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12030083 BUILDING ADDRESS: 10129 LOCKWOOD DR CONTRACTOR:BRANDON SMITH PERMIT NO, 12030083 OWNER'S NAME: BRANDON SMITH 10129 LOCKWOOD DR DA'R'E ISSUED:06/05/2012 OWNER'S PHONE: 4082193667 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUQLDIING PERMIT INFO: BLDG� ELECT� PLUMB� License Class Lic.# MECH r RESIDENTIAL r— COMMERCIAL r Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ADDITION OF 1,009 SQ FT TO FAMILY,BED (commencing with Section 7000)of Division 3 of the Business&c Professions &BATHROOM, Code and that my license is in full force and effect. CONVERT FAMILY ROOM TO MASTER SUITE8/20/12-DEF#I-TRUSS CALCS-9/19/2012-DEF#I ISS'D 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. 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 permit is issued. Sq.Ft Floor Area: Valuation:$80000 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 APN Number:34214029.00 Occupancy Type: 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 P ERM17 E+XPRRES U WORK ffS N07 S7AR7 EG granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section WffTHffN 180 OAFS OF PE'RMffT ffSSUANC E OR �'18. 180 DAYS FROM ILAS7 CALLED DIY ?EC's ON. r Signature Date Issued b< Date: OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: RE-ROOFS: 1,as owner of the property,or my employees with wages as their sole compensation, All roofs shall be inspected prior to any roofing material being installed.If a roof is wil I do the work,and the structure is not intended or offered for sale(Sec.7044, installed without first obtaining an inspection,l agree to remove all new materials for Business&Professions Code) inspection. 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). Signature of Applicant: Date: I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the California Health&c Safety Code,Sections 25505,25533,and 25534. Il will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&i permit is issued. Safety Code,Section 25532(x)should I store or handle hazardous material. I certify that in the performance of the work for which this permit is issued,I shall Additionally,should I use equipment or devices which emit hazardous air not employ any person in any manner so as to become subject to the Worker's contaminants as defined by the Bay Area Air Quality Management District I will Compensation laws of California. If,after making this certificate of exemption,I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the become subject to the Worker's Compensation provisions of the Labor Code,I must Health&c Safety Code,Sections 25505,25533,and 25534. forthwith comply with such provisions or this permit shall be deemed revoked. Owner or uthorized ag G/ Date: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's upon the above mentioned property for inspection purposes.(We)agree to save for which this permit is issued(Sec.3097,Civ C.) indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Name costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply Lender's Address with all non-point source regulations per the Cupertino Municipal Code,Section 9.18• ARCHITECT'S DECLARATION Signature �- Date 2 I understand my plans shall be used as public records. Licensed Professional BUILDING ADDRESS: 10129 LOCKWOOD DR CONTRACTOR:BRANDON SMITH PERMIT NO:12030083 OWNER'S NAME: BRANDON SMITH 10129 LOCKWOOD DR DATE ISSUED:06/05/2012 OWNER'S PHONE: 4082193667 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING HERMIT INF®: BL®G f- I;I_,ECT f- >PI,>UMI1;� License Class Lic.# IMl1ECII RESIDENTIAL f— COMM[]ERCIAIL Contractor Date BA 1 hereby affirm that I am licensed under the provisions of Chapter 9 & DESCRIPTION:ADDITION OF 1,009 SQ FT TO FAMILY,BED (commencing with Section 7000)of Division 3 of the Business&Professions BATHROOM, Code and that my license is in full force and effect. CONVERT FAMILY ROOM TO MASTER SUITE 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. 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 permit is issued. Sq.Ft Floor Area: Valuation:$80000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:34214029.00 Occupancy Type: correct.1 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, PERMIT EXPIRES 7 WORK ffS NOT STARTED ESD costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 7180 DAYS OF PERMIT ffSSUANC E (DR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM OM(LAST CALLED ffNSPIECTffON. 9.18. _ J Signature Date Issued by: Date: OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain 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 Safety Code,Section 25532(x)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air 1 certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,l Health&Safety Code,Sections 25505,25533,and 25534. 