12090182 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 888 CANDLEWOOD DR CONTRACTOR:RBT CONSTRUCTION,INC PERMIT NO: 12090182
OWNER'S NAME: CHIEN-PING LU R CHARLENE LEE 489 DOHA DR DATE ISSUED:09/20/2012
OWNER'S PHONE: 4085925443 SAN JOSI1,CA 95117 PHONE NO:(408)261-2327
❑ LICENSED CONTRACTOR'S DI?CLARA"PION
��� � � BUILDING PERMIT INFO: BLDG (- ELECT❑ PLUMB r
License Class ,�T(� Lia# n
-�'— —` hI F.CII [ RESIDENTIAL (J COMMERCIALr
I hereby
or Date
hereby affirm That I a en,ed unJer the provisions o Chapter 9 306 DESCRIPTION:REMOVE AND REPLACE THE STUCCO AT THE FRONT
(commencing with Section 7000)of Division 3 of the Business&Professions ELEVATION(800 SQIT)AND KITCHEN REMODEL(110 SQF1)
Code and that my license is in full force and effect.
hereby affirm under penaly 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.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of die work for Which this Sq.PI Floor Aren: Valuntion:$15000
permit is issued.
API'I,IG\\I'CER'1'IFIG\T'10N A PN Number:36919025.00 Occu pancy Ty pe:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
_
Signature Date
r—>/ Issued by: , fru%Gf7 Date:
❑ OWNER-RUILDER DECLARATION
RE-ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Laefor one Of All roofs shall be inspected prior to any roofing material bcimg installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,andthe structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sce.7044,Business R Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR RI:ITER
I hereby affirm under penally of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IIA%ARDOUS DIATERIALS DISCLOSURE
Compensation,as provided Ibr by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of work for which this permit is issued California Health S Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health S
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should 1 store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. conlaminants as defined by the Ray Area Air Quality Management District I will
I certify that in the performance of die work for which this permit is issued I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
not employ any person in any manner sons to become subject to the Worker's
Health S Safely Code,Sections 25505,2 533,and 25534.
Compensation laws of California. If,alter making this certificate of exemption,I
become subject to the Worker's Compensation provisions ofthe labor Code,I must Owner n authorized agent / I h_
forthwith comply with such provisions or this permit shall be deemed revoked. wL� Dale: �(
Al'I'LICANT'CIiR'I'IFICA'I'ION CONSTRUC"FION LII\DING AGEVNCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned propeny for inspection purposes.(We)agree to sore
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence Of the
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCH ITIiCf'S DECLARATION
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CONSTRUCTION PERMIT APPLICATI6N(D -�
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 I
CUPERTINO (408) 777-3228 • FAX (408)777-3333• building(o)cuperlino.org �� I
❑ NEW CONS-1-RUCI-ION ❑ ADDITION ALTERATION/TI ❑ REVIS ION I DEPERRED ORIGINAL PERMIT#
PROJECTADDRESS APNH ( Z' I9_0
OW, d `v r V PHONf((l) ^ , /(� E-MAIL �
.\IE
STREET O� CITY, STATE,ZIP FAX
CONT CT NAM - ([ "- I PHONE E-SIAIL A-j h�y
STR EfA O @J O O, �!1jv /�/p CITY,4ATG •LIP `v /,1/1' — u�W FAX
1313OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT (,J4ONTRACTOR ❑COW, ACTORAGENT 11 `AYRCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONT L? R NAME LICE# mj;R LIC SE TYPE BUS.LIC q
oUa
COMPANYISAME n 6o /-_ ' E-\TAIL FAX
STREET ADDRESS �1, �/ry CITY,STATE,ZIP,,, Cp �� Z PHONE
ARCHITECT/ENGINEER NAME 1.10ENSENUAIBER IVU BUS,LIC# OSI 'r
COMPANY NAME E-SIAIL FAX -
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORE: _
/D D 1. ' ./J i lG/ G E /��i✓J EG.
