15080004-DP PUB868 CANDLEWOOD DR
15080004
F/P
LAURA BRUNTON TRUSTEE
SCANNED BOX #663
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 868 CANDLF WOOD 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
j7 LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
License Class Lie. N� `�� .Z
RECONFIGURE (E) BEDROOM CLOSET TO
ENLARGE/COMBINE
_ _1 _ ,-, /y
Contractor �Jl�f(�r -�g-. Date$ "3_ _��_.
TO OTHER BEDROOM (NON-STRUCTURAL), REMODEL
(E)
I hereby affirm that I am licensed and he provisions of Chapter 9
BOTH HALL (40 S.F.) AND (E) MASTER BATH (44 S.F.)
(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: $17000
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 the work for which this
permit is issued,
APN Number: 36919026.00
Occupancy T e
p y YP
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
to building construction, mid hereby authorize representatives of this city to enter
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned properly for inspection purposes, (We) agree to save
180 D -S FROM LA-S— D INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which y accrue against szid City' consequence of the
granting of this permit. ditionally, the applican d stands and will comply
ssu ate:
with all non -point so regulation r the C in unicipal Code, Sect
9.18.
r,
Sign re Date
RE -ROOFS:
All roofs shall b¢ urspected prior [o mry 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 (See.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. 1 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(a) 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 Manage nent District I
performance of the work for which this permit is issued.
will maintain compliance with the Cup no Mus - 'pal Co pter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 2 5,25 , a d 2
Section 3700 of the Labor Code, for the performance of the work for which this
Owner I
permit is issued.
or authorized gent: 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 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 properly 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
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333' buildinq Gncuoertino.org /S-0 9�000 y
❑ NEW CONSTRUCTION ❑ ADDITION . ❑ ALTER4TION / TI I- REVISION / DEFERRED ORIGINAT. P>= MTT+!
PROJECT ADDRESS �/() �CGW d I� Y� C Uo,IQ,T I1� CA_
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STREET ADDRESS �-
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ED OWNER R OWNER BUILDER ❑ owKERAGENr ❑ CONTRACTOR ❑ CONPRACTORAGENT ElARCHITECT CI ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAME - ,J -
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LICENSE TYPE
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COMPANY NAME
E-MAIL
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STREET ADD
CITY, STATE, ZI
PHONE
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COMPANY NAME
E-MAIL
FAX
STREETADDRESS
CRY, STATE, ZIP
PHOTIE
DESCRIPTION OF WORK �--
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FXISTRBIUSE
PROPOSED USE CONSTRTYPF.
%STORIES
—�"
I
USE
TYPE
OCC,
SQ.FT.
VALUATION (S)
E)CSTG
NEW FLOOR
DBLIO
TOTAL
—
AREA
AREA
AREA
NET AREA
._
BATHROOM - KITCHEN OTHER
REMODEL AREA 113, AREA REMODEL AREA
(JD
PORCHAREA ur KAiEA TOTALDECNPORCHAREA GARAGEAREA: ACH
ATTACH
.". DWELLING UNTES:
IS A SECOND UNIT AYES
SECOND STORY ❑YES
-—
BEINGADDED? ENO
ADDITION? ENO
PItE-APPLICATION AYES IT YES, PROVIDE COPY OF
PLAHmNGAPPL: ENO PLANNINGAPPROVALLETTER
I IS THE BLDG AN ❑
EICHLERHOAIE?
-
TOTAL. VALUATION4
—
By my signature below, I certify to each of the following: I am the property o\ author' agent to act o e property oe' f I have read this
application and the information I have provided is co eet. I have read the Description of Work and verify i accurate. tocamply %N applicable local
ordinances and state laws relating buildi Ig const tion, I authorize representatives ofCupertino
to en th -Identified property for inSpec purposes.
Signature of Applicant/Agent:
Date: g 3 ZbI
SUPPLEMENTAL INFORMATION RE UIRED -
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�_`—. `t b.E
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❑#O,FER THI`CTJtTER
New SFD or Multifamily dwellings: Apply for demolition permit for
OR
'I��8T7II,DII\GYD RE{�{y- "'��Y
existing building(s). Demolition permit is required prior to issuance of buildm
permit for new building.
1 - �
� c
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
-
_ Copy of Planning Approval Letter or Meeting with Planning prior to-Rt
submittal of Building Permit application.
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Bld flpp_201 Ldoc revised 06121117
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 868 CANDLEWOOD DR
DATE: 08/0312015
REVIEWED BY: MELISSA
APN: 36919 026
BP#: /
"VALUATION:
1$17,000
"PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE: p
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.)
,Wch• Alan Check
Pluinh flan Check
klec. Plan Check
Mech. Pennil Fee:
Phimb. Permit 1,cc:
Elec. Permir Fee:
Other rWech. lnsp.
Other Plumb lnsp.
Other Phu" Insp. ET
,'tech. Insy_ Pee:
Phnnb. hasp. Fee:
Elec. Linz Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Puhlic Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are hased on the preliminary information availahle and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Efl. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
84 I s.f.
$645.00
Remodel, Bath (<=300 sf)
1REMRESBAT
i
Suppl. PC Fee: (j) Reg. 0 OT
FO.0
This
$0.00
PME Plan Check:
$0.00
16 S.E
$431.00
Remodel, Other
1REMRESOTx
Permit Fee:
$0.00
Suppl. Insp. Fee:(D Reg. ® UT
0.0
Ins
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tar:
Administrative Fee:
0
E)
Work Without Permit? ® Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
tD
i
Travel Doeuinen/ation Fees:
Strong Motion Fee: IBSEISMICR
$2.21
Select an Administrative Item
Blde Stds Commission Fee: IBCBSC
$1.00
SUBTOTALSd
$3.21
$1,076.00
TOTAL FEE:''
$1,079.21
Revised: 07/02/2015