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15120037CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19460 RICHWOOD CT CONTRACTOR: KUBRO CONSTRUCTION PERMIT NO: 15120037 OWNER'S NAME: LIM PONG AND ESTHER TRUSTEE & ET AL 658 ARBUTUS AVE APT 3 DATE ISSUED: 12/04/2015 OWNER'S PHONE: 6505751360 SUNNYVALE, CA 94086 PHONE NO: (408) 839-5800 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] �� d 1 REPLACING (E) SLIDING DOOR AT DINING ROOM AND License Class_, Lic. # 7I REPLACING (E) HALLWAY SLIDING DOOR WITH (N) t� n, Contractor KUBRO U�� lantll�ti�► Z 4 l5 WINDOW AT SAME LOCATION AND SAME WIDTH. I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 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 Sq. Ft Floor Area: Valuation: $1500 performance of the work for which this permit is issued. K,ave and will maintain Worker's Compensation Insurance, as provided for by ion 3700 of the Labor Code, for the performance of the work for which this APN Number: 37501011.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 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 6441 granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: 1 with all non -point source regulations per the upertino Municipal Code, Section RE -ROOFS: 9.18. �� nature Date •= All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION ' Signature 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 1, 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 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: Health & Safety. Code, Section 25532(x) 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 Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. t Section 3700 of the Labor Code, for the performance of the work for which this J Owner or authorized ager ..,ail Date: i permit is issued. 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. work'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 upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, 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 CONSTRUCTION PERMIT APPLICATION COMIdiUNITY DEVELOPIAENT DEPARTMENT -BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 85014-3255 r (408) 777-3228 - FAX (408) 777-3333 - buHdino(c—�cuDerlino.ora CUPERTINO, ❑ KEEW CONSTRUCTION L1 ADDITION ❑ A.Li ERATION / TI ❑ REVISION / DEFERRED 1 -5 12 ou3a ORIGIN a1, PERIYE T J IPRoj_Cr ADDRSS iow i'1 Pi r u i. i/wn 12N _ 'A' :7 '�- _ n f — 1 / OR`NERNA}✓Bt,1�2JvC� S ?iON�6 5*7S I E•NRIL S -170-H-1 A-DDRESS Ci i Y, STATE, ZIP I FAX 12=3 q tg COty?ACT NAME PHONEN:AII STREET ADDRESS J� �` /� , , 1 '❑ CITY, STATE, ZIP I FAX OV r1t ❑. 011'h_P,-3UIIDEZ Ol�?�rRAG tiT Co\-r.4CTOR ❑ COKI?.4CTOR'.GTT ❑ 'ac=—CT ❑ _'1 GLS=�R ❑ Dc1_LOPS ❑ !_}�fh? CONiZi J CTORNA}✓E I LICEN'SENUA4EER w 3o I LICTSE TYPE I BUS. LIC R COlf3ANYNA�,� E•NSIL �� I ku g Com. Nk L Co I FAX STREET P DDR CS5z) WILL, p I L L C- ( CITY, STAin�i� �� N or 5( �`+ 1 � PiiOlh� 0 3 � 3-1 S2 ARC?Si ECT/ENGD EER NA ✓:E I LICENSE NTT'ASER 3T23. LIC R COMPANY NAME E-MAIL FAX STREET ADDRESS I CITY, STAT R: ZIP I PH01rL DESCRIPTION OF WORK fZv--t Q 9� a C ®4i� AJD'Z&?LkCe !p' 114 E)3STLNG USE PROPOSED L'SE CONSTR. TYPE "STORIES i USE TYPEI OCC. SQ.FT. VALUATION (i) E715T0 N`EW FLOOR DEMOI TOTAL AREA AREA AREA MET AREA BA7HPIOO}vi Iii Ci Id OTS R REMODEL AREA7FL2,103DELAREAE PBI,iODHL AREA PORCH AREA D=CK F.RE.A TOTAL DECKIPORCii ?.RSA G.