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13120074FA CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10143 LOCKWOOD DR CONTRACTOR: K C WU CONSTRUCTION PERMIT NO: 13120074 OWNER'S NAME: FREMONT, CA 94536 PHONE NO: (510)739-1365 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ' ! Z �r/ ADD 499 S.F. TO SFD, REMODEL (E) KITCHEN & BATH License Cla—,B., 1 Lie. # b `� (TOTAL 140 S.F.) & REPLACE WATER HEATER WITH (N) <"7~ / `�3 C �� TANKLESS Contractor � Cpe l4 Date REV # 1- REPLACE (E) SEWER LINE & ADD PROPERTY LINE I hereby affirm that I am licensed under the provisions of Chapter 9 CLEANOUT PER CUPERTINO SANITARY - ISSUED 2/13/15 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: SANITARY 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 erformance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $80000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 34214030.00 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 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 DAYS F CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, Led costs, and expenses which may accrue against said City in consequence of the by: Date: 3 granting of this permit. Additionally, the applicant understands and will comp) with all non -point source regulations per the Cupertino Municipal Code, Se n ROOFS: 9.18. (- _f �^ t Signature Date J r All roofs shall be inspected prior to any roofing material being installed. If a roof is any installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: 1 hereby 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct 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 the Cupertino Municipal Code, Chapter 9.12 and 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 the Health & Safety Code, Section505, 2 , and 25534. Date Owner or authorized agent: 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, I 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 source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date :K CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10143 LOCKWOOD DR CONTRACTOR: Kc w6t PERMIT NO: 13120074 NS 7 Z aC- vN OWNER'S NAME: PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ADD 499 S.F. TO SFD, REMODEL (E) KITCHEN & BATH /' _ License Class c 3 6 Lic. # 0'/ 04- -)L-]Q (TOTAL 140 S.F.) & REPLACE WATER HEATER WITH (N) -a _ n l � " TANKLESS Contractor I hereby .rm 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: $80000 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 34214030.00 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 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 DAYS F ALL 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 y' Date: granting of this permit. Additionally, the applicant understands and will comply with all �� Date - �l y 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 61 inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby 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 owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct 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 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 have and will maintain Worker's Compensation Insurance, as provided for by for this the Health & Safety Code, Sections 25505, 25533, and 25534. /! Section 3700 of the Labor Code, for the performance of the work which Owner or authorized 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, I 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 source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10143 LOCKWOOD DR CONTRACTOR: WONG PAKMAN AND PERMIT NO: 13120074 WANG FEN-HUA TRUSTE OWNER'S NAME: CUPERTINO, CA 95014 PHONE NO: JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] ❑ LICENSED CONTRACTOR'S DECLARATION ADD 499 S.F. TO SFD, REMODEL (E) KITCHEN & BATH License Class Lic. # (TOTAL 140 S.F.) & REPLACE WATER HEATER WITH (N) TANKLESS 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: $80000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 34214030.00 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 C IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN S OF P T ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 1 ED INSPECTION. 