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10060117 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19962 PORTAL PLZ CO'4TRACTOR:KRT INC PERMIT NO: 10060117 OWNER'S NAME: LILY LU 21001 SAN RAMON VALLEY BLVD DATE ISSUED:06/21/2010 ER's PHONE: 4083562922 SAN RAMON,CA 94583 PHONE NO:(925)556-0632 LICENSED CONTRACTOR'S DECLARATION f— BU LD[NG PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# r rnrn Nter � MECH RESIDENTIAL COMMERCIAL Contractor i l.'� DateJOB DESCRIPTION: REPLACE ROOF WINDOW SHRINK OPENING TO I hereby affirm that I am licensed under the provisions 9 ACI;OMIDATE (commencing with Section 7000)of Division 3 of the Business&Professions NEIV ROOF FLASHING INSTALL NEW SIDING&TRIM LIKE Code and that my license is in full force and effect. FOI.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 provided by Section 3700 of the Labor Code,for the performance of the work for this AP:J Number:36945030.00 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 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 Iss led by: Date: granting of this permit. Addition the applicant understands and will comply with all non-poi t source regula oris per the Cupertino Municipal Code,S ction 9.18. / RE-ROOFS: Signature Date tf 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 insl ection. LJ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Sig iature of Applicant: Date: 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I hove 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 ma ntain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: He:ilth&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 ma 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 Air Quality Management District I performance of the work for which this permit is issued. wil maintain compliance with the Cupertino u ipal Code,Chapter 9.12 an 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sect' s 25 5,25 33 nd 25 3 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Ow ner or authorized agent: ate: 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. woi k's for which this permit is issued(Sec.3097,Civ C.) Lei der's Name APPLICANT CERTIFICATION Lender'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 upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION mnify and keep harmless the City of Cupertino against liabilities,judgments, .s,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 Lic rased Professional 9.18. Signature Date CITY OF CITY OF CU PERTINO GENERAL BUILDING CUPERTINO PERMIT APPLICATION FORM APN # � D� Date: 2 ( `v Building Address: /'?9�v Mailing Address (if different from building address): 6( , 4tw rLook vo-, , Cos Cr4l-65 , CAL, Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: (Exterior work only) Yes ❑ No Ifes, pro letter from HOA Owner's Name: L 6 LLI L Phone #: 1/ o6 15 Contractor: 1c RT t NC., Phone: 9.2 5 - 55 G-o 40 3 2 Fax: SA- A(S Contractor License #: �,544?68 Cupertino Business License #: Contact: Ktg�4 -rRCMJX Phone: 9 215 Fax: ��'5- 55lp-o(o3Z Residential Commercial ❑ Job Description: ClaFIAC61 (.L�2� R Lt kC -- Roo F W i N Vo car' S k- R i t.ak o 19(S N t NC-, To A CCc ktA i DA,T(& P jT LLr Pao lr 1 LJ 5TA L t�L C�t(� SSG IN f� q6 t VY1 • Ll l�2 Building Permit Info: Bldg ❑ Elect ❑ Plurr b ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B ❑[-- Valuation: V//4Bo. op Square Footage: Project Size: Express E9-----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. oints Achieved: For help, contact Build it Green at www.builditmen.ol Revised 07/14/09 CITY OF CITY OF CUP'ERTINO GENERAL BUILDING' APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applica ions (up to 400 sf) B additional stucco application .pNv kcte \0`4. 