Loading...
12050092 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10154 DENISON AVE CONTRACTOR:KAIDA MARGARET AND PERMIT NO: 12050092 YASUO TRUSTED: OWNER'S NAME: KAIDA MARGARET AND YASUO TRUSTEE 10154 DENISON AVE DATE ISSUED:05/09/2012 OWNER'S PHONE: 4082556136 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lic q MECH RESIDENTIAL COMMERCIAL Contractor Date 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE AND RELOCATE WATER CLOSET AND TUB, (commencing with Section 7000)of Division 3 of the Business&Professions REMOVE Code and that my license is in full force and effect. AND REPLACE BATHROOM WINDOW 1 hereby affirm under penally 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,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$3000 permit is issued. APPLICANT CERTIFICATION APN Number:31628012.00 Occupancy Type: I certify Ihat I have read this application and state 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and hairless the City ofCupenino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,anJ expenses wvhich may accn�c against said City in consequence of the granting of this permit Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. .{ Issued by: / 54ey_ ATG/y Date: y-��— Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any rooting material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the properly,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Dale: I,as owner of the propcny,am exclusively contracting with licensed contractors to construct Ore project(Sec.7044,Business&Professions Code). AL1,ROOF COVERINGS TO BE CLASS",\"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Cerlilicate of Consent to sclf-insure for Worker's IIAZ.ARDOUS MATERIALS DISCLOSURE: Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the health& Section 3700 of the Labor Code,for the performance of the work for which this Safely Code,Section 25532(a)should 1 store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Ilealth&Safety Code,Sections 25505,25533,and 25534. Compensation laws of Cali fnmia If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,1 must Own or authorized I; �d age ,.,/ forthwith comply with such provisions or this permit shall be deemed revoked. —{ �pG�+L--lam=Dale: APPLICANT CERTIFICATION O CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that[here is a construction lending agency for the performance of work's correct. I agree to complywi[h all city and county ordinances and state laws relating for which this permit is issued(Sea 3097.Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCIIITECF'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ,(�/7�/� 1 understand my plans shall be used as public records. Signature /A!�'� DateLicensed Professional CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31628012. 00 DATE ISSUED. . . . . . . : 05/09/2012 RECEIPT #. . . . . . . . . : BS000016760 REFERENCE ID # • . . : 12050092 SITE ADDRESS . . . . . : 10154 DENISON AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : KAIDA MARGARET AND YASUO TRUST ADDRESS . . . . . . . . . . : 10154 DENISON AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : MARGARET KAIDA CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : KAIDA MARGARET AND YASUO TRUST ADDRESS . . . . . . . . . . : 10154 DENISON AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1.00 41. 00 0 . 00 41. 00 0 .00 1BCBSC VALUATION 3, 000 . 00 1 . 00 0 . 00 1. 00 0. 00 1BPFIXTURE NO OF FIXTURE 2.00 18 . 00 0 . 00 18. 00 0. 00 1BSEISMICR VALUATION 3, 000.00 0.50 0. 00 0. 50 0. 00 1PPERMITFE FLAT RATE 1.00 44 . 00 0. 00 44 .00 0. 00 1STINSP UNITS 1.00 130. 00 0. 00 130 .00 0.00 1TRAVDOC FLAT RATE 1.00 44 . 00 0. 00 44 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 278. 50 0. 00 278 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 278.50 #3946 --------------- TOTAL RECEIPT 278.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION --------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING 512 FINAL HANDI-CAP CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION Im ADDRESS: 10154 Denison Ave DATE: 05/09/2012 REVIEWED BY: Sean APN: BP#: -VALUATION: 1$3,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 RPFIX USE: PERMIT TYPE: WORK Remove and relocate water closet and tub remove and replace bathroom window. SCOPE .11-:h. Ph", ( 1,,,,4 Plumb. Plan Check 0.0 hrs $0.00 Oo. Yhnr 02,E k )/"ch. Itawir I2,c Plumb. Permit Fee: IPPERMIT 1 0.s. IA:r 'a (.0", 1h,/' I... Other Plumb Insp. 0.0 hrs L$44.00 0/h," /:%e,.bnp_ dJrrh. bnp. Fr, Plmuh. Gt,p_Fer: Ehr. 1"'I (err NOTE: This estimate does not include fees due to other Departments(ie. Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addh7 info, FEE ITEMS (Fee Re.solulion 11-053 En' 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Plumbing Suppl. PC Fee: (F) Reg. O OT F0,0Thrs $0.00 $18.00 IBPFIXTURE Fixture or Trap PME Plan Check: $0.00 Permit Fee: Hourly Only? O Yes (E) No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $44.00 i.