10060120 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19823 PORTAL PLZ CO-;TRACTOR:KRT INC PERMIT NO: 10060120
OWNER'S NAME: LIH-CHUNG KUO 21001 SAN RAMON VALLEY BLVD DATE ISSUED:06/21/2010
ER'S PHONE: 4087365900 SAN RAMON,CA 94583 PHONE NO:(925)556-0632
LICENSED CONTRACTOR'S DECLARATION F F F
5 BU LDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# F
n c , )� � MECH RESIDENTIAL COMMERCIAL
Contractor R Iv Date l8
I hereby affirm that I am licensed under the provisions f Cha ter 9 JOB DESCRIPTION: REPLACE ROOF WINDOW SHRINK OPENING TO
ACl:OMIDATE
(commencing with Section 7000)of Division 3 of the Business&Professions NEI V ROOF FLASHING INSTALL NEW SIDING&TRIM LIKE
Code and that my license is in full force and effect. FOL LIKE
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:$1600
I have and will maintain Worker's Compensation Insurance,as proviF
Section 3700 of the Labor Code,for the performance of the work for AP;J Number:36946035.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above info PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating 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 FROM LAST 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
granting of this permit. Additionally applicant understands and will comply Issiied by Date:
with all non-poiZTtL,,4Aate
n per he Cupertino Municipal Code,S tion _
9.18.
nI /D RE-ROOFS:
Signature 1)4 All roofs shall be inspected prior to any roofing material being installed.If a roof is
instilled without first obtaining an inspection,I agree to remove all new materials for
ins[ection.
IJ OWNER-BUILDER DECLARATION
Sigi iature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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 It.ve read the hazardous materials requirements under Chapter 6.95 of the
Cal ifornia 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(x)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's mai erial. 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 Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with th Cuperti nicipal Code,Chapter 9.12 an
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sect' s 25 ��RDatek)
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent t `
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
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I he reby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. wo►k's for which this permit is issued(Sec.3097,Civ C.)
Ler der's Name
APPLICANT CERTIFICATION Ler der's Address
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
ninon the above mentioned property for inspection purposes.(We)agree to save
mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
,is,and expenses which may accrue against said City in consequence of the I ur derstand 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 Lici rased 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 . . . . . . . . : 36946035 . 00
DATE ISSUED. . . . . . . : 06/21/2010
RECEIPT #. . . . . . . . . : BS000010668
REFERENCE ID # . . . : 10060120
SITE ADDRESS . . . . . : 19823 PORTAL PLZ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LIH-CFUNG KUO
ADDRESS . . . . . . . . . . : 19823 PORTAL PLZ
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : KRT ITC-GARY PIRDDY
CONTRACTOR . . . . . . . : KENNETH R TROUT LIC # 30426
COMPANY . . . . . . . . . . : KRT IrC
ADDRESS . . . . . . . . . . : 21001 SAN RAMON VALLEY BLVD
CITY/STATE/ZIP . . . : SAN RFMON, CA 94583
TELEPHONE . . . . . . . . : (925) 556-0632
FEE ID UNIT QUANTITY AMOLNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----- ----- ---------- ---------- ----------
1BCBSC VALUATION 1, 600 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 1, 600 .00 0 .50 0 . 00 0 .50 0 . 00
1STPLNCK HOURS 1 .00 126 . 00 0 . 00 126 . 00 0 .00
1WINREP EACH 8 1 .00 38 . 00 0 . 00 38 . 00 0 .00
----- ----- ---------- ---------- ----------
TOTAL PERMIT 165 .50 0 . 00 165 .50 0 . 00
CITY 4F
CITY OF CUPERTINO
GENERAL BUILDING
C U P E RT'N 4 PERMIT APPLICATION FORM
jMtoNd-0
APN # Date:
15W o 55. oo
Building Address: ' gga 3 (2o a-T-a L r6A ZA
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA: (Exterior work only) Yes ❑ No E9""If yes, provide letter from HOA
Owner's Name: L!k - C144NG kLl0 Phone #: e�o 9. 43to. rj�jo0
Contractor: p�T- t 1.�, Phone: 445 - 554.-o(,,32-
Fax:
032Fax: SA441%cs
Contractor License
Cupertino Business License #:
Contact: KtAO'4 -t-RCri1GT Phone: 't2-5
Fax: ��'S� 551p-o Co 3 Z
Residential Commercial F-1
Job Description: R&pjAGS - (. k6 r R U AcG -• Roar W&N o w-
Sk1RlNk Ot�C��1INOs TD 14GCC'rvvlD/l'( k44TU "
I w STA L L t t C*L\.T 5L V IN G � M WV\ • W keg 64:4Z L'l 1�
Building Permit Info:
Bldg Lam-- Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B Q_� (1' __r
Valuation: V// op Square Footage:
Project Size: Express ❑ Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set& the sheet index.
joints Achieved:
t1 or help, contact Build it Green at www.builditgreen or
Revised 07/14/09
CITY OF
CITY OF CUPERTINO
Lai GENERAL BUILDING' APPLICATION
CUPERTINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 STUCOAP Stucco Applica tions (up to 400 sf) B
additional stucco application
1 WINREP Replacement windows/sliding glass B
6 door ea 8 windows
1WINMEWSTR New Window-structural shear B
wall/masonry includes plan ck fee
1 EPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Pei mit Fee M
1 PPERMITFEE Plumbing Perrr it Fee P
IELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P
ISTPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
1BCBSC Cal Bldg Stancards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residc ntial B
1BSEISMICO Seismic Commercial B
1 TRAVDOC Travel & Docv mentation B
1 BUSLIC Business License B
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