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11060113 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19948 PORTAL PLZ CONTRACTOR:KRT INC PERMIT NO: 11060113 OWNER'S NAME: YI-CHANG WANG 21001 SAN RAMON VALLEY BLVD DATE ISSUED:06/16/2011 C11"NER'S PHONE: 4089961128 SAN RAMON,CA 94583 PHONE NO:(925)556-0632 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB 'n 19r License Class ./ Lic.# � MECH RESIDENTIAL COMMERCIAL Contractor_(C( Date 1 l I 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 and effect. REROOFING 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 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1800 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:36945026.00 Occupancy Type: 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Aeg`777� Date t 1. Issued by �� — Date: �+ \ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: 1 have and will 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 performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air 1 certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. 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. Je7��dagent. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of"ork's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, C and expenses which may accrue against said City in consequence of the Lender's Address ig of this permit.Additionally,the applicant understands and will comply wwm all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 27 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36945026 . 00 DATE ISSUED. . . . . . . : 06/16/2011 RECEIPT #. . . . . . . . . : BS000013792 REFERENCE ID # . . . : 11060113 SITE ADDRESS . . . . . : 19948 PORTAL PLZ SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . YI-CHANG WANG ADDRESS . . . . . . . . . . : 19948 PORTAL PLZ CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-3329 RECEIVED FROM . . . . : K.R.T. , INC. CONTRACTOR . . . . . . . : KENNETH R TROUT LIC # 30426 COMPANY . . . . . . . . . . : KRT INC ADDRESS . . . . . . . . . . : 21001 SAN RAMON VALLEY BLVD CITY/STATE/ZIP . . . : SAN RAMON, CA 94583 TELEPHONE . . . . . . . . : (925) 556-0632 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 800 . 00 1. 00 0 . 00 1 .00 0. 00 1BSEISMICR VALUATION 1, 800 . 00 0 .50 0. 00 0 .50 0. 00 1WINREP EACH 8 1. 00 380. 00 0. 00 380 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 381.50 0. 00 381 .50 0. 00 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: DATE: 06/14/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$1,800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK remove and replace clear story window to facilitate reroofing SCOPE NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn7 info. FEE ITEMS (Fee Resolution 09-051 E . 7-1.110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Window/Sliding Glass Door Suppl.PC Fee: G Reg. 0 OT 0.0 hrs $0.00 $380.00 1WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Feel@ Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 4 Acoustical Fee: 0 Yes ) No $0.00 Q Work Without Permit? 0 Yes E) No $0.00 G Plaaming Fee $0.00 Select a Non-Residential G Building or Structure Q i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $380.00 TOTAL FEE: $381.50 Revised: 04/29/2011 CONSTRUCTION PERMIT APPLICATION �,✓ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building(a)cupertino.org \ ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS IS To 1h rPL, ^L�2-.,k Q A # �t//� q� o�J�., OWNERNAME 11/ "l r l/ "� �fC� (�J PH QQ E-MAIL STREET ADDRESS CIT�Y++STATE,ZIP G !r FAX l.� pE.�CT,j�✓C3 ��0 I T CONTACT NAMEE-MAIL PHONE E-MAIL� •e^ zJcct s3cC�c STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAILK T T� C.- LICENSE NUMBER s-�� LICENSETYPE �� BUS.LIC# 3 O K COMPANY NAME J.- E-MAIL C7 �►-y� l T-NG K1't.'(=Alc a, SBc�wQs►c,. til - 01 a FA r . STREET ADDRESS CI Y,STATE ZIP PHONE -k1001 S R,An,o� VAu.Ey woA '-ISI P Moo CA5g di:)Is- -d3z ARCHITECT/ENGINEF,R NAME LICENSE NUMBER BUS LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 7 DESCRIPTION OF WORK rw IV-O USG .--N _ &4-- Cf—C2 g fz_S To 2 5 T pa 1 O 1 't'',a IFA 4T t- e2Do L-A GE MSL N r EXISTING USE PROPOSED USE CONSTR.TYPE N STORIESML: Y DESCMMON SUFT, VALUATION S, EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER - REMODEL AREA REMODEL AREA REMODEL AREA ' PORCH AREA DECKAREA TOTAL DECK/PORCH AREA GARAGE AREA:❑ DETACH — __t_ ❑ ATTACH a DWI TA IN(,UNIT'S IS A SECOND UNrr ❑YLs SECOND STORY ❑YI:S BUNGADDED'. ❑NO ADDITION- ❑NO PRI;.APPLICA ZION ❑ YL, IF YLs.PROVIDE.CO}'Y OF PLANNER'S NAME, RECEIVED BY, TOT'r.. LUATrON: PLANNING APDL 9 ❑ NO PLANMNO APPROVAL I.EI i'LR By my signature below,I certify to each of the following: I am the property owner or authorized agent 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 and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t ilding construction. I authori re r ves of Cupertino to enter thea ove-identified property for inspection purposes. Signature of Applicant/Agent Date: t� SUPPLEMENTAL INFORMATION REQUIRED PLAN G> TYPE' xoUtNGsrn New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER- cauNTeR ❑ BvrtDtNGPtANREvtEw existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ ExPREss ❑ PLANNMG PLAN RE%rrJEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD Pusuc WORKS form if any Hazardous Materials are being used as part of this project. 0 LARGE, a i=i Dmyr _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. ❑ MAJOk o si NlTARYSEvVERDISTWCr Ct.`C`NWRONMENTAc IMAL x BldgApp_201 Ldoc revised 03/16/11