�ntcn uttiun 7"co Administrative Fee: (ADMIN $41.00 Q Work Without Permit? Yes (F) No $0.00 0 Advanced Planning Pce: $0.001 hours hours Inspections Q Travel Documentation Fee: ITRAVDOC $44.00 $130.0STINSP Inspection, Hourly 0 0 I Suone Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item 131ds Sids Commission Fee: IBCBSC $1.00 SUBTOTALS: $130.501 $148.001 TOTAL FEE: $278.50 Revised: 04/01/2012 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777228• FAX(408)777-3333•buildina(a)cuoertino.orG ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DIERRED ORIGINAL PERMIT p PROIEC ADDRESS NAO/ Amt APN a D �� OWN I 9EM tso� pR/p� ER ME E-MAR SI=ADORM �t CITY, STATE ZIP ,/ CONTACT NAME Ai9k FAX 1010/5-ViSOn r✓{ r,/'✓ k CA �/J Yo��,' —/1 3 E-MAR HA AC K'Er' ma— M45ATO (�A tp�.. STREET ADD, t^ , �Y ' 1 N �µC CrrY.STAnTE ZIPS Cn p t c/ FAX '(OWNER ❑ OWNER-BUADER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrIEC ❑ENGINEER ❑ DEVELOPER ❑ TENAN CONTRACORNAME LICENSE NUMBER LICENSE TYPE Bus.LICA COMPANYNAME E-MAIL FAX STREET ADDRESS - CITY,STATE ZIP PHONE ARCHITECTIENGWEER NAME LICENSE NUMBER Bus.UC p COMPANY NAME E-MAIL FAX STREETADDRESS QTY,STATE ZIP PHONE DESCRIPTION OF WORK USE PROPOS %PSE CONSTLTYPE' NS Rff5 USE TYPE OCC. SQFr. VALUATION(S) E=Q NEW FLOOR /DEMO Y TOTAL AREA AREA AREA NET ARIA I/ T7Z !J BATHROOM KITCHEN 0 - I / RIINODELAREA REMODEL REMODEL AREA FORM AREA TOTAL DECWPORCH AREA GARAGE AREA: ATTACH ATTACH a DWELJNG UNITS: MASECONOUNTT YES SECOND STORY YFS / BBINGAODaD4 o ADI'Mom NO PRE-APPLICATION []YES WYFS,pROVB]E COPY OF fS THa BLDG AN ❑YFS RE BY: - TOTAL VALUATION: PLNNINGAPPLO NCNO PLANNCIG APPROVAL LErrflt BICHLzR ROME? �4N0 �n DDO ^_ By my signature below,I certify to each of the following: 1 am the property Avner or authorized agent?to act on the property owttees behalf.•I have read this application and the information I have provided is correct I have read the Description of Work and verify it is acuate. l agree to comply with all applicable Iota) ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identifed property for inspection purposes. Signature of Appbeant/Agent �7 Date: p— SUPPLEMBNTAL INFO TION REQUIRED PLANCHECK TYPE AOIITLYG SLIP New SFD or Multifamily dwellings: Apply for demolition permiBUILDING I for 11d oven-T"-COUx= ❑ PLAN REVIEWexisting building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ ExPRM ❑ PLANNING PLAN REVIEW _.Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C3 STANDARD ❑ PUBLIC WOIos form if any Hazardous Materials Bre being used as part of this project ❑ LARcx ❑ Fina Our _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ arnvmolmrnmrAL HEALTH_ B/dgApp_201 Lace:revised 06/21/11 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228"FAX(408)777-3333• buildino(5cuoertino.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 APN BP# 'O S{ 17 o AVE OWNER NAME OWNER ADDRES MA94AK 2-r KA )0A o i S� FNi $off A DESCRIPTION OF WORK: 6A41,f-o /e.M-A 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.) p 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. 2. I 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. 3. 1 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 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. 5. 1 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. _IpJ8. 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. lr_�_7. 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. ,�_8. 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. OmnerBuilderFolnl 2010.doc,-�'ised04/14//0 �9. I understand I may obtain more information regarding my obligations as an "employer"from the Internal Revenue Service,the United States.Small Business Administration,the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board(CSLB)at 1-800-321=CSLB(2752)or www.cslb.ca.gov for more information about licensed contractors. "A-110. I am aware of and consent to an Owner-Builder building permit applied for in my name,and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. t_11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. Jr"k 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license,the Contractors'State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint.Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property,you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be Issued,this form must be completed and signed by the property owner and returned to the agency responsible for Issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's si nature. Property Owner's Signature: CSL Date: - --- -- -- --- -:-- -- ---- - ---- ---------------------------------- ------------- ------ ----- ------------------ - (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an . agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: ON'1ffir'Builder'Foi-,,7 2010.doc revised 04/14/10 £x2� - T / i - - // I �e� .- ICA INI D ELOP EPA TMENT - ILDI_GD -I _N CUP_ TI O _ Thlssef of pia sands c '-atione S be kept at the _ -- -job site durin constru tion:_- nla I to-- keany changes orate ns on same ,w deviate' - —_ therefrom, tho tap rovaltrom_the,B 'IdingOfticlal _ - -- _ - The stampin .of this �and MALL NOT -be held to perm' h violatipn ofany provisions of any City.Ordinance w State Lew, = I BY DATE - - - -- -- - -- - PERMIT NO.. - MARGARET KAIDA - CUPERTRM4 DENISON AVE Building Depane pERTINO, CA 95014 408-255-6136 MAY 0 9 2012 REVIEWED FOR C MPLIANC� FOOTNOTE � ��PY - -- Reviewed By: — No electrical changes - - _ Ty- Lj ...... . r .. MARGARET KAIDA .... _.-- -- - 10154 DENISON AVE CUPERTINO, CA 95014 - 408-255-6136 "..._: : FOOTNOTE No electrical changes - -_.