10060118 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19966 PORTAL PLZ COPITRACTOR:KRT INC PERMIT NO: 10060118
OWNER'S NAME: DAVID HUANG 2 10 01 SAN RAMON VALLEY BLVD DATE ISSUED:06/21/2010
VNER'S PHONE: 4089960896 SA'1 RAMON,CA 94583 PHONE NO:(925)556-0632
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT I— PLUMB
License Class Lic.#
%V1
MECH[_ RESIDENTIAL r— COMMERCIALr
Contractor Date
JOI;DESCRIPTION: REPLACE ROOF WINDOW SHRINK OPENING TO
I hereby affirm that I am licensed under the provisions of Chapter 9 ACCOMIDATE
(commencing with Section 7000)of Division 3 of the Business&Professions NEA✓ROOF FLASHING INSTALL NEW SIDING&TRIM LIKE
Code and that my license is in full force and effect. FOF 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 for by
Section 3700 of the Labor Code,for the performance of the workfor w ' is AP V Number:36945032.00 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 Lied by: Date: �Z1�
granting of this permit. Additions the applicant understands and will comply
with all non-point source reguVonser theCupertino MunicipalCode,Section
9.18. /� ny rROOFS:
Signature Date tG !� All 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
ins section.
IJ OWNER-BUILDER DECLARATION
Si€nature 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
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)
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 t ave read the hazardous materials requirements under Chapter 6.95 of the
Cf lifornia 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 m:derial. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the aii•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 upertino M is al Code,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti 2550 2553 ,a 25534'" /
Section 3700 of the Labor Code,for the performance of the work for which this O vner or authorized agent: Date:
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,I must I I iereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. w)rk's for which this permit is issued(Sec.3097,Civ C.)
L-nder's Name
APPLICANT CERTIFICATION L°nder'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
,non 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,
...,ts,and expenses which may accrue against said City in consequence of the I .mderstand 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
CITY OF CUPERTINO
GENERAL BUILDING
C U P E RT E N° PERMIT APPLICATION FORM
APN # � Date:
Building Address: 9gn62-ra !, f2LA
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 H—,If yes, rovide letter from HOA
Owner's Name: Phone #:
�/av i C� �u A�ry C� 41 off•44Co. 08`lCp
Contractor: IAC R-r t NC, Phone: 4A 5 - 55 G-o(0 3 2-
Fax:
Fax: 54- A(S
Contractor License #: :jt�5WOZ
Cupertino Business License #:
Contact: KM-4 rt'R6UCT Phone: 't2-15 - o-gS 30
Fax:
Residential [ Commercial ❑
Job Description: pj Ac-C�5 - (-1.�� �- U kG ' Rao f W I N V0 L
Sov,iwk 019C9NiNCy To A-C-CoWn(,pL3� �trs�� �aot� F��SNtNG-
t Q STALL t L C$C-.T St V IN G -6 t3�,m - Ll kLQ le Ll
Building Permit Info:
Bldg N, Elect ❑ Plurlb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, I-B ❑ II/IIIN-A ❑ II/VI B, IV-HT, V-B [--}- �Z' I
Valuation: #/,&Bo. op Square Footage:
Project Size: Express Standard ❑ Lar e ❑ 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.buiiditgreen.c r
Revised 07/14/09
CITY OF
CITY OF CUPERTINO
GENERAL BUILDINIs APPLICATION
CUPERTINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
1�I V e 1 WINREP Replacement A indows/sliding glass B
IQ 3 door ea 8 win lows)
1 WINMEWSTR New Window-:structural shear B
wall/masonry includes plan ck fee
I EPERMITFEE Electrical Pern-it Fee E
1 MPERMITFEE Mechanical Pe:mit Fee M
1 PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P
I 1STPLNCK-(3 Hr Min Standard Plan IMeck (when no E/M/P) B
when not over counter) hourly-stand alone
I 1BCBSC Cal Bldg Stanc ards Commission Fee B ALL PERMIT
TYPES
1 IBSEISMICR Seismic Resid(ntial B
IBSEISMICO Seismic Co=-ercial B
1 TRAVDOC Travel & Doci:mentation B
1BUSLIC Business Licer se B
5 of 5
CITY OF CUP]IRTINO
4 ITEMS OF 40 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: LDt :
APN . . . . . . . . : 36945032 . 00
DATE ISSUED. . . . . . . : 06/21/2010
RECEIPT #. . • . . . . . . : BS000010668
REFERENCE ID # . . . : 10060118
SITE ADDRESS . . . . . : 19966 PORTAL PLZ
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER DAVID HUANG
ADDRESS . . . . . . . . . . : 19966 PORTAL PLZ
CITY/STATE/ZIP . . . : CUPERgINO, CA 95014
RECEIVED FROM . . . . : KRT IT\C-GARY PIRDDY
CONTRACTOR . . . . . . . : KENNE'T'H R TROUT LIC # 30426
COMPANY . . . . . . . . . . : KRT IYC
ADDRESS . . . . . . . . . . : 21001 SAN RAMON VALLEY BLVD
CITY/STATE/ZIP . . . : SAN R7,MON, CA 94583
TELEPHONE . . . . . . . . : (925) 556-0632
FEE ID UNIT QUANTITY AMOUNT 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 :-26 . 00 0 . 00 126 . 00 0 . 00
1WINREP EACH 8 1 . 00 38 . 00 0 . 00 38 . 00 0 . 00
---- ------ ---------- ---------- ----------
TOTAL PERMIT :,65 . 50 0 .00 165 .50 0 . 00