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10060121 CITY OF CUPERTINO DUILDING PERMIT BUILDING ADDRESS: 19902 PORTAL PLZ CONTRACTOR:KRT INC PERMIT NO: 10060121 OWNER'S NAME: YUNG-CHING WANG 21001 SAN RAMON VALLEY BLVD DATE ISSUED:06/21/2010 VNER'S PHONE: 4084472504 SAN RAMON,CA 94583 PHONE NO:(925)556-0632 LICENSED CONTRACTOR'S DECLARATI N BUILDING PERMIT INFO: BLDG I— ELECT r PLUMB License Class Lic.# MECH r— RESIDENTIAL F_ COMMERCIAL Contractor Date JOI;DESCRIPTION: REPLACE ROOF WINDOW SHRINK OPENING TO I hereby affirm that I am licensed under the provision of Ch ter 9 ACC'OMIDATE (commencing with Section 7000)of Division 3 of the Business&Professions NEN I ROOF FLASHING INSTALL NEW SIDING&TRIM LIKE Code and that my license is in full force and effect. FOP 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 Section 3700 of the Labor Code,for the performance of the work for whi t i AP14 Number:36946009.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION �T 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 led by: Date: granting of this permit. Additional ,the applicant understands and will comply with all non-point source regulat' ns er the Cupertino Municipal Code,Section 9.18. Ak&r �� RE-ROOFS: Signature Date (G ` All roofs shall be inspected prior to any roofing material being installed.If a roof is insl alled without first obtaining an inspection,I agree to remove all new materials for IF V insl Pection. tJ OWNER-BUILDER DECLARATION Sig 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 h ive read the hazardous materials requirements under Chapter 6.95 of the Ca ifornia 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 1 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 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 Cupertino Anicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety CodeASeet* 5 5, 5 (and 25534. )Section 3700 of the Labor Code,for the performance of the work for which thisOv ner or authorized ageDate: / permit is issued. 1 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 h;reby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. we rk's for which this permit is issued(Sec.3097,Civ C.) Le nder's Name APPLICANT CERTIFICATION Lender'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, .sts,and expenses which may accrue against said City in consequence of the I understand 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 Li sensed Professional 9.18. Signature Date CITY Or- CITY OF CU PERTINO GENERAL BUILDING C U P E RT t N a PERMIT APPLICATION FORM 10W© la l APN # Date: �g Ll(P ppb .pU Building Address: QD�a too Qra L, P L iA ZA Mailing Address (if different from building address): Are Hazardous Materials being used as part of this prc ject? Yes ❑ No HOA: (Exterior worli only) Yes ❑ No �f yes, provide letter from HOA Owner's Name: Y u"A& ^ G ���� Phone #: Z/0 9. Contractor: p<RT- t t,�, Phone: 9A 5 - 55 G-O Co 3 2- Fax: 5AWACS Contractor License #: �r,j#4?o$ Cupertino Business License #: Contact: Kt96-4 TRCMJCr Phone: `t -'S-*4 -8833 Fax: �a-5' 551P-olo3Z Residential Commercial ❑ Job Description: LlcS<P[,ACCE; U kG -- Rao 1+ W&N 00 QW- SV*a�r�ir� o��c�Nir�G To ,a.Gccuv�%aa-� A tUx Paot� FLAS4(r4G- 1 Q STA L L N4 MLI,-T SSL V LN Cis Building Permit Info: Bldg Or Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/VI/V-A ❑ II/VI B, IV-HT, V-B [--- Valuation: 4W//�.Bo. op Square Footage: Project Size: Express [I— Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of th--, Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set& the sheet index. 'oints Achieved: Lfor help, contact Build it Green at www.builditgreen.o r Revised 07/14/09 CITY OF CITY OF CUPERTINO GENERAL BUILDING 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 Ovid h 1 WINREP Replacement windows/sliding glass B 0 �.(� door ea 8 windows 1 WINMEWSTR New Window-structural shear B wall/masonry i ncludes plan ck fee 1 EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone EL;ctric Pln Ck (hourly) E 1 MECPLNCK Stand Alone M,,chanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Phunbing Pln Ck(hrly) P I 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 IBSEISMICR Seismic Reside itial B 1BSEISMICO Seismic Comm;rcial B 1 TRAVDOC Travel & Documentation B 1 BUSLIC Business Licen,;e B 5 of 5 CITY OF CUPERTINO 4 ITEMS OF 40 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lott : APN . . . . . . . . : 36946019 . 00 DATE ISSUED. . . . . . . : 06/21/:2010 RECEIPT # . . . . . . • • . : BSOOOOL0668 REFERENCE ID # . . . : 10060121 SITE ADDRESS . . . . . : 19902 PORTAL PLZ SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : YUNG-CHING WANG ADDRESS . . . . . . . . . . : 19902 PORTAL PLZ CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-3364 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 RTMON, 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