The URL can be used to link to this page

12080197 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19968 PORTA].PLZ CONTRACTOR:KRT INC PERMIT NO: 12080197 OWNER'S NAME: KWON OH MOON AND IIAE KYUNG 21001 SAN RADION VALLEY BLVD DATE ISSUED:08/27/2012 OWNER'S PRONE: 6266989772 SAN RADION,CA 94583 PHONE NO:(925)556-0632 ❑ LICENSFD CONT'RACTOR'S DECLARATION - BUILDING PERDIIT INFO: BLDG (_ ELECT r PLUDIB r7License Class_ Lic.p 72 5:�( !FO !p r r, r DIECH RESIDENTIAL COAIAIERCI.IL Contractor (� Z C Danc 27 -l— hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE CLERESTORY WINDOW TO (commencing with Section 7000)of Division 3 of the Business&Professions FACILITATE Code and that my license is in full force Solid effect. REROOFING hereby affirm under penaltyof 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. 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 Sq. Ft Floor Arca: Valuation:$1500 permit is issued. APPLICAN'I'CERTIFICA'IION ANN Number:36945008.00 OccupancyType: I certify that I have read this application and state that the above information is correct.I agree m comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section - Signature Date_�� Issued by: �Ei9iY /G/7 Dale: �'•��•�� ❑ O\VNER-BUILDER DECLARATION RP:ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material beug installed.If a roof is the following two reasons: installed without first obtaining an inspection,1 agree to remove all new materials for I.as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sce.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER hereby affirm under penalty of perjury one of the following three Ideclarations: have a d wi RAZ.ARDOUS MATERIALS DISCLOSURE 1 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Ilealth&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the perfomtance of the work for which this Safety Code,Section 25532(a).should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air pemtit is issued, contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work forwhich this permit is issued,I shall maintain compliance with the Cupertino Dlunicipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code.Sections 25505,25533,and 25534. Compensation laws of Cali forma. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Ow e n t razed agent: forthwith comply with such provisions or this permit shall be deemed revoked Date: 7, APPLICANT CERTIFICATION CONST'RUCT'ION].ENDING AGENCY I certify that I have read this application and suite that the above information is I hereby affirm that there is a construction lending agency for the performance of vork's correct.I agree to comply with all city and county ordinances and state laws reigning for which this permit is issued(Sec.3097,Civ C.) to building construction,mid hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against Iiabilitics,judgmems, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCI I ITFCI"S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CONSTRUCTION PERMIT APPLICATION 1G COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION Q 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 \! ) O o CUPERTINO (408)777-3228• FAX(408)777-3333•buildinDancupertino.om ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT q PROPER ADDRESS I-1 I !br` porNe\ •to zc, APN0 �' ^� A45 OO 7� OWNER NAME `� � el PHONE CX, .P9• titi 626 GM 1-12 bfi0.n On ,`• Dm STREET ADDRESS I I Ori \ C', , ,ZIP O` FAX CONTACT NAME ,U• \ PHONE, E-MAIL cN5 0.bovQ. STREET ADDRESS CITY,STATE, ZIP FAX rat OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NANIE V i r" /i LICENSENUMBER LICENSE TYPE Q BUS.LICI�JOLL IO a/ CG%IPANYNAbfE Klp TJ-rU IlME- AIL J J F S t7 r STREET ADDRESS ALI CIN,STATE, 2 ZIP Tool 5 ✓ tan V41.41�`?13LJA S N 6Moe1 GA g58'3 SONE ss�i-06'mZ ARCHITECT/ENGINEER NAhIE LICENSE NUMBER BUS.LIC A COMPANY NA,\CE E-NIAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORT: EMo✓= P�nJ PLS L� i nlDo — I O `�- tT (-J e L--CV EVSTINGUSE PROPOSED USE CONSIR.TYPE •STORIES USE TYPE OCC. SQ.FT. VALUATION EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECI RCH AREA I GARAGE AREA'. DETACH (]ATTACH +DWELLING UNITS: IS A SECO"UNIT LJYES SECONDSTORY YES DEICADDEDr E]NO ADDITION'. EINO i7 PREdPPLICATION ❑YTS IF YES.PROVIDE COPY OF Ia THE BLDG AN ❑1T5 _RECTI\ D Y: TOTAL VALUATION: PLANNINGAPPLX ONO PLANNING APPROVAL LETTER EICHLER HOME'. ANO E Zr -</rl, OOH By my signature below,I certify to each of the following: I am the property owner or authorize agt to act on the property owner's behalf. I have read this application and the information 1 have provided is correct. I have read the Description of WorA and rify it is accurate. 1 agree to comply With all applicable local ordinances and stare laws relatin construction. 1 authorize rep re enlatives of Cupertino to enter the aajbo e-identified property for inspection purposes. Signature of Applicant/Agene to din eT& �y i Date: 1 -:1— SUPPLEMENTAL INFORMATION REQUIRED �iT �fr` .f��cxEci:n•Pn?r�.� -:sL��.�"` RotiTiuc sl lr r.- New SFD or Multifmil7 dwellings: Apply for demolition permit for ❑ o\ rxF.eOUSTcER"•';a'e + BUILDING P-EAN.REVIEW existingbuilding(s). Demolition F$ permit is required prior to issuance of eg permit for new building. ❑ EAPRFss '' rt3 ,;,.•: -y ❑ rl;\NNINc PLnN RFv IFw P' _Commercial Bldgs: Provide acompleted Hazardous Materials Disclosure 3❑`STAN nnao �' �Q""1 ❑ PpB11C wORRY.'A '{� '" •^' T if anv Hazardous Materials are being used as pan of this project. t❑�'u,\Rei 7e-. ❑ FIRe DF{T`Cr"3 �, _Copy of Planning Approval Letter or Meeting with Planning prior to `''t ' �R'�. � ,:vvl S' ' ,} `" -'•� '>I`�r'.^'. ❑ N1\JOR";fi / ❑ Sp ' submitral of Building Permii application. NT\RN 1Iw ER DIS4r.[�riu�. S� r �. ;•. T Q I:N 'IRo MFNTAI.xFAI ni" 't#, BldgApp_201 l.doc revised 06/21/11