12050124 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10194 BONNY DR CONTRACTOR:TARO OR SACHIE PERMIT NO: 12050124
ONOZAWA
OWNER'S NAME: TARO OR SACHIE ONOZAWA 10194 BONNY DR DATE ISSUED:05/152012
OWNER'S PHONE: 4084722977 CUPERTINO.CA 95014 PIIONF.NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIALCOMMERCIAL
License Class Lic.t REMODEL KITCHEN 77 SQ FT TO INCLUDE NEW
CABINETS,
Contractor Date APPLIANCES AND TILE- REMODEL BATH 50 SQ FT
1 hereby affirm that 1 am licensed under the provisions of Chapler9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license 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 whichthis permit is issued. Sq.Ft Floor Area: Valuation:$13000
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the labor Code,for die performance of the work for which this APN Number:35911046.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRIp IF WORK IS NOT STARTED
correct 1 agree to comply with all city and county ordinances and stale laws relating WITHIN 18 D 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 AST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, -,-5
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 by: Dale:
with all non-paint source regulations per the Cupertino Municipal Code,Section
9.18,
RE:ROOFS:
Signature Dale 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
1 hereby affirm that I em exempt from the Contractor's License Law for one of Signature of Applicmr. Date:
the following two reasons: AL1,ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,aid die structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to IIAZARDOUS M ATERIALS DI.SCLOSI IRF:
construct the project(Sec.7044.Business&Professions Code). t have read the hazardous materials requirements under Chapter 6.95 of the
California Ileallh&Safety Code,Sections 25505,25533•and 25534. 1 will
I hereby affirm under penally 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 malerial. Additionally,should 1 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 t
performance of the work for whichthis 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 Ileallh&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this g
permit is issued Owner or authorized a em:
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person many 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
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and slate that the above information is
correct.I agree to comply with all city and county ordinances and stale 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 hamnlcss the City of Cupertino against l tabilities,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 Prolcssional
9.18.
Signature Dale �/—
�Z
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35911046. 00
DATE ISSUED. . . . . . . : 05/15/2012
RECEIPT #. . . . . . . . . : BS000016827
REFERENCE ID # . . . : 12050124
SITE ADDRESS . . . . . : 10194 BONNY DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : TARO OR SACHIE ONOZAWA
ADDRESS . . . . . . . . . . : 10194 BONNY DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED •FROM . . . . : TARO ONOZAWA
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY TARO OR SACHIE ONOZAWA
ADDRESS . . . . . . . . . .-: 10194 BONNY DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ------ ------ ----------
1BCBSC VALUATION 13,000.00 1. 00 0. 00 1 . 00 0. 00
1BSEISMICR VALUATION 13, 000.00 1. 30 0. 00 1.30 0. 00
1REMRESBAT SQ FEET 50.00 588. 00 0. 00 588 .00 0. 00
1REMRESKIT SQ FEET 77.00 588. 00 0. 00 588 .00 0.00
TOTAL PERMIT 1178 .30 0. 00 1178 .30 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 1, 178.30 CHK
---------------
TOTAL RECEIPT 1, 178.30
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
1[3 1 ADDRESS: 10194 BONNY DR DATE: 05/15/2012 REVIEWED BY: Sylvia
APN: BP#: `VALUATION: $13,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION t R3SFDREM
USE: PERMIT TYPE:
WORK REMODEL KITHCEN 77 SQ FT BATH 50 SQ FT
SCOPE
,L/eeh. Plan C'hark Pluurb. Pion Check Elva. Plan Chick
mech. Prnuir Fire: P11w1b. Permit Fee: Eley. Pel mif Pre:
Odrrr,lfech. ln.ap. Otho'Plumb In.sp. Ocher Bloc. In v,
lkeh. Inop. Fre: Plunrh, hirp. Fri: Dec.hr.pr. Pcc:
NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School
District,ere). Thesefees are based on lite prelimina information available and are only an estimate. Contact die Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 EfC 7/1/1/1 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel,Bath (<=300 so
Suppl. PC Fee: Q Reg. Q OT FO.OThrs $0.00 $588.00 IREMRESBAT
PME Plan Check: $0.00 77 s.f. Remodel,Kitchen(<=300 so
Permit Fee: $0.00 $588.00 IREAIRESKIT
Suppl. Insp. FeeQ Reg. Q OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
C'unso-mrtion 7'ax.
rl dmini,cfroliee!ire: Q
Work Without Permit? ().Yes iE) No $0.00 (E)
Advanced Planning,Fee: $0.00 Select a Non-Residential 0
Building or Structure
Truro(Duc:ummrinNun Fees': 0
Strong, Motion Fee: IBSEISM/CR $1.30 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $2.301$1,176.001TOTAL FEE: 1 $1,178.30
Revised: 04/01/2012
CONSTRUCTION'PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO. CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333• buildingecuoertino.orD
❑NEW CONSTRUCTION EI ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINALPERMITA
PROJECT ADDRESS r J [L � APN 4 551 1
OWNER NAME Tt IDQ ie oh C -PHONE UQ /I i L�Q.Jr]I E-MAIL
STREET ADDRESS D ( q CrrY`$TATE,ZTIP d'/`u ^ ' FAX
CONTACT NAME On G� w ! PHONE( 6 /fji' Z 2,q q ((E-MAIL
STREET ADDRESS rZM� n CIT1�Y,STATE, ZIP I� FAX
oVl �V' _
OWNER 0 OWNER-BUILDER ❑ OWNERAGENT ❑'CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC4
COMPANY NAME E-MAIL FAX
STREET ADDRESS CRY.STATE ZIP PHONE
ARCHITECT/ENGNEER NAME LICENSE NUMBER BUS.LIC 4
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY.STATE,ZIP PHONE
DESCRIPTION OF WORK
IPV N'1 - l C�
c b+'�,✓rs a 4d o-i.-
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIFS
USE TYPE OCC. $Q.FT. VALUATION(5)
EXISTG NTW FLOOR DEMO TOTAL /�
AREA AREA AREA NET AREA R- 1(I`/ 12 •N"��7
BATHROOM KITCHEN_, OTHER
REMODELAREA{ % REMODECARFA� ;D S` REMODEL AREA
PORCHAREA I DE RFA TOTAL DECK/PORCH AREA GARAGE AREA: HDETACH
AA
ACH
4 DWELLING UNITS: IS A SECOND UNIT. YFSSECONDSTORY ❑YES
BEING ADDED' ONO ADDITION` ONO
PRE-APPLICATION ❑YTS IF YES.PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED Y: Vt TAL VALUATION'
PLANNNGAPPL4 []NO PIANNNGAPPROVALLETTER EICHLER HOME' [3 NO C t
000
By my signature below,1 certify to each of the following: 1 am the properly owner or authorized agent to act on the property owner's hchalf. I have read this
application and the information I have provided is co t. III read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and stale laws relating to building c ction. authorize representatives of Cupertino to enter the above--ii-cicntifed property for inspection purposes.
