of Consent in self-insure for Workers Compos action,as provided for by Section 3700 of the lana,Code,for the performance of the work for which his permit is issued. 1 have and will maintain Worker's Compensation Insurance,or mquired by Section 3700 of the labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: caricr: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Olds section need not W completed if toe I conit is Infant,hundred dollars(Slq)) m less.) 1 eenify Na in the performance,of the work for which this permit is issued,I shall not employ any loosen in any manner so as to boc aobjc I to the Workers'Compcnsation Laws of California.Dau ADplicam NOTIC APPLIC61 :If,afar ma ong is Ccn unL of Eacmption,you should r IZMI subject there Compensation previsions of the Labor Code you must .J z, formwi ywdh such provisions or this permit shall he deemed revoked. Z O CONSTRUCTION LENDING AGENCY . 1 hereby affirm that there is a Conswction lending agency for performance of CLQ be work for which this pcount is board(See3097,Civ.C.) U] Lenders Name 4. Lendc,'s Addrau U J O I certify Nat 1 have tend this application and sure that the above Information is ry f-' conch.I agree to comply with all City and county ordinances and sure laws relating to U building Construction.and hereby auNerine mpresenutives of this city to enter upon the . G above-mentioned property for inspection purposes. (•+ m(We)agree save,indemnify and keep hannloss the City of Cupertino against Ie, liabilities,judgments.costs and expenses which may in any way see=against said City U Z APPhis Korn. LICANT UNDERSTANDS tAND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. GL�-- Re-roofs tgnatofc of Anpl"a run c'm ale 1AZAR000S MATERIALS DISCLOSURE Type of Roof 'IL pplicanr or future building occupantstom or handle hvardous material a defined by the Cupenino Municipal Code.Chapter 9.12,and the Health and Safety cwe.Section 25532ta)? All roofs shall be inspected prior to any roofing material being installed. Yn Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree toremove emit hazardous aircontaminantsas defined by the Bay Area Air Quality Management all new materials for inspection. D'strin? / ❑Yes �{I� 1 have mad the hazardous materials requirements undt,r Chapur6.95 of Ne Califon ria Hca"&Safe,Cade.Seeumu 25505.25533 and 25534.1 understand Nat if Ne,Wilding dors trot curtendy Lame a Lnanl.Nal it is my rcsponsihilily ro notify Ne,cupant of Ne mt,m InmustbemetpriorarissuanceofaOrtirca ofOccupzncy. Signature of Applicant Date owneC fixed agent S Date All roof coverings to be Class "B" or better CITY OF CUPERTINO om 2 of 16 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36903008 . 00 DATE ISSUED. . . . . . . : 09/13/2005 RECEIPT # . . . . . . . . . : 31168 REFERENCE ID # . . . : 05080092 SITE ADDRESS . . . . . : 10159 S BLANEY (BLDG 2) SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LAKE BILTMORE APARTMENTS ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : LAKE BILTMORE APART. CONTRACTOR . . . . . . . : BRYAN BROWN LIC # 27131 COMPANY . . . . . . . . . . : PARAGON SERVICES/RGM BUILDERS ADDRESS . . . : . . . . . . : 2812 TRINITY SQUARE DR CITY/STATE/ZIP . . . : CARROLLTON, TX 75006 TELEPHONE . . . . . . . . : (972) 478-2255 OFEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- -- - - --- -- - - -- ---------- ----- ----- ---------- ---------- ---- -- - - -- BENERGYADD PLAN SETS 1 . 00 34 . 86 34 . 86 0 . 00 0 . 00 BPERMFEE VALUATION 850 . 00 83 . 16 0 . 00 83 . 16 0 . 00 BSEISMICOM VALUATION 850 . 00 0 . 63 0 . 00 0 . 63 0 . 00 BPLANCKADD PLAN SETS 1 . 00 34 . 86 34 . 86 0 . 00 0 . 00 TOTAL PERMIT 153 . 51 69 . 72 83 . 79 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- =========------------------- 101 FOUNDATION 102 PIERS 103 UFER 104 REBAR 105 ANCHOR BOLTS 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCRATCH COAT 313 ROOF NAIL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY 505 FINAL ELECTRICAL 506 GAS TEST 507 FINAL PLUMBING 508 FINAL MECHANICAL 09 FINAL GRADE 510 FINAL PLANNING 14 FINAL PUBLIC WORKS A.S.E. 255 N. Market St . , Suite #220 San Jose, Ca. 95110 (408) 999-7441 Permit # 050800091 Thru 05080106 r PLAN CHECK NUMBER: 05318 .CUP September M, 2005 PROJECT: The Biltmore Structural Repair Details 10159 South Blaney Ave. Engineer: John Clinton 510-2360-7435 ------------------------------------------------------------- DOCUMENTS ATTACHED: VIA: 1 SETS OF DRAWINGS HAND DELIVERY ------------------------------------------------------------- Dear Sue : The attached document were reviewed and cleared by our office. 1 . Project engineer to inspect all repair works and to • submit Structural Observation Report per note #7 of the plans . q ( ' CITY OF CUPERTINP cuP CITYNo OF PERMIT APPLICATION FORM 0 APN# Date: Building Address: Mailing Address (if different from building address): /7/69 Sbv // 41,LIZ-Y Tn✓U e �voj q Owner's Name: 11¢,kk ,a 1.47- .0447,»ic`.17's Phone#: N O S'i/n/S'FT- iOG,L0."4 ✓JIs5'0 ContractortSda i License #: Ge ✓ �qeI S"3 Contact: Phone: 97a Cupertino Business License#: 4F4/.v to.- Fax: ,2 y7 Building Permit Info: R Bldg 2' Elect ❑ Plumb ❑ Mech ❑ Job Description: 64ac,4 o4 YOcW4 Re.^moi tr To f<yzrcbo cvr^ov;J' toes 7-yv yr To Residential �ez`�vJ°uTs ®rR ATJAC/>TA/A<l' Commercial ❑ Sq.Ft. Floor Area: ,v.r $/Sq.Ft.: Cost of Project: "V.od �a 1 Occupancy Group: Type of Construe on: Please check this box if the project is a T !oF —5RJn rr/0 second-story addition: ❑ Project Size: Standard ©` Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elee 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING `c' (� zC) ,eoca .;W � ASO. 1 of3 ;� 4- 7, 7 � r Q- CITY OF CUPERTINO CUP TYOF PERMIT APPLICATION FORM Quanti Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 STY OF CUPERTINO r` CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL —"— —" PPERMITFEE— —Plumbing-Permit- ssue ----PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING • 3 of 3 CITY OF XPERTINO BUILDING DIVISION PERMIT ;CONTRACTOR INFORMATION:Ij BUILDING ADDRESS: PARAGON SERVICES/RGM BUILE ffftlgTNO-05080092 OWNER'S NAME: PERMIT ISSUE DATE LAKE BILTMORE APAR MENTS 2812 TRINIT 2005 .aNE: SANITARY NO. CONTROL NO. (972) 478-2255 ARCHITECF/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 °00 LICENSED CONTRACTOR'S DECLARATION wC 1 frosty affirm that I am licensed under provisions of Chapter 9(commencing Job Description iW wiNSection]O(glj rfDivisionJof the BuSxasaM Profrssiou Cak.Wmyliccrvc is �« Imm�mrtxand eraa REPAIR PLYWOOD CUTOUTS-HARDY BOARD j = License ClassLk.P e Date Contractor CONTRACTOR: PARAGON SERVICES, INC tJ` ARCHITECTS DECLARATION aubo T understand my plans used u public records �yU jv, Professional OWNER BUILDER mDECLARATION E n o 1 remor .(firm thea 1 1. exempt from On Cssions o License Law for the p o following mason.(Section ID3 L6, t.Business and Improve, demolish, Cake Any tiny or county E m� which rtyuims a permit m wnamcL eller,impmrc,demolish,car repair any xtmnuu prior m its issuance,also wituires the applicant for such Permit to rile a signed statement that he is licensed p rmant to the pmvisiom of the Contractor's License law(Chapter 9 Sq. Ft. Floor Area Valuatio$850 (commencing with Section 7")of Division]of the Business and Professions Cock)or `<— But he Is eampt therefrom and the,basis for the alleged exemption.Any violation or Section 1031.5 by any applicant for a Permit subjects the applicant o a civil penalty or APN Number Occupancy Type not moa than five hundred dollars(S500). 36903008 . 