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15020154 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18485 CHELMSFORD DR CONTRACTOR:YASUKAWA DANIEL G PERMIT NO: 15020154 AND LINDA L OWNER'S NAME: YASUKAWA DANIEL G AND LINDA L 18485 CHELMSFORD DR DATE ISSUED:02/27/2015 OWNER'S PHONE: 4082420554 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E] KITHCEN REMODEL (156 SQ FT)TO INCLUDE M,E,P'S License Class Lie.# 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: 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. Sq.Ft Floor Area: Valuation:$38000 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 APN Number:37522048.00 Occupancy Type: permit is issued. 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 WITHIN 180 DAYS 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 DAY ST CALLED INSP TION. 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 Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 918. RE-ROOFS: Signature Date 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 reby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,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) n I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE nstruct 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. I 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 Management District I performance of the work for which this permit is issued. will maintain compliance with th upertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectis 550733,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: G. Date permit is issued. I certify that in the performance of the work for which this permit is issued,I shall t employ any person in any manner so as to become subject to the Worker's mpensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY 1 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, 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 urce regulations per the Cupertino Municipal Code,Section Licensed Professional 9 18. 2 Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ig 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildinci atcupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESSC/ S APN# 3-76-22-/^� �� /10 OWNER NAME � ��.. %kP-A" PHONE _� Z-�� E-MAIL Cf ASLQ STREET ADDRESS (/ g I�r �K n I(//e I WS CITY, STAT ,ZIP FAX CONTACT NAM PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ^1l�,� y LICENSE NUMBER S�/_C'�� LICENSE TYPE BUS.LIC# A Awl COMPANY NAME r '/ _ E-MAIL FAX STREET ADDRESS L CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK Ca tG OWf p EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL �1 AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH ARE I GARAGE AREA: DETACH []ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEINGADDED? []NO ADDITION? [-]NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECENED$ _ * TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO '+�' i 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 ovided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to i Ing t tion. I authorize representatives of Cupertino to enter the above-identif d property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL O TION REQUIRED pLAIV•CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for �, OYER THE�COUNTER ❑ UII DING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building z permit for new building. ❑.,EXPRES5 ❑ LANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑;" STANDARD, - ❑ PUBLICWORKS form if any Hazardous Materials are being used as part of this project. CI LARGE;? ❑ LIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ' submittal of Building Permit application. ❑ MAJOR; ❑ $ANITARYSEWER DISTRICT ❑ NVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 18485 chelmsford dr DATE: 02/27/2015 REVIEWED BY: Mendez Ila ___APN: BP#: "VALUATION: 1$38,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK kithcen remodel 156 sq ft to include m e 's SCOPE a Mech. Plan Cheek Plumb. Plan Check 17ec.flan Check 19c:>crh. Permit hire; Plumb. Permit Fee: Elec. Permit Fez Other,1lech. lnsp. E1F_L___ 01l¢er Plumb Insp. Orlon Elec.Insp. 1114e* Insp. Fe : Plumb. Irish.Fee: Elec.Insp. Fere: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Thesefees are based on the preffinWha information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 156 s.f. Remodel,Kitchen(<=300 sfl Suppl.PC Fee: (E) Reg. ® OT 0.0 hrs $0.00 $645.00 1REMRESKIT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee.0 Reg. ® OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: zldrninistrative Fee: Work Without Permit? ®Yes iq No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) or Structure 0 Travel Doeun2enlalran Fees: Building � Strong Motion Fee: IBSEISMICR $4.94 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $2.00 ,.F a..., $6.94 $645.00 K, TO L FEE $651.94 Revised: 02/14/2015 R OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building0cupertino.org - 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# OWNER N'. �,:� _ OWNERADDRESS 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.) N 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- er"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. . I 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. . I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may construction t myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her n me instead of my own. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license num ers on permits and contracts. &t5. 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 nsidered an"employer"under state and federal law. 6. 1 understand if I am considered an employer under state and federal law, I must register with the state and fe ral 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. N7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family r =idential 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 'an financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction def cts in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 hI understand I may obtain more information regarding my obligations as an"employer"from the Internal ev ue 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. 0. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am party legally.and,.financially responsible-for.proposed construction activity at the site address listed above. 1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide b pplicable laws and.requirements that govern Owner-Builders as well as employers. 2. 1 agree to,notify the issuerof this-formimmediately of any additions,deletions, or changes to any of the - in r tion I have provided:oh,this form.;Licensed:contractors are regulated by laws designed to protect the public. If you contract with-::someone-who:does.notbavea=;license,the Contractors' State License Board may be unable to assist you with any financial,loss you may.su.stain.as-a result-of a complaint. Your onlyremedy against unlicensed - - .Contractors may be in civil court Itis 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 properlylicensed 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 i suing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acc ble to city may be required to be presented when the permit is issued to verifythe roe owner's signature, Property Owner's Signature: I LJ e. 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: OwnerBuilderForm 2010.doc revised 04/14/10 Dan and Linda Yasukawa 18485 Chelmsford Drive Cupertino,Ca 95014 SCOPE: Kitchen remodel, no structural changes. Update cabinets,appliances, Lights,electrical outlets ALL CA 2013 Building Codes Apply Vn1J©CL =light in glass ront cabinet r; =recessed ceiling Light,convert ;; ;; •;' •.; from florescence to LED AW— AAR =Back splash electrical outl ' P Y •. . a I .h Hood Vent «'»•h =New drop lighting �-_ N com URJrry O t-O P11E. C F,�;N�a � BUILD bw.• : ••.•;•. ; e 4X a •....♦ pFi�1J�� " u This of plans an sp ur,1avg,,i to rr.,e any con' ru �c� e job site dunn9 Chang or a` ra v+lth,out apPrv�°u ��� CUP t�,ere`rom, ,�.:.t��iT _' EF7TINC1 c tan and g iC.�' �}jrl ,, ; .i damping t`�;s P rr�at c; t d nq QeDartment The be an apPrI 5 _ to Permit or a y City ordin:ncz i� >; �...w�..,.w� a .� 2015 c,", arrY REVIEWED r ;�,,e CODEVVY connPiIArvcEReviewed 8 w•.... �� �(j'j � •i ••i �i: ��e G1: •i •s i .r...ASC,•' le.✓ •.�..• .��'�• .•�.•• •