05080101 CITY OF CUPERTINOx^+
BUILDING DIVISION pRR ., T C�INtiI XCTOR,INFOI2 JON"
BUILDING ADDRESS: PARAGON SERVICES/RGM BUIL S"S"T NO.05080101
OWNER'S NAME: PERMITEdiUEDATE
LAKE BILTMORE APARTMENTS 2812 TRINITY 2 05
NE:
SANITARY NO. CONTROL NO.
(972) 478-2255
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
sero
LICENSED CONTRACTORS DECLARATION Job Description
wp I herby affirm that 1 am licensed under provisions of Chapter 9(commencing
6 W with Section]IXgBof Division 3ordm Business and Professions Cmic.entl my license is
n mu sera arta effect. REPAIR PLYWOOD CUTOUTS (2)
j n� License ClassLie.x
=moo oma m
Comcmr CONTRACTOR: PARAGON SERVICES, INC.
3 19 ARCHITECTS DECLARATION
�a—i I understand my plans shall k used as public records
aU
C. Licensed Professional
OWNER-BUILDER DECLARATION
MI hereby affirm Nat 1 am exempt from the Contractor's License Law for the
o O following reason.(Section IID I.5,Business and Prit esxionv Cade Any city or county
i m� which inquires a penot to construct,alter,impro c,demolish.or repair any structure
prior to its issuance,also requires the applicant forsuch permit o file asigned.slammenl
that he islmunsed pursuanuo the provisions of the Contractors License Law(Chapter 9 Sq.Ft. Floor Area Valuatiok$850
y_O (commencing wi th Section 7000)of Division 3 of the Business and Professions Code)or
i 3
this he is exempt thimcp oro and the basis for he alleged caemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than BM hundred dollars(1500). 36903008 . 0 0
1,as owner of the preperty,or my employees with wages a their sole compensation,
will do the work,and themructom is not intended or offered for sale(Sec.7D44.Business q rrr��� tt
and ProloCuons Code:The Contractor's License Law does not apply to an owner of RN
f� '1 Required Inspections
Lim,unywhobuildsorinnomssthereon,and whotloessuchwmkhimselfprthougn his U I//,=,\U111�
own employees,provided that such improvements are not intended or offered for sale.If.
however,the building or improvement is sold within one year of completion.the owner-
builder will have the burden of proving the he did not build or improve for purpose of aa00[
sale.). OCT 2 7 L �aJJ
❑1,as owner of the property,am exclusively contracting with licensed connotation,to
consuuct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- (�
se taw does not apply to an owner of property who builds or improves hereon,and, ria p ft�(I ® las\11
who contra to for such projects with a conBacmr(s)licensed pursuant Ne Conuacto's tI1R11')✓s))yllfhl�t(I' 11tjIJ Lu1�V11
License a
exempt under See. ,B&PCfor this reason
C
Owns Data
KER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of to following declarations:
1 W,c and will maintain a Certificate of Consent to self-insum for Worker9Compen-
retioo,as provided for by Section 37M of the Labor Code,for Ne performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,az required by Secdon
37W of the Labor Code,for Ne performance of the work for which this permit is issued.
My Worker's Compenaauan Insurance,Cartier and Policy number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This suction need not be completed Rise permit is forenc hundred dollan,(g IIX)
tar Its,.)
I sonify Lha in the performance of the work far which this permit is issued,I shall not
employ any person in any manner rots to Mc�esubjecua the Workers Comptour ion
Laws of California.Date /'—
Applicant
NOTICE TO APPLICANT:If,a@rmaks gg this of Exemption,you should
become subject to the Worker's Compcnssumn provisions of the Labor Code,you must
,JO fothwi to comply with such provisions or this permit shall be deemed mvoomi. .
Z CONSTRUCTION LENDING AGENCY
(-. I hereby aMrm Nat there is a conswninn kndin6 agency for the performance of
D: the work for which this permit is issued(Sec.3097,Civ.C.)
[a7 Lender's Name
z Len
deh Address
U 0 1 certify that 1 have read this application and state that Ne above information is
ILL F coned 1 agree to comply with all city and county ordinances and sum laws totaling m
OU building constriction.and hereby authorise representatives of this City to enter upon the
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
.Fi r0.A liabilities.judgments,costs and expenses which may in any way accrec against aid City
U in consequence or the gmmingofthis Permit. �'��t'_f,
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date f
SOURCE REGUL'IONS. {
a / Re-roofs '� f
Signature ofAVContractor Dam
I IAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will nhe applicant ur future building occupant score or handle bavamous matunai
az defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety .
Code,Section 25532ta)? �No All roofs shall be inspected prior to any roofing material being installed.
C)Yes `r
Will thea applicant or future building pan aer for t or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
tap s p a Air Quality
.
Fmil it,, us air contaminants az JcfncJ by the Bay Arca Ase Quality Managcmcm all new materials for inspection.
Dist ix?
C]YC'
I have read the havardous materials requirements under Chapter 6,95 of the Calirm-
niaHui"Safety Cock,Sections 25505.25533 and 25534.1 understand that lfthe building
one
not wrrendy have a tenant that it a
my responsibility m no
ry d e acup.,of the
requiremcnae which must M met poor m issuance or a CeNficam or Ocapang Signature of Applicant Dale
All roof coverings to be Class"B" or better
Owa lho' gent Date
nor u—laactl
CITY OF CUPERTINO
m 11 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 # . . . : 05080101
SITE ADDRESS . . . . . : 10159 S BLANEY (BLDG # 11)
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
WE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--- - ------ ---- --- -------- - - ---------- - - - - -- - -- - - - - - - - - - -- ----------
BENERGYADD PLAN SETS 1 .100 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
509 FINAL GRADE 510 FINAL PLANNING
�14 FINAL PUBLIC WORKS
eo
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 34, 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 .
CITY OF CUPERTIN�
rr°r PERMIT APPLICATION FORM
CUPERTINO
O
N # Date: x
Building Address: Mailing Ao ress (if different from building address):
lel-51 SOU // !: _ ,5V) q
Owner's Name: ,(,p et= ,a/t7- j,WF'Alr-r Phone#:
�,�, An/q Si/N3t'T /�/OG C� .OtvL=cp/'»7r.✓%> G- O �J ._�'3 c5�
0 on
ContractorfJ'da > License #:
Mlldee,tl S.tr v c r S we I S'3
Contact: Phone:9?a V->,P Cupertino Business License#:
1F,r/v roti Fax: ,R 7
Building Permit Info: R
Bldg 2' Elect ❑ Plumb ❑ Mech ❑
Job Description: 440C,4S 1'4Y0004 r To , tcc 7?4v S To . .
Residential cz �I ,✓OV dtii ATrA�Nt/J
r,e,v/A<s Commercial ❑
Sq.Ft. Floor Area: AS -k xisT/n/6 $/Sq.Ft.:
60
,Cost of Project: oo Occupancy Group:
Type of Construe on: Please check this box if the project is a
T /oe -V ee 'CIO second-story addition: ❑
ro'ect Size: Standard 2' Largge ❑ 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 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY IEnergy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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�� P!�-- U 7,7�
11 w- CITY OF CUPERTIN
OF PIT APPLICATION MRM
CUPERTINO
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 PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE —Bldg Permit Fees _BUHJDING
BPFIXTURE Pblg 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 Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 clip MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Liglifing 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
BRENfRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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Ra&mISTY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Sigris, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Sob 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_Pe"rmit_Issue""--_ --- PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
•
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