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