Signature of Applicanl/AgenD , Date: J u z/Z
SUPPLEMENTAL-ENFORNtlITTIN REQUIRED — PIANCHECKTYPE ROUTINGSLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for pyER•THE-COUNTER ElBUILDING PLAN REVIEW
existing building(s). Demolition permit is required priorto issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ mADOR El SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B/dgApp 201 I.doc revised 06121111
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333- buildingecuoertino.oro
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADDRESS oi9 BaflN r APN BP#
OWNER NAME -rglt $ C2 OWNERADDRESS G a D/' Lt� K6
DESCRIPTION OF WORK:
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We
will not Issue a building permit until you have read, initialed your understanding of each provision,signed, and
returned this form to us at our official address Indicated. An agent of the owner cannot execute this notice unless
you, the property owner,obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.)
-t 0_1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner-
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
Z2. 1 understand building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
_-L_L3. I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
--j-0-4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
- 6. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars($500), including labor and materials, I may be
considered an"employer"under state and federal law.
_±IL6. I understand if I am considered an"employer"under state and federal law, I must register with the state and
federal government,withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each"employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
--�b7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction
defects in the workmanship or materials.
Oi+voerBuilderFwm 2010.doc revised 04/14/10
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number:
?P�MaNt
Name of owner. TghD 4. .1 •60-di 'e O ;10--aq*Z4�P�T�No
e at too
Project address. I I -I T. RONVI �I �pR�y� .oslbe makeel
�1 d S-e�,(�oau°�"anty '`dev\ai��
Contact person. Towo Ono sa- ya I$iYoi� ,s,c�h�sa'e, y"�I-(Ng
wejaat do+ (nr SNANX
\ob 0ban90 W- Ok P r6 n� ;Ped%0-,�of the�`a e tyvJ
Net square footage of lot. S „ejetiom, 1S Ptan a apps^, ce or s
a skoon9 'intt oc W y u`
EjxistitlP�tioPelstons°t a os
Square footage: First floor: owl
Second floor:,
a (
Garage:
TOTAL: oca�tt N
Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N
f
Is privacy protection planting required for the project? Y• F�I�� COPY
Build it Green Total Points �@,'+,, • 1
On what floor(s) is work being done?
Brief description ofwork:� Knt�6eu a&d fim% m t-pnrvakf/t-egmk/
Code editions: 2010 CBC (Y - N)2010 CFC (Y- N)2010 CMC (Y-N)
2010 CPC (Y- N)2010 NEC (Y-N)
California Green'Building Standards Code 2010
Effective 1/01/11 C��vV
Vk l5 Z�1
Plan Review Process Work Book <• Page -8-
Revised 12/21/10
fate Sgc(nit OnoZgwnl
1x 1 14 �ovtrt� Pr
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.COMMUNITY DEVELOPMENT DEPARTMENT r n
BUILDING DIVISION-CUPERTINO tT II V 1
IAPPROVED the-)-)
Z
Th's set of plans and specifications MUST he kept at em
Job site during construction. It is unlawlvt'r.,make any
IIchanges or alterations on same,Or'0
tfterefrom,without approval from the Building Oiticial.
� / II
The stamping of this plan ry,
epeciflortions ShALL NOT
6eheldtopermitortote approval of the violalicn
bf any provisions of any Ordinance or State Law. f !
BY i
�
DATE
j PERMIT NO.
t I
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. . . �9� $ Sadie Oga2gw9
T a��.roOf"h la 194 R�Ny g—
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�= _ _ - S►nnw�tr &
To b z�
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DEMBUIL NG DIVISION E UNITY -CUPERTI OENT
C3F7)
" APPROVED
This"set of plans and specifications MUST he t at the
job site during construction/it is un1wr.2,go$te1e'any
c ae �e
therefr� ,without approval from the Building Crflcial.
The sta
Ing of this plIn.anpecificaflons ShiALI_nOT
be hel to.permit or t �rdinaal ofor S�ale(Lar"'
of any rovislons of
BY '�
DATE , 5—
PERMIT. O.
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
31 Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: tSbPERMITN Z
OWNER'S NAME: o Iq Nozawa PHONE #
GENERAL CONTRACTOR: BUSINESS LICENSE #
ADDRESS: 10 ZN1 r CITY/ZIPCODE: q Q
*Our municipal code requird 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 SUBCONTRACTORS HAV ^ BTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
1 am not using any subcontractors:
ure Date
Please check applicable subcontractors and complete the following information:
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