10070087 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 916 CANDLEWOOD DR CONTRACTOR:SYCAMORE HOMES,INC PERMIT NO: 10070087
OWNER'S NAME: CEDRIC D&MONIQUE CARUTH 920 THOMPSON PL STE 130 DATE ISSUED:07/12/2010
4'ER'S PHONE: 4087490307 SUNNYVALE,CA 94085 PHONE NO:(408)749-0307
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT r- PLUMB
License Class Lic.# �Jl Cj
7 / MECH r RESIDENTIAL r- COMMERCIAL
Contractor !1/31��C% Date 7'G,Z'X10
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:200 AMP ELECT SVC UPGRADE
(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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2000
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which t 's
permit is issued. APN Number:36919022.00 Occupancy Type:
APPLICANT CERTIFICATION
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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
9with
.18 all non-point source regulations per the Cupertino Municipal Code,Section Issued by Date:
Signatur G � Date '/Z-Z.A j 0
RE-ROOFS:
LJ OWNER-BUILDER DECLARATION 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
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
[certify that in the performance of the work for which this permit is issued,I shall Health&Safe Ce,Section 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's Owner orhrzed en -
Compensation laws of California. If,after making this certificate of exemption,I Date: 7 �2
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. U CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that 1 have read this application and state that the above information is Lender's Name
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 Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
nify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR-- BUILDING DIVISION
Ell ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$2,000
PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Du lex APPLICATION
USE p TYPE:
as
3U
APPLIANCE/EQUIP TYPE CAPACITY FE:41 ID QTY BP FEES
Temporary Power 1ER'"<200 1 $42
TOTALS: $42.00
Elec.Plan Check 0.0 1 hrs $0.00
Elec.Permit Fee: 1EPERMIT
Other Elec.Insp. 0.0 hrs $42.00
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the Dept./or addn'l info.
FEE ITEMS (Pee Resolution 09-05I Eff. 7/U09) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
I {' ,!, . i C,.
`3 ,t P C
PME Unit Fee: $42.00
PME Permit Fee: $42.00
t
Travel Documentation Fee: ITRA VDOC $42.00
Select an Administrative Item
Bld,-= Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $127.00 $0.00 TOTAL FEE: $127.00
Revised: 6/30/2010
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT.' RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B1}:. Lot :
APN . . . . . . . . : 36919022 .00
DATE ISSUED. . . . . . . : 07,'12/2010
RECEIPT #. . . . . . . . . : BS000010844
REFERENCE ID # . . . : 10070087
SITE ADDRESS . . . . . : 916) CANDLEWOOD DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : CEI)RIC D & MONIQUE CARUTH
ADDRESS . . . . . . . . . . : 2096 LINCOLN
CITY/STATE/ZIP . . . : SAIT JOSE, CA 95125
RECEIVED FROM . . . . : SYCAMORE HOMES INC
CONTRACTOR . . . . . . . : CHINS K. SMITHER LIC # 31412
COMPANY . . . . . . . . . . : SYCAMORE HOMES, INC
ADDRESS . . . . . . . . . . : 920 THOMPSON PL STE 130
CITY/STATE/ZIP . . . : SUZTNYVALE, CA 94085
TELEPHONE . . . . . . . . : (408) 749-0307
FEE ID UNIT QUANTITY hMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -- -------- ---------- ---------- ----------
1BCBSC VALUATION 2, 000. 00 1 . 00 0. 00 1. 00 0 . 00
1EPERMITFE FLAT RATE 1 . 00 42 . 00 0. 00 42 . 00 0 . 00
1ERT<200 UNITS 1. 00 42 . 00 0. 00 42 . 00 0 . 00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 .00
-• -------- ---------- ---------- ----------
TOTAL PERMIT 127 . 00 0 .00 127. 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 127 . 00 VISA
---------------
TOTAL RECEIPT 127 . 00
CITY OF
`20 CITY OF CUPERTINO
GENERAL, BUILDING
CUPERTINO PERMIT APPL[CATION FORM
APN# OZZ Date: -'LOI 0
Building Address:
MailingAddress (if different from ilding address):
201&
Are Hazardous Materials being used as part of this project? Yes ❑ No 9
HOA: (Exterior work only) Yes ❑ No Z If yes, rovide letter from HOA
Owner's Name: Phone #:
Z,4 r� 7
Contractor: Phone: B/
�S, Fax: 4O,9 741-®7S' o
Contractor License#.t3 76-3 l S
Cupertino Business License #:
Contact:� / % I
% I Phone: 40-15 - 5 - 035'� erNN��Dr
Fax-4.0,6- _ 07 5'1
Residential Commercial ❑
Job Description: l
Building Permit Info-
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ IVIII/V-A ❑ EVIII B, IV-HT, V-E ® 3
Valuation: Square Footage:
Project Size: Express 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.
Points Achieved:
For help,contact Build it Green at www.builditgre'n.or
Revised 07/14/09