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06080056CITY OF XPERTINO • kaa,v---- IX!QN'T�2AC ORiNF'*QRMATiQN BUILDINIC.DIVISION PERMIT � N:' BUILDING ADDRESS: PUNEET AGARWAL PERMff No.06080056 21796 HYANNISPORT DR OWNER'S NAME: PERMIT ISSUE DATE PUNEET AGARWAL HE: SANITARY NO. CONTROL NO. ARCHMIC (ENGINEER: BUILDING PERMrr INFO BLDG ELECT UMB MECH PLO O O LICENSEDCONTRACTOR'S SDECons { 17O Job DOSCrIpUgg1 t' c� of OON underof of 9 (commencing 1 heroby afflm0).f that 1 am ands IW) p—� l Code. is Divuian 3 of the Budrmaaod Pro@aioN Cede, and my Ikea¢ W with Section dLm Bu nd Pdal mmnse mandertaL and effect GAS LINE FOR KITCHEN STOV f[J��_A License Clan Lk. Ar Da¢ CanDEC TS DECLARATION ARCHITECTS W I udcrmnJ my platy Nall he used in public ranw Licensed Professional OWNER -BUILDER DECLARATION I hemhrm y a?that I am exempt from the Comractm's License Law far Ile fallowing moon. (Satins, 7031.5. Business and Profanation Codc: Any city or county which an uidn a permit to convene, alter. improve. dcmalW, or repair any s recturne prior to in issuance. also rryuim the appliam (arsuch Permit an fik aaigmd autemeru Contractor's Luaam Law(Chapur 9 Sq. Ft. Floor Area Valuation that an u liceNcd pursuant to the proWioNOl the (commencing with Swam 7000) of Division 3 of the Burd. and Profanation Cade) a Nu W is exempt lWasomen and am Esau Im the alleged aaempdsL My Nolaeon of _----3j&RWg;�Wr—U U Occupancy Type Section 7031.5 by any applicant Tor a Permit wbjecu me applicant to a civil finally of not mom dun live hundred dollars ($500). ❑ t, w owner of Ik Property, or my eroployea with wages at their rale cmnpewdan, Required Inspections q P will do the work, and the accurate W act inuMed or offered (a, Win(Sec. 70th, Badness; arta Profession Code The Contractors License Law does, cot apply a an owrcr N f rtryeny who bu ilds aiImproves thereon. and slut dao smh wmk himself. through his awn employees provided that such Improvements see not inundd too@cod for ala U. however. the building or Improvement W said within cue year of completion. the owns. builder wIU have dm burden of proving that M did not Wild in Improve for purpose of cold.). 0 1, in uwrcr of the Property, am exclusively contracting with licensed ronuanura ho com oa the project (Sec. 7064. Business and Protessom Cade:) The Comracmrs LM clime Law does not appy to an p Tru of pro cuty who Wilds or improves desmon, and. who eonuaa for such pmjecu with a conuactor(O Banned p idem m 0 dre Contractors License law. ❑ I um exempt undo Sm. . B k P C Tor this roasan Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby aff m under Penally of perjury ane of this following declarallons: I ham ad will maintain a Certificate of Conant to self-Insum for WorkersCompcn- setion, u provided for by Sulirm 37M or the Labor Code, roe the peaamana of the wad, for which this Permit is imm d. 0 1 have and will maintain Workers Compensation laaraacc. a required by Secdan 3700 ]( the Labor Code, fm the perfamanee of the work for which this permit is issued. My Workers Compensation Insurance carrier and Polity number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (ThW motion mod not becomplsed if the permit is forme hundred dollars IS= ' or less.) 1 comfy that m the performance at the work for which this period W issued, I nhall nal employ any person in an�Compensation my7cWrn . Laws ofCaliforalk Data _ Appli NOTICETO APPLICANT: If. Ccsi n of Exemption, you should Cfwr ompensation abord Provisions at deLehrCode, you mus haeme subjectinit Worker's Camp n p s of ' forthwith comply with such Provisions Or this Permit shall bcdamed rowkcd. Or this CONSTRUCTION LENDIN AGENCY finding agenry for tiro Performacec of 1 hereby eflirm this mem W loading s ed (SO..30 me work, fur which this permit u issued (Sec. 3097, Civ. C) Lenders v Leders Add Address 1 certify mat I have read Nis application ad mto a a the allow Informaiun is ' correct. L agree to comply with all city and county ordinances