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10060124
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19822 PORTAL PLZ CONTRACTOR:KRT INC PERMIT NO: 10060124 OWNER'S NAME: YOHAN LEE 2 1 C 0 1 SAN RAMON VALLEY BLVD DATE ISSUED:06/21/2010 ✓NER'S PHONE: 3102183884 SAN RAMON,CA 94583 PHONE NO:(925)556-0632 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# r r ,��-- ,t � o{ MECH RESIDENTIAL COMMERCIAL Contractor �YL I �1"�. Date �1 O� I hereby affirm that I am licensed under the provisions of Cha ter 9 JOI DESCRIPTION: REPLACE ROOF WINDOW SHRINK OPENING TO ACC OMIDATE (commencing with Section 7000)of Division 3 of the Business&Professions NES I ROOF FLASHING INSTALL NEW SIDING&TRIM LIKE Code and that my license is in full force and effect. FOR 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:$1600 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the workfor w 'c is APN Number:36946041.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Addition the applicant understands and will comply Issued by Date: with all non-poi t source regula ons er the Cupertino Municipal Code,Section _ 9.18. /- RE-ROOFS: Signature Date l$ I D All -oofs shall be inspected prior to any roofing material being installed.If a roof is Inst;filled without first obtaining an inspection,I agree to remove all new materials for ins f ection. Li OWNER-BUILDER DECLARATION Sign 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) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I hs ve 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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Hes Ith&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 material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air -ontaminants as defined by the Bay AreaAir ality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino M al Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio s 2550 255 d 25 3 Section 3700 of the Labor Code,for the performance of the work for which this110 permit is issued. Owner or authorized agent: ate:_�V 0011 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 hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. wor k's for which this permit is issued(Sec.3097,Civ C.) Ler der's Name APPLICANT CERTIFICATION Ler der'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 ^gin the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION minify 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;nsed Professional 9.18. Signature Date CITY OF CURERTINO 4 ITEMS OF 40 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: L,:)t : APN . . . . . . . . : 36946011 . 00 DATE ISSUED. . . . . . . : 06/21/ 2010 RECEIPT # . . . . . . . . . : BS000010668 REFERENCE ID # . . . : 10060124 SITE ADDRESS . . . . . : 19822 PORTAL PLZ SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER YOHAN LEE ADDRESS . . . . . . . . . . : 19822 PORTAL PLZ CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-3363 RECEIVED FROM . . . . : KRT IN:!-GARY PIRDDY CONTRACTOR . . . . . . . : KENNET3 R TROUT LIC # 30426 COMPANY . . . . . . . . . . . KRT IN:! ADDRESS . . . . . . . . . . : 21001 3AN RAMON VALLEY BLVD CITY/STATE/ZIP . . . : SAN RA14ON, CA 94583 TELEPHONE . . . . . . . . : (925) 556-0632 FEE ID UNIT QUANTITY AMOU\TT 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 155 .50 0 . 00 165 .50 0 . 00 CITY OF CITY OF CU.PERTINO GENERAL BUILDING C U P S RT t N O PERMIT APPLICATION FORM D12 APN # � -4� ��J � Date: Building Address: Mailing Address (if different from building address): 411c /J. P,a.1,t u t--sA AV. r2\6 p©N D o 6c*A cw I GA A Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: Exterior work only) Yes ❑ No If Yes, provide letter from HOA Owner's Name: Y&04,4 L Phone #: -310, al$, 3 S9� Contractor: p<p,T' t�„, Phone: �'- A 5 - 55 G-O!0 3 2- Fax: 5A-wt6 Contractor License #: J��ZH69 Cupertino Business License #: Contact: K&.04 -CRO-LET Phone: `tZr,, 'S c'g83-4 Fax: �- Residential Commercial ❑ Job Description: R&F/,QC-6 - C- k6 fry f,?- U kG Rao F W&N Va U-r S ov,i N k C AS N t NCs TD A GGtr w�l DaT� D'l(s l�.s' dao l� F L'�S lit N� IQSTALL Acscu 5LbtNG �; rRihn - (-tvz.g trcrz Building Permit Info: Bldg 9-- Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: F] F1nc 1-A, 1-B II/III/V-A II/III B, IV-HT, V-B [ V f Valuation: #/j . ap Square Footage: Project Size: Ex ress 0' 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. Points Achieved: Z!�O- For help, contact Build it Green at www.builditgreen.o r Revised 07/14/09 CITY OF CITY OF CUPERTINO 1-01 GENERAL BUILDINis APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Descripti:)n Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B 17 additional stucco application 0q () � 1 WINREP Replacement windows/sliding glass B 1 4 door ea 8 windows 1 WINMEWSTR New Window-:tructural shear B wall/masonry ncludes plan ck fee IEPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Pei mit Fee M 1 PPERMITFEE Plumbing Perm it Fee P 1 ELCPLNCK Stand Alone El-Ictric Pln Ck(hourly) E 1 MECPLNCK Stand Alone M echanical Pln Ck(hrly) M I PLMBLNCK Stand Alone Pl imbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone I 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES I 1BSEISMICR Seismic Residential B IBSEISMICO Seismic Commercial B 1TRAVDOC Travel & Documentation B 1BUSLIC Business License B 5 of 5