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. Owner o authorized agent: Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. /f 1 understand my plans shall be used as public records. SignatureDate /r /�- Licensed Professional CI<'1 Y OF C>I..P EIfg'1(INO BUILDING PERMIT BUILDING ADDRESS: 10129 LOCKWOOD DR CONTRACTOR:BRANDON SMITH PERMIT NO: 12030083 OWNER'S NAME: BRANDON SMITH 10129 LOCKWOOD DR DATE ISSUED:06/05/2012 OWNER'S PHONE: 4082193667 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: ]BLDG r ELECT F PLUJIa'i[1B F License Class Lic.# IVIECH RESIDENTIAL r COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ADDITION OF 1,009 SQ FT TO FAMILY,BED (commencing with Section 7000)of Division 3 of the Business&Professions &BATHROOM, Code and that my license is in full force and effect. CONVERT FAMILY ROOM TO MASTER SUITE 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. 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 permit is issued. Sq.flat Floor Area: Valuation:$80000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:34214029.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK lIS NOT STAINED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 7180 DAYS OF PERMIT>IT IISSUANC E OR with all non-point source regulations per the Cupertino Municipal Code,Section MO DAYS FROM(LAST CALLED INSPECTION. 9.18. Signature Date Issued bf.�� �--- — Date: -C OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MIATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air 1 certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. +J become subject to the Worker's Compensation provisions of the Labor Code,1 must forthwith comply with such provisions or this permit shall be deemed revoked. ®caner or authorized age Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of%ork's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature � Date �l � 9 �2 Licensed Professional C= OF CUP E]E UNO FEE IESTMATOR-BUID WNG MW RON ADDRESS: 10129 LOCKWOOD DR. DATE: REVIEWED BY: APN: 1BP#: �0,3ODg� *VALUATION: 1$5,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex PIENTAMATION 1GENRES USE: PEItMflT TYPE: WORK SCOPE ?th"r Alct';-lay El I Othat('1rur;i,bi,r; E7-- ,. NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These Lees are based on the relimina information available and are on/y an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Yee Resolution 11-053 0: 7/11111 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1,009 s.f. Deferred Submittal Suppl. PC Fee: (D Reg. Q OT 0.0 hrs $0.00 $932.00 IDF PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. C Q.Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C"•tgts;rvc1iin2 T(;,r• .fa(I,ii,i lli5l;"ilil.(' )'c.'(': 0 Work Without Permit? ® Yes 0 No $0.00 1 1 0 Advanced Planning Fee: $0.00 Select a Non-Residential E) Building or Structure 0 Tl'QVi'l �JLDf'I/YiIL'Yillt/1(�711"C'(';5': � Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldtz Stds Commission Fee: IBCBSC $1.00 jJ SUBTOTALS: $1.50 $932.00 'I OTAlL F EE: $933.50 Revised: 07/01/2012 CITY OF CU PIERTINO ADDRESS: 90129 lockvvoad dr. DATE: 03/96/2092 REVflEWEID BY: bobs. . . .. . ,r. APN: / I P#: _30083 K�ALIIAT><®N: 1$80,000 Y PERNIIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRINIARY SFD or Duplex 2nd Unit? Yes 0 No PENTAMATION 1R3SFDADD USE: 0 OTC. d Yes E)No PERMIT TYPE: WORK [construct new addition famil room bathroom bedroom= 1009 s.f. convert famil room to master SCOPE oom electrical only. OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID ISP FEES ISP FEE IID CONSTR. s.P R-3(Custom) II-B,111-B,IV,V-B 1,009 $2,438.81 1R3PLNCK $1,586.38 1R31NSP TOTALS: 1,009 $2,438.81 $1,586.38 MEC(EI,HOURLY (:) Yes Q No PLUMB,1HIOURILY Q Yes Q ilio (ELIEC,HOURLY Q Yes E)No Elec.Plan Check k--O] hrs $0.00 Elec.Permit Fee: IEPERMIT ElOther Elea Insp. 0.0 hrs $44.00 NOTE:This estimate does not include fees due to other Deparl►nents(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelindna information available and are onl an estimate. Cantact the Det or addn'l in o. FIEF ITEMS (Fee Resolution 11-053 Eff 71111L FELE QTY/FEE M 11SC ITEMS Plan Check Fee: $2,438.81 F-T-6-1 # Electrical Suppl.PC Fee: Q Reg. 0 OT Q,Q hrs $0.00 $44.00 1BREMRECEP Recep/Switch/Outlets PME Plan Check: $0.00 2 Electrical Permit Fee: $1,586.38 $65.00 1 1BREA;7=7 Fixtures,Lighting Suppl. Insp.Fee-.0 Reg. Q OT EHI hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $44.00 0 Work Without Permit? 0 Yes Q No $0.00 G) Advanced Plannine Fee: PLLONGRNGR $131.17 Select a Non.-Residentiat Q Travel Documentation Fee: ITRAVDOC $44.00 Building or Structure Q Strong Motion Fee: IBSEISMICR $8.00 Select an Administrative Item Bldg_Stds Commission Fee: IBCBSC $4.00 SUBTOTALS: $4,256.36 $109.00 TO'T'AL FIFE: $4,365.36 Revised: 1/19/2012