09030035 777777
CITY OF CUPERTINO
BUILDING DIVISION PERIVIIT � �"`� �
1 PERMIT NO.
BUI
Tn' ARK CIRCLE WEST # 3 TBD - r'0 BE DETERMINED 09030035
OWNER'S NAME: PERMIT ISSUE DATE
WAY & MAN-LI TU 03/11/2009
ONE: SANITARY NO. CONTROL NO.
ARCH1TECf/ENGINEER: BUILDING PERMIT INFO
REPAIR DRY ROT DECK, 50 SQ BLDG ELECT PLUMB
MECH
0
u o c LICENSED CONTRACTOR'S DECLARATION T _ _ ._r T__ -1ob Description
m 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
with Section 70110)of Division 3 of the Business and Professions Code,and my license is
5Zy in full force and effect
DIRZ Class Lic.M
Dam Contractor
ARCHITECTS DECLARATION
-� I understand my plans shall be used as public records
�yU
4 Q y Licensed Professional
rn 3 OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
E p OeG following reason.(Section 7031.5,Business and Professions Code:Any city or county
.4 m V which requires a permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit to file a signed statement
- < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
Y (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
A R F 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(5500).
0 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 Required Inspections
and Professions Cade:The Contractor's License Law does not apply to an owner of q P
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.If.
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
l )
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
cense 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.
❑I am exempt under Sec. B&P C or this reason
-i f `l,ic..// lf' Dam 30-3/0
OwnerA
WOR ERS PENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
,j I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,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 am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any marinea m become subject to the Workcrs'Compensation
Laws of California.Date—, �1 — '
Applicant g
NOTICE TO APPLICANT:1,alter making this Mrtiricate of Exemption,you should
become subject to the Workers Compensation provisions of the labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z"' CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of .
the work for which this permit is issued(Sec.3097,Civ.C.)
W QLender's Name
a, Lender's Address
U O 1 certify that I have read this application and state that the above information is
V.a"c correct.l agree to comply with all city and county ordinances and sum laws relating to
0 V construction,consction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes
LL (We)agree to save.indemnify and keep harmless the City o
pf Cupertino against-4
cy rn liabilities,judgments,coats and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit Date
�+ APPLICANT UNDERSTANDS AND,WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
,1 Re-roofs
Signature of Applicant/Contractor Dam T of F.00f
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Cede,section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
0 Yes 15 no
If a roof i s installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
,l hazardous air contaminants as defined by the Bay Area Air Quality Management all new Materials for inspection.
District?
0 Yes 041.
1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs mol cturentiy a tenant that i is y responsibility to notify the occupant of the
requirements w'h be met issuance of a Certificate of Occupancy. Signature Of Applicant Date
Owner or authorized agent Dale
All roof coverings to be Class" ''or better
tat
CITY OF CUPERTINO
CITY OF
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
68636 035
APN # Date:
326-32-013-03 March 09, 2009
Building Address:
10221 Park Circle West #3 Cupertino, CA 95014
Mailing Address (if different from building address):
Owner's Name: Phone#
Way & Man-Li Tu (408)736-5900
HOA: (Exterior work only) Yes ❑ No [
If yes, provide letter from HOA
Contractor: � Phone:
��re%•cS rF�"�
Antonio Estrellas (408) 421-8113
Fax:
Contractor License#:
Cupertino Business License#: 2k7 17'�
Contact: Phone:
Antonio Estrellas (408) 421-8113
Fax:
Residential F-)j Commercial El
Job Description:
Repair dry rot deck, 50 sq. ft.
Building Permit Info:
Bldg M] Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
� - 3
1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B
Valuation: IPZ410r Square Footage:
50 Sq. Ft.
Project Size: Express [�J` Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set& the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditer een.or
Revised 02/05/09
CITY OF CUPERTINO
ADDITO:v/REMODEL
FEE SCIHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Sq Ft Group
DECKS 1R3SFDADD OR
1R3SFDREM
1 DECKWOOD Deck (Wood)-Each B
(Each)
1 DECKRAIL Deck R ailing-Each B
(Each)
GARAGES 1R3SFDADD OR
DETACHED 1R3SFDREM
1 GARDTW<=1 K Wood ]game up to B
1,000 c F (each)
1GARDTM<=1K Masorvy up to 1,000 SF B
(each)
BCONSTAXR Constniction Tax Res
(new dotached garage)
PATIO'S OPEN 1R3SFDADD OR
1R3SFDREM
1PATIOWOOD Wood Frame up to 300 B
SF
1PATIOMETAL Metal frame up to 300 B
SF
1 PATIOOTHER Other frame up to 300 B
SF
PATIO'S CLOSED 1R3SFDADD OR
& SUN ROOMS 1R3SFDREM
1 PATIOENCLW Enclosed Wood up to B
300 SF
1 PATIOENCLM Enclosed Metal up to B
300 SF
1 PATIOENCLO Other Enclosed Patio up B
to 3003F
1 COVPORCH Porch ('overed-Each B
(Each)
REMODELS 1R3SFDREM -
1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan
300 SF check
1REMRESBAT Bath Ri;model up to 300 B 66
SF
1 REMREOTH Other F_emodel up to 300 B 66
SF
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Sq Ft Group
1MECPLNCK Stand Mone Mechanical M
Pln Ck (hourly
1 PLMPLNCK Stand J%,lone Plumbing P
Pln Ck (hourly)
l 1 BCBSC Cal Blc.g Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic; Residential B
' 1 TRAVDOC Travel k Documentation B
1BUSLIC Business License B
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: w c ta:_ PHONE #
GENERAL CONTRACTOR: F
I am not using any subcontractors: �o
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSI:*TESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date