12080196 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19982 PORTAL PL7 CON'TRACT'OR:KRT INC PERMIT NO: 12080196
OWNER'S NADP E: LIU PEIYA ET AL 21001 SAN RADION VALLFY BLVD DATE ISSUED:08272012
OWNER'S PIIONF,: 4089781263 SAN RAM ON,CA 94583 PRONE NO:(925)556-0632
❑ LICENSED CON'IRAC-FOR'S(D�ECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB
License Class Lic.q -2 �'Y �Qj ��,��' /1_ r M, r'
ra-_'-1,; /L �'� 1fECH RESIDENTIAL COMMERCIAL
Contractor- tmiz r�npc
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RENIOVE&REPLACE CLERESTORY WINDOW TO
(commencing with Section 7000)of Division 3 of the Business S Professions FACILITATE
Code and that my license is in full force and effect. REROOFING
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to sclf-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 Fluor Area: Valuation:$1500
permit is issued.
APPI,ICANPCF.R'I'IFIC,\TION APN Number:36945001.00 Occupancy Type:
I certify that 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against Iiabilities,judgments,
costs,and expenses which may accrue against said City in consequence ofthe WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands mid will comply, 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. (� may/
Signature_ — Date 6 �� Z Issued by: /,��/✓ /9j�i� Date:fj'-a7�'p
❑ OWNER-RUILDER DECLARATION
RE-ROOFS:
hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,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(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,nm exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETFER
1 hereby affirm under penalty of perjury one of the follaving three
declarations:
I have and ill maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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 S 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 S
Section 3700 of the Labor Code,for the perfommnce of the work for which this Safety Cade.Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Ilealth&Safety Code.Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate ofexemption,I
become subject to the Worker's Compensation provisions of the Labor Code,1 must Own r o r'. d agent: Mate'
�—
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION CONS'T'RUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating 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 liabilities,judgments, 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 IITECI"S DECLARATION
with all non-point source regulatims 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 r\' -I "
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION �C/ 0
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 o
CU PERTI NO (408)777-3228• FAX(408)777-3333•buildingGncuoertino.om
❑NEW CONSTRUCTION El ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMITN
PROIER ADDRESS ^Q 1 o
4r�\ P\��G APN B
OWNER NAA C \ ( � PH hE
P�1 q LIN.., .�Aa t---=t•L�-.-o-r Ors R-11 1263
STREET ADDRESS �1 a0f \ �a CITY,STAIE,ZIPo. FAX
f C" a.1�GC,p. Ci0
CONTACT NAME PHONE E-MAIL
STREET ADDRESS n /I I/ CI Y.STATE,ZIP A-
FAX
OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAhB: K R 1 TN ( LICENSEhVNIBER LICENSETYPE Q BUS.LIC �JQ Lf �`
COMPANY NAME KR T•1.-` 1 C_ EM1IAIL l J F \ J5/5T 0(6
STREET-L 001 S .Je9n o VgKre7GF_VP 141 ern.STtel L.NP t�MOCI GA 8583 os Ss6-D6•�
ARCHITECTIENGIN'EERNAStE V LICENSENUh1BER BUS.LIC4
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORE:
EXISTING USE PROPOSED USE CONSTR.TYPE I YSTORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NETAREA
BATHROOM KITCHEN OTIiER
REMODELAREA REMODEL AREA REMODEL AREA
PORCH AMA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA' DETACH
ATTACH
Y DWELLING UNITS'. ISASECONDUNIT ❑YES SECONDSTORY QYES
BEING ADDED? ONO ADDITION? ONO �^
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF ISTHEBLIIGAN ❑YTSrRECEiD r}�I�'+��.. w `'• TO,T/ALfTV�A'L}UATION;
PLANNING APPLY ONO PLANNING APPROVAL LEITER EICHLER DOMES 0 N •t�{' 4
By my signature below,I certify to each of the following: I am the property owner orauthortzed/hiep to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work,andrift'it is accurate. I agree to comply with all applicable local
ordinances and state laws relating tto building construction. I authorize pr a tali Cupertino t enter the aboovrridentifie�property for inspection purposes.
Signature of Applicant/Agenl: UN— er L Z' _�� -Date
SUPPLEMENTAL INFORMATION REQUIRED *""
T•+.Ic PI,AN CHECK TYPEy.:�F y;,,�"•}I.ur. ROUTING 511Pn
New SFD or Multifamily dwellings: Apply for demolition permit for `-'r �M %'r- ' 'r� '• "'" ' -g' �+r`` -p`e' iT^>9
Y 'ERTHE.COUNT •,,,§ER. y❑'BUILDING PLAN RE\mw
existing building(s). Demolition permit is required prior to issuance ofbuilding a I + t' rz �y��6'
permit for.new building. ❑ E\PRFSSj "`r'''�' ❑ PITA\1nC PLA\KEY tEw dLo -..
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure t❑ sTo Rl � "`2 ❑❑ tiB IcuoRFs '?'"�"
Tom if anv Hazardous Materials are being used as pan of this project f•� �Y;,s
-❑ L\RC6.1(w.. ri13I+':a ElFlRE DFPisr
Copy of Planning Approval Letter or Meeting with Planning prior to 'iae- ' - " T-r Y+rµSs'' ' �"^:r:=' ' '} .?
submittal of Building Permit application. `us�oRta; •5 � -%,,,.� �❑�SANITARYSFNER DISTRICT$ yy
-0 ENVIRO VNIENT LIIEALTIFMini"
B(dgApp_201 Ldoc revised 06/21/11