The URL can be used to link to this page

10060122 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19890 PORTAL PLZ CONTRACTOR:KRT INC PERMIT NO: 10060122 OWNER'S NAME: ERIKA ORTIZ 2 10 01 SAN RAMON VALLEY BLVD DATE ISSUED:06/21/2010 VNER'S PHONE: 4082573051 SAN RAMON,CA 94583 PHONE NO:(925)556-0632 N( LICENSED CONTRACTOR'S DECLARATION T r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# r-- .,,.! - MECH# RESIDENTIAL COMMERCIAL Contractor�� L", Date [� r f JOE DESCRIPTION: REPLACE ROOF WINDOW SHRINK OPENING TO I hereby affirm that I am licensed under the provisions of Cha ter 9 ACC OMIDATE (commencing with Section 7000)of Division 3 of the Business&Professions NEVI 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. A Floor Area: Valuation:$1600 1 have and will maintain Worker's Compensation Insurance,as provided fbVbn Section 3700 of the Labor Code,for the performance of the work for w ' th APPI Number:36946010.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION /9 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 2- granting granting of this permit. Additiona ,the applicant understands and will comply Isst ed by: Date: with all non-point source regulat' ns er the Cupertino Municipal Code,Section _ 9.18. / RE-ROOFS: Signature Date l/ l D All i oofs shall be inspected prior to any roofing material being installed.If a roof is inst;Bled without first obtaining an inspection,I agree to remove all new materials for insp-ction. IJ OWNER-BUILDER DECLARATION Sigr ature 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 have read the hazardous materials requirements under Chapter 6.95 of the Cal fornia 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: Hep 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 mal 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 :ontaminants 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 Cupertino M i al Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505.255 d 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Ow ger or authorized agent: - _U Date: 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-eby 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 is 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 -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, -its,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 Lia;nsed Professional 9.18. Signature Date �* eITY 4F IQCITY OF CUPERTINO GENERAL BUILDING cT a PERMIT APPLICATION FORM APN # Date: I CP c0 0 I b . OU &'—'Z�,�o Building Address: Q$g o fro 2l-A L P&42-4 Mailing Address if different from building address): Are Hazardous Materials being used as part of this p roject? Yes ❑ No HOA: (Exterior work only) Yes ❑ No ��If yess, provide letter from HOA Owner's Name: Phone #: �fo8•�-��- 30�� Contractor: I<Rr Phone: 4A5 - 55 Contractor License #: jf�5964?og Fax: SA-mcs Cu ertino Business License #: Contact: KtRN TRcrLcr Phone: `t 215 - Fax: 0'' 57- 551.-o!o �Z Residential Commercial ❑ Job Description: ClFsPl,�►�6 (,i;k6 6 lZ Lt kG - Rao r W oc3 L S1+V,I N o t�t� NCy TD �4 GCe VY�i DQE DJ(s(mss' �Za D l� F L S N l N� i►j s-rq LL Wetas StdlN� a6, �vv1 • Lt kca l561Z V l�r,6 Building Permit Info: Bldg Q, Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B [� Valuation: / �Bo, ap / Square Footage: -Project Size: Express Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of thf Green Building/LEED Checklist& attach it— ,oints t'oints Achieved: to the application or if applicable, include in plan set& the sheet index. L L�or help, contact Build it Green at www.builditgreen.or Revised 07/14/09 CITY OF CUP]3RTINO 4 ITEMS OF 40 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 369460L0 . 00 DATE ISSUED. . . . . . . : 06/21/ 2010 RECEIPT # . • . • • • • • . : BSOOOOL0668 REFERENCE ID # . . . : 10060122 SITE ADDRESS . . . . . : 19890 ?ORTAL PLZ SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER ERIKA DRTIZ ADDRESS . . . . . . . . . . : P.O. BJX 2775 CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 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 RAMON, 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 . 00 126 . 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