SCIS NGU PROPOSED USE CO\STR-TYPE 1 0STORIES
USE TYPE OCG SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEStO TOTAL
AREA AREA AREA NET AREA /
BATHROOM MCHEN OTHER
REMODEL AREA RESIODEL AREA •ID REMODELAR❑\
PORCH AREA DECK AREA TOTAL DECKWORCH AREA GARAGE AREA- oItACII
❑ATTACH
#DWELLING UNITS: ISASECOSo ti N I'1' ❑ ES SF,CONUS'I'ORY ❑YFS
masG,um)eua ADurnDN? 0t0
PRC-APPLICATION []YTJi IF YES,PROVIDE COPY OF IS'I'Ell:BLDG AN ❑YES RECEIVED BY: - TOT,\ VALUATION:
PLANNING APPL# P<0
PLANNING APPROVAL LETTER r.ICHLERHOMt:! ,EI-NO _ / 220/
By my signature below,I certify to each of the following: I am the propeny owner or authorized agent to act on the propeny owner's behalf. I h5ve read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply With all applicable local
ordinances and state laws relating to building consuuction. I authorize representatives of Cupertino 10 enter the above-identified proply or inspection purposes.
Signature of ApplicanVAgem: Date:
SUPPLEMENTAL INI' 'ION REQUIRED I-LANCueCK1'YPE ROU'rINGSIAP
_New SFD or h'lultifamily dwellings: Apply for demolition permit for o\•ER=ruF:couNTER BUILDING PIAN:REVIRW
eXisting building(s). Demolllion perrnil is required prior to issuance of building �,,/
permit for new building. ❑ EXPRESS tA�PLANNING PII REVIEW
_Commercial Bldgs: Provide a completed I lazardous Materials Disclosure ❑ SIANDAao ❑ I'UBLICSS'ORKS
four if am' Hazardous Materials are being used as part of this project.
❑ 1.\RGE ❑ FIRE UEPT.
_Copy of Planning Approval Letter or Mccling With Planning prior to -
submittal of Building Permit application. ❑. MAJOR - ❑ S,\NI'1'AR1'SE\YEH DISI'RICI'
❑ enwnovau:N'cu;uenl:ru
BldgApp_T011.doc revised O6/21/11
CiTY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
2 ADDRESS: 888 Candle Wood Dr. DATE: 09/20/2012 REVIEWED BN':.Sean
APN: BP#: 'VALUATION: $15,000
*PERMIT TYPE: Building Permit PLAN CIIECK TYPF,: Alteration/ Repair
PRIMARYPENTAMATION
USE: SFD Or DUpIBX PERMITTYPE: 1GENRE
WORT: Remove and replace the stucco at the front elevation 800 sq ft. and Kitchen Remodel 110 sq ft).
SCOPE
Ahmh. Plan Check Phaub. Plan Check E/ec.-Plan Check
blech, Pencil Fee: Plumh. Permit Fee: I Elec. Permit Fee:
011ier A1ech.Insp. Otter Plumb/nap. Other Clcv.Insp.
,Meth. hnap. Fee: Phmtb. brep.Fee: Flee. hasp.Fee:
NOTE: This estimate does not includejeev clue to other Departments(i.e. Planning, Public{forks, Fire,Sanitary Server District,School
District,etc.). These ees are based on lite prelintinan•in orntrttion available and are onlh,an estimate Contact the Dept for aildn'I info.
FEE ITEMS (Fee Resolution /1-053 Elf 7/1/1/1 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 800 s.f. Re5[LICCO
Supp]. PC Fee: Q Reg. Q OT FO.0 hrs $0.00 $501.00 ISTUCOAPP
PME Plan Check: $0.00 110
S. Remodel, Kitchen(<=300 so
Permit Fee: $0.00 $600.00 /REMRESKIT
Suppl. ]lisp. Fee0 Reg. Q OT 1 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Cons•nvtction Tax:
Administrative Fee: O
Work Without Permit? O Yes Q No $0.00 G
Advanced Planning Fee: $0.00 Select Non-Residential Q
Travel Documentation Fees: Building or Structure
i
Strong Motion Fee: IBSEISMICR $1.50 Select an Administrative Item
Bldg Sids Commission Fee: IBCBSC $1.00
SUBTOTALS: $2.50 $1,101.00 TOTAL FEE: $1,103.50
Revised: 07/01/2012
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