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 Date: 7 granting of this permit. Additionally, the applicant understands and will co with all non -point source regulations per the Cupertino Municipal Code, S c ton 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. fif OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby 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) , as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 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 the Cu ertino M 'cipal Code, Chapter 9.12 and 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 the Health & Safety Code, Sections 5,105 , a d 25534. Owner or authorized agent: Date: rmit 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, I 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 source re ulation er the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date f% CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10143 LOCKWOOD DR DATE: 12/09/2013 REVIEWED BY: MELISSA PC FEE ID APN: 342 14 030 BP#: 1o7bd -7 -VALUATION: $80,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? • Yes No OTC. 0 Yes ONo PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK ADD 499 S.F. TO SFD REMODEL E KITCHEN & BATH TOTAL 140 S.F. & REPLACE WATER SCOPE HEATER WITH (N) TANKLESS OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.L PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 499 $1,579.00 IADDPLCK $1,284.00 1ADDINSP like hall, (cc: $0.00F$28.00 # Plumbing IPRwHEATR Water Heater Permit Fee: $1,284.00 Suppl. Insp. Fee -0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 T__= TOTALS: 499 $1,579.00 $1,284.00 MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY 0 Yes 0 No ELEC, HOURLY 0 Yes 0 No MISC ITEMS Plumb. Plan Check 0.0 1 hrs $0.00 /-/tcc- t'%cry Chcck $1,579.00 Plumb. Permit Fee: 1PPERMIT Other Plumb Insp. 0.0 hrs $47.00 Uih' ,' /'1' bm"', hrs $0.00 like hall, (cc: $0.00F$28.00 # Plumbing IPRwHEATR Water Heater NOTE: This estimate does not include fees due to other Departments (Ge. riannmg, ruouc rrvrns, . err, �u.«<u•y ,�rv�• �-•�•• ��••��- 1'' t'on available and are onlyan estimate. Contact the Dept or addn'1 into. District, etc). These Lees are based on the re tmtna FEE ITEMS (Fee Resolution 11-053 E(f: 711;'13) to orma i FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,579.00 =s.£ $418.00 Remodel, Other 1REMRESOTH Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00F$28.00 # Plumbing IPRwHEATR Water Heater Permit Fee: $1,284.00 Suppl. Insp. Fee -0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 T__= < "onsiruction Tax: Idininistrativc 1 ire: 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Plannin& Fee: IPLLONGR $69.86 Select a Non -Residential Building or Structure 0 D, Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $8.00 Select an Administrative Item 1 Bids Stds Commission Fee: IBCBSC $4.001 SUBTOTALS: $3,038.861 $446.00 TOTAL FEE: $3,484.86 Revised: 10i0ii20i3 CITY OF CUPERTINO I�Y`_Yl/JI FFF. FCTIMATOR — WILDING DIVISION APPLIANCE/ EQUIP TYPE 10143 LOCKWOOD DR DATE: 02/13/2015 REVIEWED BY: MELISSA IQADDRESS: APN: 34214 030 BP#: 13120074 `VALUATION: Iso *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex p # PENTAMATION 1 RPSS PERMIT TYPE: USE: Permit Fee: Sh l WORK REV # 1 - REPLACE E SEWER LINE & ADD PROPERTY LINE CLEANOUT PER CUPERTINO SCOPE SANITARY - ISSUED 2/13/15 APPLIANCE/ EQUIP TYPE FEE ID Plumb. Plan Check 0.0 hrs $0.00 QTY UNITS BP FEES Rec. Pennir Fee: Sewer, Sanitary 1 PRSEWER � )i/wr lilec. Insp. E3 1 # $25 Permit Fee: Sh l Suppl. Insp Feta PME Unit Fee: $25.00 PME Permit Fee: $48.00 —I L Administrative Fee: 1ADMIN $45.00 - $0.00 TOTALS: i Travel Documentation Fee: ITRA VDOC $25.00 Strong Motion Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer Dtstrict, c 00 I_ _ L ---,J .L_ vn;mhte and are nnty an PwimatP. Contact the Dent for addn'l info. uis[ncy e[a ineae ee� u•e uu�au v • - --- are FEE ITEMS (Fee Resolution 11-053 Ejf 7/1/131 FEE Plumb. Plan Check 0.0 hrs $0.00 '.lec. P/on Check /tech, P Plumb. Permit Fee: IPPERMIT Rec. Pennir Fee: Other Alech. Insp. Other Plumb Insp. 0.0 hrs L $48.00 � )i/wr lilec. Insp. E3 ,kfech. Insp. Fee: PME Plan Check: $0.00 Permit Fee: Sh l NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer Dtstrict, c 00 I_ _ L ---,J .L_ vn;mhte and are nnty an PwimatP. Contact the Dent for addn'l info. uis[ncy e[a ineae ee� u•e uu�au v • - --- are FEE ITEMS (Fee Resolution 11-053 Ejf 7/1/131 FEE QTY/FEE ---- MISC ITEMS Plan Check Fee: ,Suppl. PC' Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Feta PME Unit Fee: $25.00 PME Permit Fee: $48.00 construction Tax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? C) Yes E) No $0.00 idr(nu•f d Planning (ices i Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: $0.00 Select an Administrative Item —L Bldg Stds Commission Fee: $0.00 SUBTOTALS: $166.00 $0.00 TOTAL FEE: $166.00 Revised: 01/06/2015 r,&� i I I o l (-�3 LB J C�.e-f , cA 1501 �L FTS 1�cv) 7�- 3i 2 oa n 1 kc Joe Z,,,_ .