10090169 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20060 RODRIGUES AVE BLDG 12 CONTRACTOR:DEVERA PERMIT NO: 10090169
CONSTRUCTION INC.
WNER'S NAME: LAKE BILTMORE APARTMENTS 1941 D BERRYESSA RD DATE ISSUED:09/20/2010
SAN JOSE,CA 95133 PHONE NO:(408)441-9598
ONVNER'S PHONE: 6509313400
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class__D- Lic.#
MECH RESIDENTIAL COMMERCIAL
t
Contractor LK_Date
JOB DESCRIPTION: BLDG 12 APT H DRYER VENTS:DRYER VENT,LAUNDRY
I hereby affirm that I am licensed under the provisions of hapter 9 &
(commencing with Section 7000)of Division 3 of the Business&Professions M.BATH FAN NOT VENTED TO OUTSIDE
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two 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 Valuation:$300
performance of the work for which this permit is issued. Sq.Ft Floor Area:
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36903008.20060.12 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAY$—OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS LACALLED INSPEC ION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of theIssued by: -- - ' Date: =
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. RE-ROOFS:
nature __.j2 � Date_C _ All roofs shall be inspected prior to any roofing material being installed.If a roof is
t _ installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION Date:.
Signature of Applicant:_,
hereby affirm that I am exempt from the Contractor's License Law for one >f ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons:
I.as owner of the property,or my employees with wages as their sole compensaticn,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE
1,as owner of the property,am exclusively contracting with licensed contractors it,
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
the Health&Safety Code,Sections 25505,25533,and 25534.
(have and will maintain Worker's Compensation Insurance,as provided for by �
Section 3700 of the L abor Ccde,for the performance of the work for which this Owner or authorized agent:_ Date:/ t
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shal
not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
I must 1 hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor Code,
work's for which this permit is issued(Sec.3097,Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Name
APPLICANT'CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct.1 agree to comply with all city and county ordinances and state laws relal ing
wilding construction,and hereby authorize representatives of this city to enter
a the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
waemnify and keep harmless the City of Cupertino against liabilities,judgments
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature_ Date.
CITY OF CUPERTINO
4 ITEMS OF 40 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: BlY: Lot:
APN . . . . . . . . : 36S03008 .20060 . 12
DATE ISSUED. . . . . . . : 09/ 20/2010
RECEIPT #. . • • . . . . . : BS(i00011498
REFERENCE ID # . . . : 10()90169
SITE ADDRESS . . . . . : 20060 RODRIGUES AVE BLDG 12
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LA:CE BILTMORE APARTMENTS
ADDRESS . . . . . . . . . . : 19 )0 S NORFOLK ST STE150
CITY/STATE/ZIP . . . : SAJ MATEO, CA 94403
RECEIVED FROM . . . . : DEVERA CONSTRUCTION
CONTRACTOR . . . . . . . : HEVRY DEVERA LIC # 24605
COMPANY . . . . . . . . . . : DEVERA CONSTRUCTION INC.
ADDRESS . . . . . . . . . . : 941 D BERRYESSA RD
CITY/STATE/ZIP . . . : SAID JOSE, CA 95133
TELEPHONE . . . . . . . . : (408) 441-9598
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- ---------- ---------- -
1BCBSC VALUATION 300 . 00 1 . 00 0 .00 1 . 00 0 .00
1BREMVENFA NO UNITS 1 .00 21 . 00 0 .00 21 .00 0 .00
1MPERMITFE FLAT RATE 1 .00 42 . 00 0 .00 42 .00 0 .00
1TRAVDOC FLAT RATE 1 .00 42 . 00 0 .00 42 .00 ------0_00
- --------- ---------- ----------
TOTAL PERMIT 106 .00 0 . 00 106 .00 0 .00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----------------------------
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL
508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR-- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
IQAPN: BP#: EVALUATION: $300
PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY t C)"l,tI PENTAMATION 1 RMAP8
USE: Multi-Family Dwelling r,'/-00R..;,'I-i. PERMIT TYPE: i
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Ventilation Fan 1BREMVENF 1 # $21
TOTALS: $21.00
Mech.Plan Check 0.0 hrs $0.00 plomb, I'l,",Chccl
Fmech.Permit Fee: 1MPERMIT F'hu rig. Prrrr;l 1 cr: I:'r;c ter.,=pair t:a
Other Mech.Insp. 0.0 hrs $42.00 01her F'Itvrnh IrSp, C,ptfu>r!i'cp lry,
3.kch. h2,q).!,rr Pr''pnulr. Irr.t. !' fare lnsp. I x
NOTE: These fees are based on the preliminaigy in ormation available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS !Fee Resohr n 09-051 E . 77!101 FETE QTY/FEE MISC ITEMS
Plan Check f'CC.
Suppl. PC FCC
PME Plan Check: 10.00
Permit Fee:
.Srappl. 111sp Fee
PME Unit Fee: $1d 1.00
PME Permit Fee: $42.00
(7onstruction Tax
acoustical Rcvie�v Fee:
Work Without Permit? 0 Yes O No $0.00
Planning'Fees:
Travel Documentation Fee: 1TRAVDOC $12.00
Strong Motion Fee: Ado' Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
SUBTOTALS: $10 $0.00 TOTAL FEE 0
Revised: 9/14/2010
J V CITY OF (-UPERTINO
PEK
CU INO GENE", BUILDING
PERMIT APPLICATION FORM
APN # Date: 9/ /
�5 _3 00-x- ��? • 12- ►5 2010
Id
Building Address:
200f�C� RCDR►GUES AVE=NUE 1JN►T i2-H
Mailing Address (if different from building address):
IDI5q Sl7UTH BLANEY AVE=NUE CUPF_Rr1K0 , CA 015014
Are Hazardous Materials being used as part of this project? Yes L No
HOA: (Exterior work onl ) Yes ❑ No ® If yes,provide letter from HOA
Owner's Name: Phone* (tp )) 431- 3400
PROM 1;THEUS REAL ESTATE
Contractor: Phone: (409) 441 -q5a 91
DEVERA CONSTRUCTION , INC Fax: 4141 —8372
Contractor License* to4c)415
Cu ertino Business License#: 2.4005
Contact: Phone: �40% 14141
DEL Tot-AND Fax: 4t)S Lg4l
Residential Commercial
Job Description:
owl'' 12H DRYER VENT AND L.11ANDRY FAN NUf VENTED TD OUis"DE
MASTER 5AT►-1 FAN 1)OT VENTED TU CUrS1pE
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
N
1-A, 1-B ❑ E=-A ❑ II/VI B, IV-HT, -B ❑
Valuation: Square Footage:
g 30o.DD
Project Size: Express ❑ Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Bui3ding/LEED Checklist & attach it
to the application or if applicab:.e, include in plan set & the sheet index.
oints Achieved:
For help, contact Build it Green at www.builditueen.or
Revised 07/14/09
Z