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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 1 of3 �� 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 2 of 3 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 • 3 of 3