15080004CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 868 CANDLEWOOD DR
CONTRACTOR: ROCHA'S COMPANY
PERMIT NO: 15080004
OWNER'S NAME: LAURA BRUNTON TRUSTEE
2191 MONTICELLO AVE
DATE ISSUED: 08/03/2015
OWNER'S PHONE: 4048227123
SAN JOSE, CA 95125
PHONE NO: (408)593-7405
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
RECONFIGURE (E) BEDROOM CLOSET TO
License Class Lic. #_j �—� J
ENLARGE/COMBINE
Contractor ` Date —
TO OTHER BEDROOM (NON-STRUCTURAL), REMODEL
I hereby affirm that I am licensed nd he provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
(E)
BOTH HALL (40 S.F.) AND (E) MASTER BATH (44 S.F.)
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.
I have and will maintain Worker's Compensation Insurance,
Sq. Ft Floor Area:
Valuation: $17000
as provided for by
' Section 3700 of the Labor Code, for the performance of the work for which this
APN Number: 36919026.00
Occupancy Type:
permit is issued. I
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 laws
PERMIT EXPIRES IF WORK IS NOT STARTED
and state relating
to building construction, and hereby authorize representatives of this city to enter
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
180 D D INSPECTION.
costs, and expenses which y accrue against said City - consequence of the
of this ditionally,
granting permit. the applicant d stands and will comply
ssu ate:
with all non -point so regulation r the C in unicipal Code, Sect'
9.18.
Sign re Date ��
RE -ROOFS:
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
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
I hereby affirm under penalty of perjury one of the following three
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
declarations:
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
I have and will maintain a Certificate of Consent to self -insure for Worker's
Health & Safety Code, Section 25532(a) should I store or handle hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Manage ent District I
performance of the work for which this permit is issued.
will maintain compliance with the Cup no Mu ' 'pal Cc pt.9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 2 5,2
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized gent: Date:
I certify that in the performance of the work for which this permit is issued, I shall
i
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
Lender's Address
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
COM10UN1TY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - buildina(d)-cuuertino.ora
❑ NEW CONSTRUCTION F� AI]DTTinW I I A T 'rVD A Tttl7Q / TT n
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STREET ADDRESS
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DESCRIPTION OF WORK
E>OSTING USE PROPOSED USE CONSTR. TYPE r• STORIES
USE TYPE I OCC. I SQ.FT. VALUATION (S)
EXISTG NEW FLOOR DE1.40 TOTAL
AREA AREA AREA - NtT AREA '-
BATHROOM KITCHEN OTHER
REMODELAREA,4 --DEL AREA REMODELAREA / 2
/
PORCHAREA wrCKAtEA TOTALDECK/PORCHPREA GARAGE AREA: LJDErACH
❑ ATTACH
9DWELLINGUNr1'S:
ISA SECOND UNIT EJ YES
SECOND STORY ❑YES
—
BEINGADDED? EJ 1,10
ADDITION? ' ANO
PRE -APPLICATION ❑ YES IF ITS, PROVIDE COPY OF IS THE BLDG AN t^rsa v TOTAL, VALUATION:
PLA.NTNNGAPPL9 ONO PLANNING APPROVAL Ln -TIER I EICHLERHOME? ❑' YE -
_ _
--------------
By my signature below, I certify to each of the following: I am the property oc r autho ' agent to act o e property own f. I have read this
application and the information I have provided is co ect. I have read the Description of Work and verify i • accurate. e to -comply W1 applicable local
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ordinances and state laws relating buildi g const tion. I authorize representatives -of Cupertino to en in -identified property for inspec purposes.
'
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
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°��= r'_e s J}�c • �`" 4Y, '=
k PLAi� CHECK
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T1PE
ER OT SR� SLIPY r
New SFD or Multifamil d%vellings:
Multifamily Apply for demolition permit for
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existing building(s). Demolition permit is required prior to issuance of building
COUNTER e
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permit for new building.TP
t�W IM
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
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form if any Hazardous Materials are being used as part of this project.
s�,�n�e, ��
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_ Copy of Planning Approval Letter or Meeting -with Planning to
prior
submittal of Building Permit application.�AaoR
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Bldg,4pp_1011.doc revised 06121/1.1
CITY OF CUPERTINO
'MI FEE ESTIMATOR — R1j11,n1NV nirwgT(1N
1AADDRESS:
868 CANDLEWOOD DR
DATE: 08/03/2015
REVIEWED BY: MELISSA
APN: 369 19 026 BP#: *VALUATION: 1$17,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIUSE.. Y SFD or Duplex PENTAMATION
PERMIT TYPE: 1 R3SFDRE
WORK RECONFIGURE E BEDROOM CLOSET TO ENLARGE/COMBINE TO OTHER BEDROOM
SCOPE (NON-STRUCTURAL), REMODEL (E) BOTH HALL (40 S.F.) AND (E) MASTER BATH (44 S.F.)
J. M E: r ais esumare does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the nreliminaru inlarm"finn "Imit.,t,to —7— ,..,1,. — —f-4- ------ ..L,. ...,.,._„
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
Gtech. Plan ("heck
Ph! ib. Plan Chet•/i
h7ec. !'tan Chectc
;L7!.>ch. l'etmit f'etc>'
Plumb. 1`111mitT'ee:
lslec. Parmill'C'c::
Ocher A/ech. Imp.
Other Plumb Imp.
Ocher Elec. Insp.
Iflech. Imp. Fee:
- rT.-h . - m�_ -_ _
I'h!!!!b, 11isp. Fee:
Elec. Ins'). FeG''
J. M E: r ais esumare does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the nreliminaru inlarm"finn "Imit.,t,to —7— ,..,1,. — —f-4- ------ ..L,. ...,.,._„
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
DKI s.f.
$645.00
Remodel, Bath (<=300 sf)
IREMRESBAT
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
=s.f.
$431.00
Remodel, Other
IREMRESOTH
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
%.onsiruction 7CLl':
Administrative Fee:
0
E)
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
or Structure
Travel Doeuinentolion Fees:Building
Strong Motion Fee: IBSEISMICR
$2.21
1
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.001
°SUBTOTALS ;:
$3.21
$1, 076.00
TOTAL FEE
$1,079.211
Revised: 07/02/2015