=Rf GE P+i h:L DETACH ❑ Ai TACH DA,* LLIt\G I.ThZS:I IS A SECOND UNIT 13YES SECOND STORY ❑Y=S BEING ADDED? E) NO I ADDITION? ❑NO PRZ_- DPLIC.STIO ❑Yrs IF Y'nS, PROVIDE COPY OF IS THE BLDG AN ❑ Y S D 3Y T — TOTss. VA-LUATION: PLAN ING P?P m X17 NO PLAT7\7I2\G P.PPROVAL LM -TER EICHLER HOME? ] NO _ v By my signature below, I certify to each of the following: lam the proper -j= owncr or authorized agent to act e propel L ow-ner's behalf. I have read this application andtheinformation I have prouided-s cor eet._ I=haves read t e-Description-of'Wark-and-ve-rij=-it is-accuratec= I aPree to -comply --with all applicable local-- '- ordinances and state 1a„s relating to building conSuUction. I aLthOr]- e• . SCntatives'of CllDe.rtlno to enter the above-' 'entifsed P ropaity for inspection purposes. .-. Sl�latLre or ADDlIC4']VAg ^i. .-. _ _....... ........ ... ._-' �_..._...,.... _,._ Dat'v:.-__. _2.: SUPP� �1r_ TAL Ii\F NATION REQUIRED OY�RT1;✓COL�iTx-R New SFD or Muhifarnily du eliinzs: Apply for demolition p=it for- 'r�building(s). T, t o -.r t r icc t exists-:, Demolition pe ..-its required prior to _ uance oT build;_- a- BLTILDL'�G'PL3Rr«t,tY�. pe�nIsit for new building.— _ ComlTlercial Bl-dgs: Provide a completed H_7ardous Materials Disclos re - Ent _2 L� Te}�e� forum if any Hazardous Materials are being used as part of this project. - _ Copy of Planning Approval Leer or l\!eetin- with PlannirQ prior to i Subcmllttal of BLsldir_g Pt,iInit application. *L470R _ � T�Ta YSER RIDIcIRICI _ ' '�T YiFiOnNENI-S n�SZT� Bldg:,�P.P_2011.doc revised 06/21/11 CITY OF CUPERTINO FFF. FRTIMATOR - RUII,DING DIVISION imADDRESS: 19460 Richwood Ct DATE: 12/04/2015 REVIEWED BY: Phuong APN: 375 01 011 BP#: *VALUATION: 1$1,500 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: = # $431.00 PENTAMATION 1 GENRES PERMIT TYPE: A WORK Replacing a sliding door at dining room and replacing a hallway sliding door with n window at same SCOPE location and same width. NOTE: This estimate does not includefees due to other Departments (i.e. Planning, Public Works, tire, sanitary sewer uistrccr, acnoot District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept_ for aaan'l into. FEE ITEMS wee Resofutiorl .1.1-053.Eff. 7/1/132 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # $431.00 Window / Sliding Glass Door 1 WINREP Replacement Suppl. PC Fee: Q Reg. 0 OT 1 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. Q OT70.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 t L173' 77a<SF L'11 .'s> see Work Without Permit? 0 Yes 0 No $0.00 Advanced. Planning Fee: $0.00 Select a Non -Residential Building or Structure i Strong Motion Fee: IBSEISMCR $0.50 Select an Administrative Item Bldg Suds Commission Fee: IBCBSC $1.00 .SU�BTOTALS $1.50 $431.00 , TOTAL FEE : $432.50 Revised: 10/01/2015 SCRG ; tE AW Sal D1w C &J Ptss ��'D � 1�� J iT1� �C�A �U \:)oVJ at--� ® c4A.-O � 6A 9,5011-1 -P`1 �A 6T 0(--- FF COMMUNIT BUILDI This set o — —W'v I UC mtpl d[ ine" job site during construction. It is unlawful to make any changes or alterations on same, or to deviate therefrom without approval from the. Building Official. The -'amping of chis plan and specifications SHALL NOT be held to perm: t or to be an approval of the violation of any picvis:- is of any City Ordinance or State Law, BY 614 ' e DATE PERMIT # I K�1 7 00 RECEIVED GL;, G 4 2G l� BY REVIEWED FOR CODE COMPLIANCE Reviewed By: 7�� r t:CUPERTINO f � q Ll0 RIC INCOD Cf, OWNER:'P—1 .0014 Cu-WRTI-Id LA- ef50tl-1 IPI C StlDlw& GLA5s Dook Go�vE2-c -TO 6'X3' L- , fp(Atl I�COA (' SUD�NCg �lFt5517�il� 'e'vYL ACE w 1113- MEW 1 to SL�b11SC� C�<I�S {100, vi la N& Rbbyl CSP Ri1N® epa1tment _,r ¢ Euildi�9 ODE COMpL1ANCE REVIEW FOR C BY R evlewed