10060116 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19956 PORTAL PLZ CONTRACTOR:KRT INC PERMIT NO: 10060116
�+OWNER'S NAME: CHEE&SHIRLEY TUNG 21001 SAN RAMON VALLEY BLVD DATE ISSUED:06/21/2010
+ VNER'S PHONE: 4088676447 SEAN RAMON,CA 94583 PHONE NO:(925)556-0632
LICENSED CONTRACTOR'S DECLARATION r
BI ILDING PERMIT INFO: BLDG ELECT PLUMB
License Class rl., Lic.#
� MECH RESIDENTIAL COMMERCIAL
Contractor � t.�°► Date
JC B DESCRIPTION: REPLACE ROOF WINDOW SHRINK OPENING TO
I hereby affirm that I am licensed under the provisions of Chapter 9 AC'COMIDATE
(commencing with Section 7000)of Division 3 of the Business&Professions NI W ROOF FLASHING INSTALL NEW SIDING&TRIM LIKE
Code and that my license is in full force and effect. FC R 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 f
Section 3700 of the Labor Code,for the performance of the work for w i t s AI'N Number:36945035.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above i formation is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.1 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. Additionall the applicant understands and will comply Ismby:
� Date:
with all non-point source regulatios p the Cupertino Municipal Code,Section _
9.18.
RE-ROOFS:
Signature ee" Date a A'I roofs shall be inspected prior to any roofing material being installed.If a roof is
in;tailed without first obtaining an inspection,l agree to remove all new materials for
in;pection.
L3 OWNER-BUILDER DECLARATION
Si;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 rave read the hazardous materials requirements under Chapter 6.95 of the
C ilifornia 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
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 contaminants as defined by the Bay Area Air uality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Mui ipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by tt a Health&Safety Code,Sectio 25505,2Mg!
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: 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 iereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. w ork's for which this permit is issued(Sec.3097,Civ C.)
Lender'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
croon the above mentioned property for inspection purposes.(We)agree to save
'emnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
..,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 Licensed Professional
9.18.
Signature Date
CITY OF
CITY OF CUJPERTINO
10
GENERAL BUILDING
L U P E RT I N O PERMIT APPLICATION ON FORM
APN # �9 445-
15 03500 Date: /
Building Address:
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA: (Exterior work only) Yes ❑ No If yes, 3rovide letter from HOA
Owner's Name: Phone#: o g,
C 6A Lat5 4 ,5[4 (R l.C5 N Tu res Cs
Contractor: t<R r t NC., Phone: 9A5 - 55 G-O 4c 3 2-
Fax: SA-PACS
Contractor License #: ��,5V4?o8
Cupertino Business License #:
Contact: KtgZq -rRCMXT Phone: `t 2'�
Fax: W-5- 554-o!05Z
Residential Ir Commercial ❑
Job Description: R&p,Ac6 , l.. kdr �R �.t kG Rcso F W t�Va t-
SaEa�w4� o��c�NiNG Tc ro►•trcu+n%ba-ct=� Fc.�ast+tNv-
1 Q sTa L L t L C Lr -T 5L V IN 6a aG *'3Z1 N(1 Lt l Lt
Building Permit Info:
Bldg D! Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
I-A, I-B ❑ ILII/V-A ❑ 11/111 B, IV-HT, V-B [I, 9-- (
Valuation: #//&Bo• op Square Footage:
Project Size: Express ❑ 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.
oints Achieved:
i
for help, contact Build it Green at www.builditgreen.or
Revised 07/14/09
CITY OF
CITY OF CU]PERTINO
91 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 stuc:o application
t .Div de- l�I-j IDIWINREP Replacement viindows/sliding glass B
$,0(7 door ea 8 windows
1 WINMEWSTR New Window-structural shear B
wall/masonryI includes plan ck fee
l EPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pin Ck(hourly) E
1 MECPLNCK Stand Alone Mechanical Pin Ck(hrly) M
1 PLMBLNCK Stand Alone Plumbing Pin 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 IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Resid:ntial B
1BSEISMICO Seismic Commercial B
&"M 410 cyw,(�( -
1TRAVDOC Travel & Dociunentation B
1 BUSLIC Business License B
5 of 5
CITY OF CUPERTINO
4 ITEMS OF 40 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36945015 . 00
DATE ISSUED. . . . . . . : 06/21/2010
RECEIPT # . . . . . . . . . : BS000010668
REFERENCE ID # . . . : 100601/6
SITE ADDRESS . . . . . : 19956 ]AORTAL PLZ
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . CUPERT: NO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . : CHEE & SHIRLEY TUNG
ADDRESS . . . . . . . . . . : 19721 SCOTLAND DR
CITY/STATE/ZIP . . . : SARATOGA CA, 95070-5031
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