10090168 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20040 RODRIGUES AVE BLDG 11 CONTRACTOR:DEVERA PERMIT NO: 10090168
CONSTRUCTION INC.
'.VNER'S NAME: LAKE BILTMORE APARTMENTS 941 D BERRYESSA RD DATE ISSUED:09/20/2010
OWNER'S PHONE: 6509313400 SAN JOSE,CA 95133 PHONE NO:(408)441-9598
L'IC�ENSED CONTRACT�OR'Sl DECLARATION BUILDING PERMIT INFO: BLDG� ELECT r PLUMB
License Class Lic.# I— �
MECH r— RESIDENTIAL COMMERCIAL
Contractor 7 ,�
"At—"ate L0
JOB DESCRIPTION: BLDG 1 I-APT B&D
I hereby affirm that I am licensed under the provisions of C apter 9 DRYER VENTS:
(commencing with Section 7000)of Division 3 of the Business&Professions I 1 B-LAUNDRY FAN AND DRYER VENT NOT VENTED TO
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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$300
1 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:36903008.20040.11 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 relatin€ WITHIN 180 DAYS 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 F lY1-FAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
applicant understands and will comply Issued by: Date:
granting of this permit. Additionally,the app /
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
nature Date _ Ail roofs shall be inspected prior to any roofing material being installed.If a roof is
_ installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant:_ _Date,
I hereby affirm that I am exempt from the Contractor's License Law for one c f
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
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
1 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 wnich this permit is issued will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Health&Safe
H
he eaSafety Code,Sections 25505,25533,and 25534.
I have and will maintain Worker's Compensation Insurance,as provided for by t 1�
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:_ l�
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall
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
become subject to the Worker's Compensation provisions of the Labor Code,1 mt st I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)Lender's Name
APPLICANT CERTIFICATION Lender's Address
i certify that 1 have read this application and state that the above information is
I correct.I agree to comply with all city and county ordinances and state laws relati Ig
uilding 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
indemnify 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 feguiations 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: Blk: Lot:
APN 36903008 .20040 .11
DATE ISSUED. . . . . . . : 09/20/2010
RECEIPT #. . . . . . . . . BS000011498
REFERENCE ID # 10090168
SITE ADDRESS . . . . . : 20C40 RODRIGUES AVE BLDG 11
SUBDIVISION . . . . . . .
CITY CUFERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LAKE BILTMORE APARTMENTS
ADDRESS . . . . . . . . . . : 19(i0 S NORFOLK ST STE150
CITY/STATE/ZIP . . . : SAIF MATEO, CA 94403
RECEIVED FROM DEVERA CONSTRUCTION
CONTRACTOR HENRY DEVERA LIC # 24605
COMPANY DEIIERA CONSTRUCTION INC.
ADDRESS 94:_ D BERRYESSA RD
CITY/STATE/ZIP SAN JOSE, CA 95133
TELEPHONE (41)8) 441-9598
FEE ID UNIT QUANTITY .5jMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- - --------- ---------- -
00
1BCBSC VALUATION 300 . 00 1 . 00 0 .00 1 .00 0 •
1BREMVENFA NO UNITS 2 .00 42 .00 0 . 00 42 . 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 127 . 00 0 .00 127 . 00 0 .00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-
__ _ ------- -----------------------
-- ------------
03 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
3
503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL
508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR--BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: EVALUATION: $300
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION 1 RMAP8
USE: Multi-Family Dwelling /i,��<},1 ., r- PERMIT TYPE:
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Ventilation Fan 1BREMVENF # $21
TOTALS: $ 00
Mech.Plan Check 0.0 hrs $0.00 1"himb, i lrrrt c'ficrr F'/_c. !'r<.i,r C'I:,xs
Mech.Permit Fee: 1 MPERMITt: aih. FerrttilF��t:lhi - �itdc.
Other Mech.Insp. 0.0 hrs L $42.00 t?�hc�, P;ur,21�I�rs��- Uttr�� [:ifs. Irrsr,.
i:�axf?. Ir..ii). l`'< 1'hr�nb_ Iii.+./�. t•�ra
P2��j
NOTE: These fees are based on the preliminaty in ormation available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS(Fee Resolution 09-051 E . 7i1110) FEE QTY/FEE MISC ITEMS
Plafi Check Fcc:
Suppl. P('F02
F77--
PME Plan Check: 90.00
Permit Fee:
Suppl, Insp F,ec
PME Unit Fee: $121.00
PME Permit Fee: $42.00
(`anso-iwtion 7cL
�<:ousttcr.rl Rcri�::..v hee':
Work Without Permit? 0 Yes E) No 50.00
Planningl'cres:
Travel Documentation Fee: 1TRAVDOC $42.00 i
Strom Motion Fee: Select an Administrative Item
�7
Bldiz Stds Commission Fee: IBCBSC $1.00 ��'
SUBTOTALS; $1 i)6 $0.00 TOTAL FEE: .50
6 Revised: 9/14/2010
h
0.'
V a
CITY OF C;UPERTINO
CUPS Of
GENERAL, BUILDING
PERNUT APPLICATION FORM
APN# Date:
(n 1 03 OOS", OONO- // q�i5 �2olD
P
Building Address:
20040 RODRIGOES AVENUE UNIT IID UNir 11 [3
Mailing Address (if different from building address):
IOI�q SOUTH OL-ANEY AVENUE , CUPE'RrINC , CA q5014
Are Hazardous Materials being used as part of this; project? Yes No
HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA
Owner's Name: Phone#:
PRpMET-HF0S REAL ESTArF Ci ROUP ( &50) Q31 - 3400
Contractor: Phone: (qCg) 1141 -q5 q 8
DF-VERA CONSTRUCTION, INC. 0$ 441 -Lq379'
Contractor License#: 6140415
Cupertino Business License#: 24Co 05
Contact: Phone: �4D 8) N 4l -q5 q S'
DEL TOLA N D Fax: 4a 1 -q3 7 g
Residential Commercial ❑
Job Description:
UmI► IID BAT14 FAN NCT VENTED -M OUTSIDE
uNrr II13 LAUNflRy FANRND DRYER VENT NCr VENTED ib plaiSlDE
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): �,� Occupancy Type:
1-A, 1-B ❑ H=-A ❑ II/❑ B, N-HT, V-B ❑ AM
Valuation: Square Footage:
4 We-co
Project Size: Express ❑ Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green BuildinglLEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Ants Achieved:
for help, contact Build it Green at www.bullditgreen.oriZ
Revised 07/14/09
s