and sou laws misting to building construction, and hereby authorise mpremmaivs Of this city to enter upon the ]have-mcahened prepeay for inspection purposes. (We) ]gra to ave, indemnify and keep h trmlca the City of Cupertino against j liabilitia,)adgmens. coats and expenses which may in any way accrue against aid City In consequence of the (nada[ e(mis PCMIL ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH A NO -POINT Issued by: Date SOURCE REGULATIONS. Re -roofs Type of Roof Signature o(Appllia NConuamor i 7 Data HAZARDOUS MATERIALS DISCLOSURE Walidaapplicamwfuture Wilding] Pantscam or ladle haardtiw material as defined by the Cupertino Municipal Code. Chapter 9.13, and me Health and Safety Cade. Section 255374)7�J All roofs shall be inspected prior to any roofing material being installed. [Dy. TI�a If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant Or future Wilding oauupm um equipment u devices which emit loco rdnw air canuminsnn a defined by the Bay Arca Air Quality Management all new materials for inspection. Distinct? ora I have road me laardOwmatedal) mWimmares under Clapur6,95 o(thm Califor. niaH almkSalcty Coda,Sations255U5.25533ad255N.Iunde ,buifda Wilding does not currently haw a un m, that It b my responsibility to testifyftoccuPmt of the requirements watch moa hem arto) ofa Ceni11 of m Signature of Applicant ate o o All roof coverings to be Class "B" or better owner Per amarivea agent _ Dass . !m 1 of 1 CITY OF CUPERTINO ��7uF�F1i �P[4�F�l�ly Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35613016.00 DATE ISSUED.......: 08/09/2006 RECEIPT #.........: 35561 REFERENCE ID # ...: 06080056 SITE ADDRESS .....: 21796 HYANNISPORT DR SUBDIVISION ......: CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: PUNEET AGARWAL ADDRESS ..........: CITY/STATE/ZIP ...: , RECEIVED FROM ....: PUNEET AGARWAL CONTRACTOR .......: LIC # *OWNER* COMPANY ..........: PUNEET AGARWAL ADDRESS ..........: CITY/STATE/ZIP ...: , TELEPHONE ........: •FEE ID UNIT QUANTITY BENERGY PERMIT FEE 1.00 BSEISMICRE VALUATION 200.00 PPERMITFEE FLAT RATE 1.00 TOTAL PERMIT : METHOD OF PAYMENT AMOUNT ----------------- ------------ CASH 73.73 TOTAL RECEIPT 73.73 OPERATOR: amyw COPY # : 2 AMOUNT PD -TO -DT THIS REC 34.86 0.00 34.86 0.50 0.00 0.50 38.37 0.00 38.37 -----73 73 ------0.00 ---------- NUMBER ------------------ VOICE ID ---------------------------- DESCRIPTION VOICE ID DESCRIPTION -------- ------------------- -------- -------- 106 ---------------------------- SEWER & WATER -------- ------------------- 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING 0 0.00 0.00 0.00 0.00 �!R CUPERTINO CITY OF CUPERTINO o&caio5C0 PERMIT APPLICATION FORM IAPN #3� 13—O� Date: Building Address: Mailing Address (if different from building address): 2 M 61k NN 15P 01'T BIZ CAM5grWO S01 Owner's Name: u N �' c ,zUJ k L Ph9rnq #: _— o fe 019 Contractor: License vWne� BBOILER2 Contact: Phone: Cupertino Business License#: Fax: Boiler > 500K to 1M Btu Building Permit Info: / Bldg❑ Elect El Plumb E? Mech ❑ Job Description: Residential ❑ Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: cZ pip mo Occupancy Group: Type of Construction: Please check this box if the project is a C�kS L j NF Fp�2 ti�ffE✓ S7DUE second-storyaddition: Elro'ect Size: Standard ❑ Laze ❑ Ma'or ❑ BCONSTAXBQ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI 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 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 Fr CUPEINO CITY OF CUPERTINO PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Grou BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAEUiAN A/C Units <=10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 "1 J CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM uantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary 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 Mechanicals . foot MECHANICAL MPERMITFEE Mecb 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 n U 3 of 3