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04060156 " CITY OF CUPERTINO BUILDING DIVISION PERMIT Oi BUILDING ADDRESS: 11111"b4060156 ERMITND04060156 6397 MYRTLEWO D D OWNER'S NAME: PERMIT ISSUE DATE NJ SANJAY KRISHNAMURTHY 06/17/2004 10 ONE: - SANDA,BY NO, CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLpG ELECT PLUMB MECH. 0 0 0 0 LICENSEDdunderCONTRACTORS widonsDECLARATION wi I hereby affirm Nu 1 am licensed undo provision n(CMpmr 9(commencing Job DeSCrIp000 p ILS\O IMI. ' < with Sudan 70K)0)of Division 3 of Nes a Business and PromAa1mACndn,mREPLACE ELECT. PANEL dmy1m.a.ia ��n0'+li �q n M® ? m full roma and effect, 5 g a License Classsec.a Dam Contractor /s ARCHITECTS DECLARATION JUL 2��4 1 urdersund my plans Nall be u rt used public nras G 3u Liccnud Pmfeuionat �� O OWNER-BUILDER DECLARATION a 0I 1 Wrehy.(firm that 11. exempt s An the Contractors License Law for the iOO follwhich re mason.(Section Tos5,Bmlm¢¢andn,th Professions C.or Any city or county +�$ which its ism a permit re ennwct,alter,impnw,demnllit t or e a sig any uncthm 89,000 I�^ that toitsemmedp,rsua reuant quires the theapplicant forsuch Perrino Blame Law(ned shaptert F C she m..ic ic&withSection7")ofDivision i provisions ftlaoB sines LaaxlAw(COxm)or Sq. Ft. Floor Area Valuation se F$ (m,bac.erg with Semicon]and of D earl or the Al Business and Profeon.Any i lotion or r3.. Nat he u 31.5 b Ncnlrom and the bur for be alleged exemption.Any it A.on of notSexim. than by arty applicant far a permit subjects N.applicant to a civil penalty of net mom th.nfin hundred dollars(asmB). a Occupancy Type ❑I.As owner ofthe pmperty.or my cmployeu with wagns as their ante eompmution, will do dae work and the am tum is not intended oro(fcred forsam(Sec.7044,Business and Professions Coda:Tim C.,roetors Luc=Law data not apply to an manor or Required Inspections property who bu ilds m improves daemon,and who does suc h work himself or through his own employees,provided that uch improvements are not intended or offered torula If, however,the building or improvement is sold within one year of completion.the owner builder will have Use burden of proving that he did not build or Improve for purpose of pm.). KI.u owner of Ne progeny,am eaclumnly contracting with licensed conmctors to ' .wct Ne pmjett(see.7044,Business and Profusions Code:)The Contractors Li- cenm hw dose nes apply to an Owner of property who builds or improve daemon,and who conmcu far such pmjccu witha consactor(s)licensed pursuant the Contractors L%n a Lawxe 1 am empt urger/In.. B&PC or this memo nu t RK Data �7 WORKER'S COMPENSATION pfiCl-•AAATIO N I he elfm under penalty a(perjury one of the following declarations: , 1 have and will maintain a Certificate of Consent At seV-insunc for Worker's Compcn. setion,As provided for by Section 3700 of the Labor Cadc,for the Performance of the work for which this Permit is issued. ❑1 haw and will maintain Workers Compensation Insurance,As required by Section 3700 of the labor Code,for N.performance or the work for which this permit is issued. My Workers Compeued..mount.tamer and Polity number am: Cartier. Policy No.: , CERTIFICATE OF EXEM MON FROM WORKERS' COMPENSATION INSURANCE Cris section recd not Wcompleted if the pemi,is for one hundred dollen is 1010 or Ices.) 1 certify Nat in Ne Performance of ONc work for which this Permit is issued,I Nall not employ any person in my number an u in become subject w she Waryeri Compensation Law¢of Califomis.Data ' Applicant NOTICE TO APPLICANT.If,after making this Ccnincete of Exemption,you should become subject to the Worker's Compensation provisions or the Labor Cade,you mum .,0 forthwith comply with such provisions or this permit shall he deemed ranked. 