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13050070 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21450 VAI AVE CONTRACTOR:WEIMAN LYLE A AND PERMIT NO: 13050070 KATHY A OWNER'S NAME: WEIMAN LYLE A AND KATHY A 21450 VAI AVE DATE ISSUED:05/lW2013 OWNER'S PHONE: 4084464143 CUPERTINO,CA 95014-4935 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL D COMMERCIAL License Class Lic.# REPLACE ROOF STRUCTURE OVER GARAGE/PATIO (TRUSSES); BATHROOM REMODEL(72 SQ FT; INSTALL Contractor Date (3) 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 SKYLIGHTS; REROOF RESIDENCE COMPOSITION(2342 (commencing with Section 7000)of Division 3 of the Business&Professions SQ Code and that my license is in full force and effect. 1 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:$20000 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:36205024.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS SSUANCE 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 D 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 �D granting of this permit. Additionally,the applicant understands and will compl Y: Date: with all non-point source regulations per the Cupertino Municipal Code,Sec I IF 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 1 hereby 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) I,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 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 the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized Date: permit is issued. I certify that in the performance of the work for which this permit is issued,l 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,1 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 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. Sign at Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21450 VAI AVE CONTRACTOR:WEIMAN LYLE A AND PERMIT NO: 13050070 KATHY A OWNER'S NAME: WEIMAN LYLE A AND KATHY A 21450 VAI AVE DATE ISSUED:05/10/2013 OWNER'S PHONE: 4084464143 CUPERTINO,CA 95014-4935 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL L1 COMMERCIALE] License Class Lic.# 3 l CZ998 REPLACE ROOF STRUCTURE OVER GARAGE/PATIO --AA�,, (TRUSSES); BATHROOM REMODEL(72 SQ FT; INSTALL Contractor ( Cc9►.� Date (3) I hereby affirm that I am licensed under the provisions of Chapter 9 SKYLIGHTS; REROOF RESIDENCE COMPOSITION(2342 (commencing with Section 7000)of Division 3 of the Business&Professions SQ Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: REVISION#1 TRUSS CALCS/W/REVISION TO INSTALL 2X6@ I have and will maintain a certificate of consent to self-insure for Worker's 24"O.0 @ PATIO-ISSD 7/23/2013 Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. q. nor Area: Valuation:$20000 1 have and will maintain Worker's Compensation Insurance,as provided fo, Section 3700 of the Labor Code,for the performance of the work for i APN Number:36205024.00 Occupancy e: permit is issued. �M P Y P APPLICANT CERTIFICATIOI . I certify that I have read this application and state that the aho a 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 FROM LAST 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 � � /I--G, / 7. 1 grand o ermit. Additionally,the applicant understands and will comply Issued by: r7! l7 Date: O with all on-point urce regulat ons 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 I hereby affirm that 1 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 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 construct the project(See.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,sho se 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 y Arca Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance wi the Cue icipal Code,Chapter 9.12 and l have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, a ions 25 5, and 25534. Section 3700 of the Labor Code,for the performance of the work for which this r� permit is issued. Owner or authorized agent: Date 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 1 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 1 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 FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 21450 VAI AVE DATE: REVIEWED BY: MENDEZ APN: BP#: , _305-7076 'VALUATION: 1$20,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 'IR3SFDREM USE: PERMIT TYPE: WORK REPLACE ROOF STRUCTURE OVER GARAGE/PATIO (TRUSSES); BATHROOM REMODEL 72 SCOPE SQ FT; INSTALL (3) SKYLIGHTS; REROOF RESIDENCE COMPOSITION (2342 SQ FT) 71 1 _T E/eC. PIt7'(.itCiYf ,''r. Permit Fee.: Plumb. Permit Fee: Glee. Permit Fees Other Afech.Insp. Other Plumb Insp, F7-L--- Other Elec. Insp, 7- Fil,lech. Insp. Fee: Plumb. hrsp. Fee: Elec.Insp.Fix NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District etc). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff' 7/1/1?) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 L12 J s.f. Remodel,Bath(<=300 so Suppl. PC Fee: (F) Reg. Q OT 0.0 hrs $0.00 $600.00 IREMRESBAT PME Plan Check: $0.00 2,342 1 s.f. Re-roof Permit Fee: Hourly Only? ()Yes Q No $0.00 $360.00 IREROOFRES Suppl. Insp. Fee-.0 Reg. Q OT 0,0 hrs $0.00 = # Window/Sliding Glass Door PME Unit Fee: $0.00 $400.00 1 WINREP Replacement PME Permit Fee: $0.00 Conswuction Tax: Administrative Fee: 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 0 hours Inspections 7'a vel Documentation Fees: $399.00 ISTIVSP Inspection, Hourly Strong Motion Fee: 1BSEISMICR $2.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ITBIOTAI.S: $3.00 $1,759.00 TOTAL FF"E: $1,762.00 Revised: 04/29/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 C O P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Q PERMIT# OWNER'S NAME: Q PHONE# — — 2 y GENERAL CONTRA OR: ) o BUSINESS LICENSE# ADDRESS: qj 6 441 H H fa /0 CITY/ZIPCODE: dJ 91`/2 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY 1NSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date