05080097 CITY OF CUPERTIR-
BUT� /-� �"'�iT°�+♦�`��.n ��`s� r'" si �'n' �a,} " ,
ILDING ON
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DIVISI
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BUILDING ADDRESS: _ PARAGON SERVICES/RGM BUILD RgTNGfl5080097
10159 S BL
OWNER'S NAME: PERMIT ISSUE DATE
LAKE BILTMORE APARTMENTS 2812 TRINITY SQUARE DR 09/13/2005
NE:
SANITARY NO. CONTROL NO.
(972) 478-2255
ARCHITELTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
D 0 0 0
)4:2
cos, LICENSED CONTRACTO
RderpDECLARATION lob Description
WF Iion7 affirm that Iam lime Btunder provisions of Chapter 9rmmmcnM is
a
id,SectionndeffecDivision3 of NC Businccs and Profcssintu Codc.andmyliccnse is [[""��'' ssas
in en furca and errant. II PrLYWOOD CUTOUTS (1)
jLj: License Class Lic.p u 1��0
Dam Conlraclor Il 1 lll:JJ�
ARCHITECPS DECLARATION
a2 S V I understand my plans shall be used as public recordso
_
o� LiensedPrmmosional OCT 2 7 2005
H g OWNER-BUILDER DECLARATION
I hereby affirm Nal I am exempt tram Ne Contractor's License Law far the pip pip Lq
L'
o following mason(Suction 1031.1,Business and Profcssiou Code:Any city or county p I I Yn\ �I $425
which requires a permit to construct,alter,improve,demolish,rat repair any mmnure n II lI II\\
—zy prior to its issuomm.alsorequims lWapplicam forumb Permil lafileasigncdsummam
< thathcisli..d,ursuanuolhcpmvisiomnfthc Conlsacmri Llconaslaw(Chafter9 Stj. .Floor srC3 Valuation
, $ (commencing with Section 7000)of Division 3 of the Business and Professions Coded or
that he is exempt thcaefmm and Or,basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant a civil Penalty of er Occupancy Type
not marc than firs hundred dollars
❑1.as owner of the pmpwy,army employe=with wagesas Onto sole compenaaliam,
will do the work,and the awaure is not intended or offend for sale fSce.1044,Business
and Professions Code:The Contractor's License Law docs not apply 0 an owner of Required Inspections
,tonicity who builds or improves thereon,and who does such work himself or through his
own employers.provided thatsuch improwemenu ue rom immuded.,offered forsale.If,
however,Nc building or impnv4mcm is sold within one year Of completion,the owncr-
builder will have Or burden of proving that he did not build or improve for purpose of
axis.).
❑h as owner Of Ne property,am exclusively contracting with licensed contractors to
consumer the pmjecr(Sec.7044.Business and Profession Code:)The Comment Li.
comas Law docs not apply to an owner of proPeny who Wilds Or improves themon,and
who contracts for such projects with a contractor(s)liensed pursuant to the Conuaemr's
License Law
exempt under Slee B&PQC for Of$m/axon
Owny ��J C - Dale�/�/L_
t/�fi/�W RKER'S COMPENSATION DECLARATION �✓••'
ereby union under penally of pequOr arc of the fallowing dexluation:
I have and will maintain a Certificate of Consent o ulbinsure nor Workers Compere
salon,as provided for by Section 3700 of Of Labor Calc,for Ne Performance of the
work for which this grmit is lssued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
37W of the Labor Codc,for the performance of the work for which this Permit is issued.
My Workers Compensation Insurance carrier and Policy,number art:
Cartier: Policy NO.:
CERTIFICATE OF EKEMPOON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if the permit is for one hundred dollars(SI0t)
or loss.) '
1 firmly that in the performance of the work for which this Permit is issued.I shall not
employ
y
Laws California.Person
aany,tcrsonnn in any
Date
manncru mbecome;of to be WOrkcrS Compensation
Applicant
NOTICE TO APPLICANT:If,alter makidg bris tfirprictow of Eacmption,you should
become subject to the Workers Compensation Previsions Or me labor Code.you must
.,2 rorphwilb Comply with such provisions or phis permit shall W dcermd revoked.