'Z'" CONSTRUCTION LENDING AGENCY F.N., Ihemb &Mrm that Vert is a construction lending ac run dm r g emr Performance of 6i the work(m which this gamin is issued(Sec.7097,Co.C.) A Lendcr'a Nuns Z:) nti. z Lenders Address U O 1 certify that 1 haw read this application and same that Ne above infom W un is w corrttL 1 agree to comply with HI city and county ordinances and sum laws relating to 0 U abonng eonmruesiom and herfor ire a cdonn mosey, w4 of this city to enter upon Orc �j Dal shove-memis.judgments, gm pmperst for inspection purposes gy (We).gree m eve,indemnify and keep harmless the City of Cupertino agaiut y anC. .gmn gmc the starting of expenses which may in any wayeeerm egeims said Cisy A APPLICANT of UNDERSTANDS of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCER ULApONS 1 �/R EREG N 6 -7 Re-roofs 5'9q!1,1rA fAp,hc.I1CmtAoMM, Due HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant mom or handlc huardous material As defined by the Cupertino MarICIF Code,Chapter 9.13,and the Health and Safety.1101W - ade,seetimzss33(.)7 Yen All roofs shall be inspected prior to any roofing material being installed. ❑ No Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hamodus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Dianms7 P ❑vee I have mad Ne hmandWs mammals requirements under Chapter 6.95 or the cmifor. nr Health&SaelyCodc,Sections 25AI5,25533 aru135534.1 understood OutsIrmo building does stns currently In.w a rent,Nes it r Any rupuass,diry in pouf aceupans of the roquiurrm! whim mum be et p6orw rsumce ora C"'.mo cu Date J r� � Signature of Applicant Owner or aushonnd agent pa,o -T All roof coverings to be Class'B"or better I CITY OF CUPERTINO CUPEIOTINO PERMIT APPLICATION FORM 'OPAPN# 3 / D D Date: 1 / 7 Building Address: Mailing Address/(if dif eren from building address): f-' ry CA c� /. Owner's Name: 1 Phone#: Sin �7 y' Contrac or: License#: GL� Contact: Phone: S1_ 7 7 Cupertino Business License#: Fax: Building Permit Info: Bldg ❑ Lidt< Plumb ❑ Mech ❑ Job Description: , Ra�0-1 Q6e— pec � Residential © Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Projec . 2 Occupancy Grou : Type of ConsductioPlease check this box if the project is a second-storyaddition: ❑ ro'ect Size: Standard ❑ Laze ❑ Major ❑ 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 IM 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 1of3 %UZI CITY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 Imp 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 BRENL IRHAN A/C.Units <= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFDCT 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 I Remodel Res Appliance ELECTRICAL 2 of 3 5 CITY OF CUPERTINO CU C,T o NO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Sips 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 Insection 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 Mech Permit Issuance MECHANICAL j PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING i 3 of 3 I CITY OF CUPERTINO m 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 2 Sec : Twp : Rng: Sub: Blk: Lot : APN . . . . . . . . : 36917006 . 00 DATE ISSUED. . . . . . . : 06/17/2004 RECEIPT # . . . . . . . . . : 25962 REFERENCE ID # . . . : 04060156 SITE ADDRESS . . . . . : 6397 MYRTLEWOOD DR SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SANJAY KRISHNAMURTHY ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , RECEIVED FROM . . . . : SANJAY KRISHNAMURTHY CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . . 41E TELEPHONE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- --------- - BELEC200 METERS 1 . 00 27 . 25 0 . 00 27 . 25 0 . 00 BENERGY PERMIT FEE 1 . 00 23 . 10 0 . 00 23 . 10 0 . 00 EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 BSEISMICRE VALUATION 2 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 86 . 37 0 . 00 86 . 37 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------- ----- ------------------ OTHER 86 . 37 VISA TOTAL RECEIPT 86 . 37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL