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13040049CITY OF CU PIERTINO BUILDING PERMIT BUILDING ADDRESS: 10902 CANYON VISTA DR CONTRACTOR: REICHARDT FAM TRST & PERMIT NO: 13040049 WALKER JAMES OWNER'S NAME: REICHARDT FAM TRST & WALKER JAMES 110902 CANYON VISTA DR 1 DATE ISSUED: 04/04/2013 1 OWNER'S PHONE: 4085290879 1 CUPERTINO, CA 95014 1 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (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: 1 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. 1 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. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. l 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Dale OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 1 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. 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 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. 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. (—\ _n BUILDING PERMIT INFO. BLDG' ELECT PLUMB MECH F RESIDENTIAL f— COMMERCIAL r— JOB DESCRIPTION: REMODEL KITCHEN(300SF)REMODEL TWO BATHROOMS(300SF)ADD I GAS LINE,APPROX 50 SOFT REMODEL (FIREPLACE & WET BAR REINSTALL)REPLACE 4 Sq. Ft Floor Area: I Valuation: $50000 APN Number: 35628028.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 D YS FROM ]LA A lL D II�1SPECTION. 0 Issued by: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Own r or authorized ag nt: / { 3 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Professiona / Sir➢r'\ • CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 ^ FAX (408) 777-3333 a buildinc;Pcupertino.org 13 c,LA b L4 9 ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROTECT ADDRESS 16 9 ® ?, C�6®� XLy �� W. APN # �� / _ OZ yQ OWNERNAME Pa n�6B PHONE qµ)C�Bisy�QZ 1 (� G \J��J J��� EMAIL 't STREET ADDRESS i t6 60 V � C I� -W. ` l� CITY, STATE, ZIP FAX CONTACT NAME `w A 1 „ � PHONELt* �+r (i p�q yCjj S E MAIL cam, - �J q � 170 t] au is COM `a STREETADDRESS�J 1e� �� CITY, STATE, ZIP J1'&&G,)FAX VIA U OWNER ❑ OWNHR.BUnDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSENUMBER LICENSETYPE BUS. LSC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCIUTECTIENGINEER NAME P 9�� a If LiCENSENUMBER BUS, LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS �. CITY, STATE, ZIP/51.� o� m ,,�,U `+�G�J� PHONES q + LI I& "BM DESCRIPTION OF WORK &-4' EXISTING USE Ozs,t&v 4rl'el PROPOSED USE CONSTR. S itN•e_ JYPE I # STORIES one. USE TYPE OCC. SQ.FI'. VALUATION ($) EXISTG AREA. g 0� t3 NEW FLOOR AREA((� ee DEMO AREAo TOTAL NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECIVPORCH AREA GARAGE AREA: DETACH ❑ ATTACH #DWELLING UNITS: IS A SECOND UNIT 0YES SECONDSTORY AYES BEING ADDED? ONO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECE E A PLANMNGAPPL# ONO PLANNING APPROVAL LETTER EICHLERROME? 0 N By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is corn I. I have read the Description of Work and verify it is accurate, l agree to comply with all applicable local ordinances and state laws relatE o b 'ding cons t I thorize presentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: s 1 B SUPPLEM NT INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP OVER -TAE -COUNTER ElBUILDING PLAN REVIEW New SFD or Multifaml ellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW —Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ElSTANDARD 13PUBLIC 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 1:1 MAJOR \ ElSANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH \ B1dgApp_2011.doc revised 06/21/11 Off7Y OFOUIFIEI[87NO IFIEIE IESTEMATOR — BUff LDIING MVISION AIDIDRESS: 10902 Canyon Nista Drive /DATE: 04/04/2013 REVIEWED BY: larrys APN: BP#: *VALUATION: $501000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex 2nd Unit? Yes No PENTAMATION 'IR3SFDADD USE: OTC. () Yes (D No PERMIT TYPE: WORK remodel kitchen <300 sf, remodel two bathrooms <300 sf, add 1 gas line, approx 50 sq ft remodel SCOPE (fireplace and wet bar reinstall), replace 4 doors same rough opening size. OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE IID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,Iv,v-B Other Hech. Insp, $0.00 0/her Elec.. Imp. E17- $0.00 Plurnh. Iusp. Fee: Elec. Insp. Pee: PME Plan Check: $0.00 F -2-99 7S.. $600.00 Remodel, Bath (<=300 sf) IREMRESBAT Permit Fee: Hourly Only? ()Yes (D No $0.00 Suppl. Insp. Feer Reg. Q OT Fo_.fl hrs $0.00 ®# Window / Sliding Glass Door $400.00 IWINREP Replacement PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 0 $0.00 Administrative Fee: $0.00 TECH, HOURLY 0 Yes 0 No PLUMB, HOURLY 0 Yes 0 No ELEC, HOURLY Yes Q No