7-0CONSTRUCTIONLENDING AGENCY
f<(Zi Ihereby affirm mat mere is a construction lending agency for the performance of
C4 ✓ the work for which this Permit is issued(Sec.3097,Civ.C.)
W QLondcr's Name
Cit. Londe Address
U 0 1 ccnify mal I have read this application and sum that the above information is
LL P torten.1 agree to comply wit all city and county ordinances and sue laws relating to
0 Wilding construction,and hereby euhorim mpoemnutivu of this city in enter risen me
�F17 alrove.mentioned propony for mspeelinn purposes.
(We)agree to save,indmtmify and keep harmless the City of Cupertino against
bt liabilities.judgments,costs and expenses which may in any way acme against said City
in consequence of the granting of
U z mit-
APPLICANT UNDERSTANDS IAND his oWILL COMPLY WITH ALL NON-POINT Issued by: Date t./--(3--c' v'
SOURCEII6 TIONSf
-' Re-roofs t
ignatorc of AP OARDOUS MATERIALS DISCLOSURE Dam
HAZARDOUS Type of Roof
dl the applicant or future building occupant store or handle haiurdous mamdal
of defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safely
Code,Series 8532(a)? All roofs shall be inspected prior to any roofing material being installed.
El yes Nu
Will the applicant or future building occupant use equipment or&vmea whim If a roof is installed without first obtaining an inspection,I agree to remove
mahazardnus air cnnuminama as defined by the Bay Arca Air Quality Mamagcmant all new materials for inspection.
Disricl?
❑Yes
1 have mail the hmatmirs materials requircmenu under Chapter 6.95 mine Califm.
nia Health&Safny Codc,Sections 255115,15533 and 8534.I undersand our if the building
Jars not curcnlly have a mount.that it is my revponability to nobly the occupant of Of
regrire�most Ise mcl dor toissuanm ora[enificam OfOr Paley Signature of Applicant Date
� - 'g�� All roof coverings to be Class "B" or better
Own serOwn or aumo� u Date
CITY OF CUPERTINO
�m 7 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 # . . . : 05080097
SITE ADDRESS 10159 S BLANEY (BLDG # 7)
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
FEE 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 425 . 00 83 . 16 0 . 00 83 . 16 0 . 00
BSEISMICOM VALUATION 425 . 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
1009 FINAL GRADE 510 FINAL PLANNING
14 FINAL PUBLIC WORKS
A.S.B.
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 .
•
OCITY OF CUPERTIN69 o ��
CITY OF PERMIT APPLICATION FORM L
CUPERTINO
40030
qPkPN# / d�7 Date:
Building Address: Mailing A- Jress (if different from building address):
Xeer // Z4,vl- Y C . c-Vc/ t/
Owner's Name: 4,1,xr ,aJt r m°lte:-c¢o44 r;w ✓Ts Phone#:
L.A. .q dq Su v . o gioe<• Atvt moo✓ mr ✓� c- O -S 5'3,5,5
ContractorrSva > License#:
Ge.✓ . C% v c r s nJ dp&I S'3
Contact: Phone: J0-7as'S Cupertino Business License#:
1 Fy.V e.o.L Fax: ,2 y7
Building Permit Info: R;
Bldg 2' Elect ❑ Plumb ❑ Mech ❑
Job Description: .B<odS 1�4YG°0,0 r To P<yrwen° f6,7-e&1'X Yr(a6P} Zoc�aT.o,�r To
Residential 2-C4FN ✓°vis eF1J,fA
Commercial ❑
Sq.Ft. Floor Area: AS sr",v6 $/Sq.Ft.:
Cost of Project: oo Occupancy Group:
Type of Construction: Please check this box if the project is a
T e ,5' s1Jo r-,O second-story addition: ❑
t'roject Size: Standard 2' 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> IM 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 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA
Investigation fee BUILDING
1 of 3 —
qaWi ,
*CITY OF CUPERTIN
CITY OF PERMIT APPLICATION FIRM
CUPEkTINO
Quantity 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 I 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 rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER InstaWAlter Water Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 clip MECHANICAL
BRENLkMiAN 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 Furnace> l 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
r{j�' OTY OF CUPERTINO
CITYOF 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 Inspection BUILDING
Bsvvrim 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--- --Plumbin"_PeruiifIssue "— --PLUMBING - —
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Plannin2 LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
•
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