07020095 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C �iGTaRINF( RM, TI�N'
PERMIT NO.
BUILDING ADDRESS:
10221 PARK CIRCLE WEST #4 WAY & ITAN—LI TU 07020095
PERMIT ISSUE DATE
OWNER'S NAME:
WAY & MAN—LI TU 10221 W PARK
SANITARY NO. CONTROL NO.
)NE:
BUILDING PERMIT INFO
ARCHITEC(ENGINEER:
BLDG ELECT PLUMB MECH
0 0 0
i
00 LICENSED CONTRACTOR'S DECLARATION Job Description
v I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
z with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPAIR DRY ROT DECK
y in full force and effect.
v�Z License Class Lte•S
t- Dale Contractor
ARCHITECTS DECLARATION
i 1 understand my plans shall be used as public records
)yU
Licensed Professional
y J OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
COO following reason.(Section 7031.5,Business and Professions Code:Any city or county
<, fL� which requires a permit to construct,alter,improve,demolish,or repair any structure
Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
e that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area
2 t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $550
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(S500). 326320--3
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure isnot intended oroffered for sale(Sec.7044.Business Required Inspections
and Professions Code:The Conuactor's License Law does trot apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.IL
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Conuactoes Li-
ccnse Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑1 am exempt under Sea B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-inure for WorkeesCompen- _
cation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued-
0 1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foronc hundred dollars($100)
or less)
I certify that in the performance of tJJ
t000for whichit is i d,I 11 not
employ any person in any manner to bjcct to Wo nation
Laws o(Ca1i1'orQia.Da c
Applicant C !
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
E-r 1 hereby affirm that there is a construction lending agency for the performance of
f�> the work for which this permit is issued(Sec.3097,Civ.C.)
WCI.A Lender's Name
z Lender's Address
U Q 1 certify that I have read this application and state that the above information is
►- correct.1 agree to comply with all city and county ordinances and state laws relating to
rJ U building construction,and hereby authorize representatives of this city to enter upon the
W ahove-mentioned property for inspection purposes.
L1. (We)agree to save,indcmni( d keep harmless the City of upertino against
'may t) liabilities,judgmens,toss an x s which may in any wa cc a l said City
U Z in consequence of the gran' of s permit.
�+ APPLICANT UNDAND WILL CO -POINT Issued try: Date ,O
SOURCE REGULFO7,;
c— s- _
Re-roofs -
Signature—of4fplioCkontractor Dare Type Of Roof
HAZARDOUS MATERIALS DISCLOSURE yp
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code apter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes o
Will the applicant or future building occupant use equipment or devices which
If a zoo:is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes
1 have read the hazyh':a.,L,
s materials requirements u r apter 6.95 of thc Califor-
nia Health&Safcty , ns 25505,25533 and 255 1 u erstand at if the building
docs not currcn ave athat it ismy res otil'y occupant of the
rcquircm h m -kscprior
issu efa Ce 'e cupancr. Signatu-e of Applicant Date
All roof coverings to be Class"B"or better
O r o uthorircd agent Date"
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: B1k: Lot:
APN . . . . . . . . . 32632013
DATE ISSUED. . . . . . . : 0.2/20/2007
RECEIPT #. . . . . . . . . . B3000000489
REFERENCE ID # . . . : 07020095
SITE ADDRESS . . . . . : 1 )221 PARK CIRCLE WEST #4
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . . WAY & MAN-LI TU
ADDRESS . . . . . . . . . . : 1 )221 W PARK CIR # 4
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : R:ECEIPT INTERFACE
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . . WAY & MAN-LI TU
ADDRESS . . . . . . . . . . : 10221 W PARK CIR # 4
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----------- ---------- ---------- ----------
BENERGY PERMIT FEE 83 .16 39 .92 0. 00 39 .92 0. 00
BPERMFEE VALUATION 550. 00 83 .16 0. 00 83 .16 0. 00
BSEISMICRE VALUATION 550. 00 0.50 0. 00 0.50 0. 00
----------- ---------- ---------- ----------
TOTAL PERMIT 123 .58 0. 00 123 .58 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 123 .58 VISA
---------------
TOTAL RECEIPT 123 . 58
CITY OF (XPERTINO
_
AX05
CUPER�TINO PERMIT APPLICATION FORM
.PN# Date:
326-32-013-00 February 15, 2.007
Building Address: Mailing Address (if different from building address):
10221 Park Circle West #4, Cupertino, CA 95014
Owner's Name: Phone#:
Way & Man-Li Tu (408) 736-5900
Contractor: License#:
Antonio Estrella
Contact: Phone: 408 421-8113 Cupertino Business License#:
Antonio
Fax:
Building Permit Info:
Bldg ® Elect ❑ dumb ❑ Mech ❑
Job Description:
Residential S Repair dry rot deck Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
50 Sq. Ft.
Cost of Project: $550.00 Occupancy Group:
Type of Construction: Please check this box if the project is a
Repair second-story addition: ❑
troject Size: Standard❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILER1 Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler>500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M.Btu MECHANICAL
BBOILER5 B oiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX In-I/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Co astax-Resi/Mobile BUILDING
BELEC1000 El cc 600V<= 1000A ELECTRICAL
BELEC1001 Elec 600V> IOOOA ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD ]Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of 3
CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rindl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR T zeatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS `ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM S eismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP remporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE :Mechanical sq. foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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