00 p y Yp ❑L as owner of the pmpcnY,or mY emploYcu with wages ss elf,(mit compensation, will do the work.and the awctua is not intended a Law cid fondle(pec.]Ota,Business and Pmfahobu Code:The ws tt emirs License Law dors trot apply lf an owner is Required°Inspections�(I Own property mploy b.provitimpmva Neaprove who soanacb work htmsNror Nmugh his II I l ,A�r Own cmr,the employ=. Nat such improvements as net tended ooRraW the own If, u d�i�^ Auilder,theaveongorden ofp cot ismid tas diinor ild or completion.the owed Evilder will have the burden of proving Nn k did nm build or improve for purpose of q.a sok.). /0� ❑L u Owner or the See 7 Y,am exve sively contracting with:)no Ccomnmeaa i. come La Ne project(ply to n Business and rry wh ions Code:)IDeves t icon.Li ccru�doa not applytois owner ofpropeny who builds or Improves Neeson,and whrcrntractsfor such projects with aconuutoKs)liuved pursuanuo the Contractor's Illirte-^f1n/I l�s' 'IJf' 19rt' �t`sA\VVIIJII Liccn wmpt un ,B&P C for this reason we f2 Daa ER'S COMPENSATION DECLARATION 1 hereby affirm under penally of perjury one of the fallowing declarations: I have and will maintain a CeM1lfiCme of Consent to self-insum for Worker's Compen- aed0n,m provided for by Section 3810 of the labor Code.for the performance of the weak for which this permit is issued ❑1 have and will maintain Workers Compensation Irtsurmer.as myviad by Section 3700 of the labor Code,for the peKormantt of the work for which Nis permit is issued. My Worker's Camperumion Insurance carrier and Policy number art: Carver, Policy No.: _ CERTIFICATE OF EI(EMPTION FROM WORKERS' COMPENSATION INSURANCE . This sure ire recd not bo completed ifcar permit is for one hundre4 dollars($100) of Icss.) 1 am(v that in the performance of the work for which this Permit 0 issued.l shall not employ anyperson inmymannermaz I kc c ebje it in Workeri Compensation Laws of California.Dace Applicant NOTIC APPLIC :IL afar ma ung t ts Cen eaa of Exemption.You should bccrm suld to orkcr's Compensation provisions of Nc labor Code,you most .J,Z ford wi m y with such provisions or this permit shall he deemed revoker, ZOpCONSTRUCTION LENDING AGENCY - I hereby affirm that Nene is a construction lending agency l'or the performance of W > the.,it or which this permit is issued(Sec.309'!,Civ.C) W Q lender's Namc =z lender's Address U Q 1 cenify that I have read this application and sue that the above information is D. F conctt I agree to comply with all city and county ordlnamce and sate laws relating to C)U building construction.and hereby authona mpmsematins of Nis city to enter upon the r 0. ahow-mentioned property for inspection purposes. (we)agree to sale,indemnify and keep harmless Ne City of Cupertino against F N liabilities,judgments,costs and expenses which may in any way accrue against said City . U Z APPLICANTeUNDE STANDS AtND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. 4R�— e-roofs gnuurc of Applic AZRDOUS MATERIALS DISCLOSURE on, ie Type of Roof pplicanI or fuwm building accupam store or handle haraNOus material as defined by da Cupertino Municipal Code.Chapter 9.12.and the Health and Safety Code.pectienzsslz(a)? All roofs shall be ins ected rior to an roofin material beim ❑Yea paltr: P p Y g g installed. Will the applicam or fuarc building occupant use cyuiprow or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hanrdoo air contaminantsn s as rt by On,Bay Area Air Quality Management all new materials for inspection. District? Yes 1 have mad the harardousmacrialsayuimmenu under Chapar6.95 of de Califor. nice HesIN 3 Safety Cede,Sections 155(15.25577 and 25534.1 understand hatifthe building does not currently ham a tenons that it is my rupomibility,to noli(y Ne oeeup od of the ocn bhon.hemetpoor mismmee0(acenlree Of Occupancy Signature of Applicant Date Owner 2ranScrindagem, Dme All roof coverings to be Class"B"or better f