1 WINREP Replacement windows/sliding glass B io ; 9-cu door ea 8 windows 1 WINMEWSTR New Window-Structural shear B wall/masonry i ncludes plan ck fee IEPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Pei mit Fee M 1 PPERMITFEE Plumbing Perrr it Fee P 1ELCPLNCK Stand Alone Electric Pin Ck(hourly) E 1MECPLNCK Stand Alone Mechanical Pin Ck(hrly) M 1PLMBLNCK Stand Alone Plumbing Pin Ck(hrly) P ISTPLNCK-(3 Hr Min Standard Plan IMeck (when no E/M/P) B when not over counter hourly-stand al one I 1BCBSC Cal Bldg Stanc.ards Commission Fee B ALL PERMIT TYPES I 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Comniercial B -&W" P 1TRAVDOC Travel & Documentation B 1 BUSLIC Business License B 5 of 5 CITY OF CUPERTINO 4 ITEMS OF 40 PERMIT RE-_EIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36945030 . 00 DATE ISSUED. . . . . . . : 06/21/2010 RECEIPT #. . . . . . . . . : BS000010668 REFERENCE ID # . . . : 10060117 SITE ADDRESS . . . . . : 19962 PORTAL PLZ SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER LILY LU ADDRESS . . . . . . . . . . : 116 HILLSBROOK DR CITY/STATE/ZIP . . . : LOS GPTOS, CA 95032 RECEIVED FROM . . . . : KRT INC-GARY PIRDDY CONTRACTOR . . . . . . . : KENNETH R TROUT LIC # 30426 COMPANY . . . . . . . . . . . KRT INC ADDRESS . . . . . . . . . . : 21001 SAN RAMON VALLEY BLVD CITY/STATE/ZIP . . . : SAN RPMON, CA 94583 TELEPHONE . . . . . . . . : (925) 556-0632 FEE ID UNIT QUANTITY AMOL:NT 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 OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19962 PORTAL PLZ CON TRACTOR:FRANK FIALA ROOFING PERMIT NO: 10060183 INC VER'S NAME: LILY LU 1228 QUARRY LN STE C DATE ISSUED:06/30/2010 OWNER'S PHONE: 4083562922 PLEY►SANTON,CA 94566 PHONE NO:(925)484-0124 ❑ /LICENS(E�D CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT F PLUMB License Class G 7 Lic.# ".F / fr' �� � MECH F RESIDENTIAL I- COMMERCIAL� Contractor k / /'LC1ct Date r �P� I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG K-RMV OLD B.U.R.INSTALL 1/4"DENS DECK. INST ALL CLASS A DURO-LAST ROOFING SYSTEM 6.3SQ (commencing with Section 7000)of Division 3 of the Business&Professions 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.F t Floor Area: Valuation:$6583 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. `, — APN Number:36945030.00 Occupancy Type: APPLICANT CERTIFICATION 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 HERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 18O DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the :1$0 DAYS FROM LAST CALLED INSPECTION. 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. Issu!d by: Date: /eI ature I Date 7 ///"g ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of insta led without first obtaining an inspection,I Xree toemove all new materials for the following two reasons: inspe ction. 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, Sign rture f p icant:- Date: Business&Professions Code) 1 1,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 I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I ha,,e read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the Cali ornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. com')Nance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safe y Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Add tionally,should I use equipment or devices which emit hazardous air cont rminants as defined by the Bay Area Air Quality Management District I will permit is issued. main Main compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,S coons 25505,25533,and 25534. 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 Owr er or authorize t Date:�O become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I her-by affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Len,ler's Name r�building construction,and hereby authorize representatives of this city to enter i the above mentioned property for inspection purposes.(We)agree to save Lender's Address .—emnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I un(lerstand my plans shall be used as public records. 9.18. Lice used Professional Signature Date CITY OF CUPERTINO 2 ITEMS OF 36 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 36945030 . 