14010150CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10236 LOCKWOOD DR
CONTRACTOR: LAWRENCE C &
PERMIT NO: 14010150
REBECCA W LEI
OWNER'S NAME:
1549 COUNTRY CLUB DR
DATE ISSUED: 03/26/2015
OWNER'S PHONE:
MILPITAS, CA 95035-7602
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
CONSTRUCT SFDWL LIVING, 3084 SQ FT, ATTACHED
License Class Lie. #
GARAGE 845 SQ FT, PORCH 14SQ, DECK 770 SQ FT+
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
Sq. Ft Floor Area:
Valuation: $350000
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
APN Number: 34214039.00
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
building hereby this to
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to construction, and authorize representatives of city enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
rST
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
9.18.
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.
r
OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
ereby affirm that I am exempt from the Contractor's License Law for one of
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)
1, as o fqof t e property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
cons&eJ th r ct (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
1 have and maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
will
Come}� sat.�til as provided for by Section 3700 of the Labor Code, for the
perp(n o he work for which this permit is issued.
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Muni 'pal Code, Chapter 9.12 and
I have an maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25534.
Section 3700 o&the Labor Code, for the performance of the work for which this
�3
Owner Date:
permit is issued.
or authorized agent:
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
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
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 a��!
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 10236 lockwood dr
DATE: 01/28/2014
REVIEWED BY: Mendez
PC FEE ID
APN:
BP#: 0 61
'VALUATION: $450,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY
USE: SFD or Duplex
2nd Unit? Yes • No
PENTAMATION 1 R3SFDW
PERMIT TYPE:
WORK
construct sfdwl living,2959 sq ft attached garage 845 sq ftporch 14sq, deck 770 sq ft
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,111-B,IV,V-B
4,588
$3,223.00
IR3PLNCK
$3,741.90
IR3INSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,741.90
Suppl. Insp. Fee-(F)Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
1
$0.00
TOTALS:
4,588
$3,223.00
Construction Tax: IBCONSTAXR
1 $3,741.90
# new
units
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
TL. x _1 » to ». LnL»:»,,_, ;. fnrLSLatinn availahle and are anly an estimate. Contact the Dent for addn'1 into.
LLJL/Ll-L, CLI,. 1/[cJc GCJ u•G ✓uJG» v .•... •.-..••....».
FEE ITEMS (Fee Resolution 11-053 E(f 7111132
... ...--.—___-- _-.---------
FEE
`honL Plan C'hecl,
lec. Plan Check
F'lramb. Permit Pee:
Elec. Permit Fee
Other- Alech. Insp.
011;c°r Phanh irtsp,
i?ther Elec. Insp. E1__L_
Suppl. PC Fee: Q Reg. Q OT
0.0
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
TL. x _1 » to ». LnL»:»,,_, ;. fnrLSLatinn availahle and are anly an estimate. Contact the Dent for addn'1 into.
LLJL/Ll-L, CLI,. 1/[cJc GCJ u•G ✓uJG» v .•... •.-..••....».
FEE ITEMS (Fee Resolution 11-053 E(f 7111132
... ...--.—___-- _-.---------
FEE
------ -- -
QTY/FEE
MISC ITEMS
Plan Check Fee:
$3,223.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. Q OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,741.90
Suppl. Insp. Fee-(F)Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
T_
Construction Tax: IBCONSTAXR
1
# new
units
$ 652.28
'I(J llli{f t.t ilv flet r' xr'0
L'z':
Work Without Permit? Yes (F) No
$0.00
Advanced Planning Fee: IPLLONGR
$642.32
Select a Non -Residential
Building or Structure
E)
A
Travel Documentation Fees:
Strong; Motion Fee: IBSEISMICR
$45.00
Select an Administrative Item
Bldi Stds Commission Fee: IBCBSC
$18.00
SUBTOTALS -1
$8,322.50
$0.00
TOTAL FEE:
$8,322.50
Revised: 01/15/2014