10050165 CITY OF CUPERTINO DUILDING PERMIT
BUILDING ADDRESS: 10206 CAMBERLEY LN CON TRACTOR:AIR AND PLUMBING PERMIT NO: 10050165
SYS7 EMS
"'NER'S NAME: SUBBARAMAN RAMKUMAR 285 SOBRANTE WAY STE P DATE ISSUED:05/21/2010
V,vNER'S PHONE: 4087323621 SUNIIYVALE,CA 94086 PHONE NO:(408)733-2000
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT PLUMB r
License Class -tic.#
MECH RESIDENTIAL COMMERCIAL
Contractor _� Date (?l/+
1 hereby affirm thatict,;pi71,000)
ensed under the provisions of Chapter 9JOB DESCRIPTION:RREPLACE FURNACE&ADD A/C
(commencing with of Division 3 of the Business&Professions
Code and that my licei a is in full force and effect.
1 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:$5350
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 this
permit is issued. APN Number:34242017.00 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 `JVITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 80 DAY ROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Mditionally,the applicant understands and will comply _ �7
with all non-poin/so rc,�regulations per the Cupertino Municipal Code,Section Issued by Z I _! Date:
9.18.
c:�nature -�" � Date
WtIp
RE-ROOFS:
❑ U1'NER-BUILDER DECLARATION All rt ofs 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 inspe tion.
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 Calif)rnia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the coml liance 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 Addi:ionally,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 conti minants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the iqupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,Ishall Heal h&Safety Code,Secti25505,25533,and 25534. /r
not employ any person in any manner so as to become subject to the Worker's Own•r or authorized age
Compensation laws of California. If,after making this certificate of exemption,I Date:
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. INSTRUCTION LENDING AGENCY
I here by affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for w rich this permit is issued(Sec.3097,Civ C.)
I certify that I 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
U, 'he above mentioned property for inspection purposes.(We)agree to save
i .1ify and keep harmless the City of Cupertino against liabilities,judgments,
costs,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 und;rstand my plans shall be used as public records.
with all non-point source regtlations per the Cupertino Municipal Code,Section
9.18. . r' Licei sed Professional
Signature �4 .,/ Date
(cut
CITY OF C'UPERTINO
FURNACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN # Date: .? 2� l l 0
Building Address: 1�7s=U/ �n l.'VI `, Q �' 90n
Owner's Name: JA Phoe
n #:
ILI
Contractor: v O �L S Phone
Fax#:
Contractor License#: 4 1A Cupertino Business License#:
Contact: A,� r , Phone#: � —2O
�" Fax #:
Building Permit Info:
Elect ❑ Plumb ❑ MechQ/
Residential Y J Commercial ❑
Job Description: "gel, 6/r
For Residential Installations:
Attic ❑ I"floor V 2nd floor ❑
Adhere to minimum setback requirement ❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
C st of Project: Type of Construction (Usage Class):
Strapped On Platform Bonded New Location Replacement
Project Size: Express ❑ Standard [2 Large ❑ Major❑
Valuation:
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index.
Revised 01/07/09
CITY OF CUPERTINO
FURNACE/AC
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1MRAPPVNT Residential for the install/relocate/or M
replacement of ea ,appliance vent
install ¬ incl in an ap 1 permit.
FURNACE FURN/AC
1 PGASRES Residential for ea gas piping system of P
1-4 Outlets
1 BPGAS For each gas pip:ng system of 5 or P
more per outlet.
1BCBSC Cal Bldg Standard; Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Residential Seismic B
1 MECPLNCK Mechanical Plan Check M
1 MFR=<100 Furnace Syst<=1 C Ok BTU install or M
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance up to and
include 100,000 B:u/h
1MFRN>100 Furnace Syst> 100k BTU install or M
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance over
100,000 Btu/h
1 EPERMITFEE Electric Permit Fe-; E
/ 1 MPERMITFEE Mechanical Permi:Fee - M
1 PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentetion B
1 BUSLIC Business License B
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
J
JOB ADDRESS: dt Gly'. PERMIT
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: ,� a9 i�7 PUSINESS LICENSE#
ADDRESS: �.I O .AGI P'\ vim`y Z.- 0&_11CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRA '['ORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
//�igiy(tare Date
Please check applicable subcontractors and ete I he following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum/Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
SION#
CITY OF CUPERTINO BUILDING PERMIT DATE
BUILDING ADDRESS: 916 CANDLEWOOD DR CC NTRACTOR:SYCAMORE HOMES,INC PERMIT NO:09110149
OWNER'S NAME: CEDRIC D&MONIQUE CARUTH 92( THOMPSON PL STE 130 DATE ISSUED:01/07/2010
_4ER'S PHONE: 4083162495 SUVNYVALE,CA 94085 PHONE NO:(408)749-0307
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALE]
License Class Lic.# ADDITION OF 242 SQ FT ON THE FIRST FLOOR,434 SQ
FT TO 2ND FLOOR,REMODEL 218 SQ FT TO KITCHEN,
Contractor Date Bf►TH,M. BEDROOM STRUCRURAL NO RE-ROOF
I hereby affirm that I am licensed under the provisions of Chapter 9 4/19/10-REV#1;REVISON TO STRUCTURAL&ADDITON OF
(commencing with Section 7000)of Division 3 of the Business&Professions W NDOW IN MASTER BEDROOM
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:$198000
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 this APN Number:36919022.00 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
granting of this permit. Additionally,the applicant understands and will comply Issued b ��-�'�� Date:
with all non-point source regulations per the Cupertino Municipal Code,Section _
9.18.
RE-ROOFS:
Signature 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
ins lection.
�.
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 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 ma intain 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 ma terial. 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 1,745 ,25 ,33,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which thisZZ
_ _
permit is issued. v,ner or authorized agent: C n ^�J 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 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. work's for which this permit is issued(Sec.3097,Civ C.)
Le ider's Name
APPLICANT CERTIFICATION Leader'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
in the above mentioned property for inspection purposes.(We)agree to save
mify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
s,and expenses which may accrue against said City in consequence of the I u:iderstand my plans shall be used as public records.
.ating of this permit.Additionally,the applicant understands and will comply
with all non-point sourc gulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signaturi— Date d Q
`C