00 DATE ISSUED. . . . . . . : 06/30/2010 RECEIPT #. . . . . . . . . BS000010736 REFERENCE ID # . . . : 10060183 SITE ADDRESS . . . . . : 19962 PORTAL PLZ SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . LILY LU ADDRESS 116 HILLSBROOK DR CITY/STATE/ZIP . . . : LOS GA.TOS, CA 95032 RECEIVED FROM . . . . : WM A FIALA CONTRACTOR . . . . . . . : FRANK R. FIALA LIC # 31229 COMPANY FRANK FIALA ROOFING INC ADDRESS . . . . . . . . . . : 1228 QUARRY LN STE C CITY/STATE/ZIP . . . : PLEASANTON, CA 94566 TELEPHONE . . . . . . . . : (925) 484-0124 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 583 . 00 1 .00 0 . 00 1 . 00 0 . 00 1REROOFRES SQ FEET 6 . 00 78 .00 0 . 00 78 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 79 . 00 0 . 00 79. 00 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF MY of ( oo CITY OF Ct TERTINO RERc SOF CU'PERTMO PERAHT APPLICATION APN# I?ate: A2 9 ez®`O Building Address: �'�c i G z.CA_ Owner's Name: L� l Lq Phone#: qb�- �S(L)- dW� HOA: Yes g No If es proov-de letter from HOA Contractor: -'(�C�-� 16LtC�L. oo L Ili `1 1��' , Phone #:q 3 �' a�``VAC, � . .s Fax#:e �1c� q a - �- �- Cupertino Business License.#: , -� Contractor License#: Type of Roof Covering: Existing.• Proposed: it ❑ Built-Up roof Built-Up Roof P ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes o Wood Shapes ❑ Wood Shingles ❑ Wood Shingles. ❑ Other(Specify) ( Other (Specify)U(C) S? �- Number of existing coverings ©ne ❑ Provide I.C.C.E.S. Report# E To..be Removed a Provide Mfgr. Installation Specs. Job Descriptio e,nno\e, 4� S�-c�. Residential Commercial Green Building: Please cont fete relevant-.pardon of the Coed with Planning.Dept. if Green Buulding Checldist&�Itach it to the application or if there are any restrictions: ❑ apjRlicable,include in plan set & the sheet index. Valuation: I Have Read,Understand and Will Comply with Cupertino's Tear-Off Policy: 7-� Signature Revised 42/05/09 REROOF TEAR-OFF POLICY ,,...� COMMUNITY DEVELOPMENT DEPARTMEI4T-BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE-CUPERTINO, CA 35014-3255 cu"o (408)777-3228- FAX(408)777-3333-builds ig a_cupertino.org PROJECT ADDRESS 1 cin \ R f cJ APN k OWNER NAMELII Lt PHOrl S. 3,S! - w E-MAIL STREET ADDRESSI i� 'Poi �Z C1TY. Wro ATE Zl P q FAX CO RACTORAM LICENSE NUMBER. LICENSE TYP BUS.LIC.N ' a� C>Df'n g, 0- ' C.-3 COMPANY N FAX -1 Q 111e. E �l0. as- s aa� ctry l rE cLnion, lP P >,2a�_.L49 0��� I UNDERSTAND AND-AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable Irovisions of the 2007 California Building Code. 2. You must schedule all needed inspections a minimuni of one day before the requested inspection date. Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon-Fri). 3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this inspection. A building inspector will be available wi�hin one hour. There are special hours for this service: 7:30 — 10::t0am and 1:00—3:30pm (Mon—Thurs); 7:30 — 10::;0am and 1:00 —2:30pm (Friday). 4. If plywood is installed, a plywood nailing inspection. is required. 5. In-Proeress roof inspection is required. Call for ar.in-progress roof inspection to verify building is weather tight after installation of approximately 25% of the roofing material. 6. New roof coverings shall not be.applied without first obtaining all inspections and written approvals from the building inspector. Any roofing which is ap?lied without first obtaining an approved inspection will require the removal of;all new material down to the sheathing so a proper inspection can be performed. 7. A final inspection and approval shall be obtained from the building inspector when the re-roofing is complete. To receive a final sign-off, the following items will be verified: a. Flat roofs shall have a minimum of%4"per foot o F slope and must demonstrate there is no ponding. b. Listings from approved testing agencies for all pie-manufactured products used shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation. 8. NOTE: If you call for a tear-off or plywood nailing i nspection and the work is not.complete, you will be charged a re-inspection fee of$126.00. The re-inspection fee _shall be paid before another inspection can be scheduled. By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the property owner's behalf. I understand. o c fnply with the re-roof policy stated,above. Signature of Applicant/Agent: Date: V0.2-2110 ReroofPolicy_2010.doc revised 05/17110