10238CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10238 LOCKWOOD DR
CONTRACTOR: LAWRENCE C &
PERMIT NO: 14020032
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 ❑ COMMERCIAL
CONSTRUCT DETACHED IN LAW UNIT 775 SQ FT
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:
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: $100000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 34214039.10238
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAAFJ9 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 DAYSAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Issued by: Date: 3
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.
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
Signature of Applicant: Date:
I reby 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
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)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
41Vcgpstryct ,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. 1 will
1 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 the Cupertino Municipal Code, Chapter 9.12 and
I a,d will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 255R5, 2 , and 25534.
96Ctiun 7700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent Date.
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, l
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
l 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 source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
-7 L
Date fl S �f/
Signature
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADig,DRESS: 10238 LOCKWOOD DR
DATE: 03/31/2015
REVIEWED BY: SUEW
PC FEE ID
APN:
BP#: 14020032
*VALUATION: $100,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY
USE: SFD or Duplex
•'
2nd Unit? Yes No
PENTAMATION
PERMIT TYPE: 1 R3SFD2ND
WORK
NEW 2ND UNIT 775 SQFT
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
S.I.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B1111-B,IV,V-B
775
$2,577.00
IR3PLNCK
$1,617.00
1R3INSP
PME Plan Check:
$0.00
Permit Fee:
$1,617.00
Suppl. Insp. Fee:) Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
775
$2,577.00
Construction Tax: IBCONST,9XR
$1,617.00
# new
units
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Distrirt. etc)_ These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Ef'. 711113)
FEE
QTY/FEE
MISC ITEMS
;Llc<i,
F'trrnrl�. F'r
Iaec�. PE}mit 1'E��
Other .Mech. Insp.
a her I'l urrib bast>. E17-,
)ilier Elec. Insp,
31r><lt Irr;rE �"v
I 1'o"�'
hr, t.
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Distrirt. etc)_ These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Ef'. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,577.00
Select a Misc Bldg/Structure
or Element of a Building
i
Suppl. PC Fee: 0 Reg. 0 OT
0,0$0.00
7hrs
PME Plan Check:
$0.00
Permit Fee:
$1,617.00
Suppl. Insp. Fee:) Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONST,9XR
1
# new
units
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee: IPLLONGR
$108.50
Select a Non -Residential
Building or Structure
0
0
i
Strong Motion Fee: IBSEISMICR
$10.00
Select an Administrative Item
(o�%
Bldg Stds Commission Fee: IBCBSC
$4.00
SUBTOTALS:
$4,976.49
$0.00
TOTAL FEE:
I .1AX!6=
Revised: 04/01/2014