Ifech. Nott Check Phimh. Plan Check7-7 Elec. Plan Check Ff—e /,- Perfi it Fee: Plumb. Permit Tee: Elec. Permit Tee: Other Hech. Insp, Other Phrmb Insp. 0/her Elec.. Imp. E17- I'lech. hup. Fee: Plurnh. Iusp. Fee: Elec. Insp. Pee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based an the nreliminary information available and are only an estimate. Contact the Dent for addn't info. /FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/12) FEE QTYIFEE MISC ITEMS Plan Check Fee: $0.00 200 s.f. $600.00 Remodel, Kitchen (<=300 sf) 1REMRESKIT Suppl. PC Fee: 0 Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 F -2-99 7S.. $600.00 Remodel, Bath (<=300 sf) IREMRESBAT Permit Fee: Hourly Only? ()Yes (D No $0.00 Suppl. Insp. Feer Reg. Q OT Fo_.fl hrs $0.00 ®# Window / Sliding Glass Door $400.00 IWINREP Replacement PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conso-tiction Tar: L]L_ Administrative Fee: 0 Work Without Permit? C) Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure O 0 A Travel Documentation Fees: Strong Motion Fee: IBSEISMICR $5.00 1.0 hrs $133.00 Inspections IsTilvsP�] Inspection, Hourly Bldp, Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $7.00 [$1,733.001 1 TOTAL FEE: 1 $1,740.00, Revised: 04/01/2013 CUPERTOMO COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building0cupertino.orp 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: 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 ARID VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner wilder" 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. Vh 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for construction and are not hiring a licensed Contractor to assume this responsibility. Y3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that.1 may r—otect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license umbers on permits and contracts. Y5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the o—tal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be �cnonsidered an "employer' under state and federal law. j� 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and NJederal 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. V7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family —sidential 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 . I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable fo r or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForrn 2010.doc revised 04/14/10 �,- 'F��c�m ;��,c..M iie- � , _01 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 ARID VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner wilder" 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. Vh 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for construction and are not hiring a licensed Contractor to assume this responsibility. Y3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that.1 may r—otect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license umbers on permits and contracts. Y5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the o—tal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be �cnonsidered an "employer' under state and federal law. j� 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and NJederal 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. V7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family —sidential 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 . I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable fo r or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForrn 2010.doc revised 04/14/10 y� . understand I may obtain more information regarding my obligations as an "employer" from the Internal R enue 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.csib.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I m the party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide y all applicable laws and requirements that govern Owner -Builders as well as employers. 12. I ,agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the.' formation 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 LENDINd 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.). B Lender Name: I V'M— Lender Address: "l /A 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 sidhWe. Q . e . I • .. - • - _ -01"AMFt���«� HIMM MPA ----------------------------------------------------------------------------------------------------------------------- --OT-E: ---T-h-e--6­11-6- --wing 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: Address of Authorized Agent: Tel No 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: OwnerBuilderForm 2010.doc revised 04/14/10