08020054 CITY OF CUPERTINO ::07
-- `*' -
BUILDINGDIVISION PERMIT CCQNTRACI'ORINFURMA1 3
BUILDIN4ADDRESS: PERMIT NO.
63y7 MYRTLEWOOD DR TBD - TO BE DETERMINED 08020054
7AHROCHITEZ741INGINEER:
EWS NAME: PERMIT ISSUE DATE p
MTKF VTTCN0T14TD .- 02/11/2008
NE: G A SANITARY NO. CONTROL NO.
`-J BUILDING PERMIT INFO
BLDG ELER PLUMB MECH
306 LICENSED CON7ACMR'S DECLARATION Job Description
I hereby affirm Nn 1 am licensed under provisions or Chapter 9(commencing P
IN Scene.7").fDivbkn 3.f0.Business and Pmmfessiet,Code,amy license a SVC CHO 200AMP FLUSH MNTD PANEL, REPLC 100 TO
u in full farce and effett 1 0 7 5 S
M
'�z ucenqq��Iap Lteg 200AMP
Dau T/I/ .
uH CSDECL
ee AsMapIECrsoECL3MnoN COURTESY ELECTRIC PD FOR BUS LIC 2-11-08
t� IuMcnunJ my pWu aiWlheused u Public mnrJa
6
y 0 Licensed Pottmithnal
OWNER-BUILDER DECLARATION
,05 1 therebymuch,
aiThm that 11, exempt from the Contractor's r.License Law for the
y o O follwhich eca turns. amoseebt t 7 m LS, t.Mona and PmfLR1aN COJr:Any Clly or counmuton
3 which mquims a permit ro enruwec aloe.Improve,h eNbh.rilmpeig any ancient
_tae pdorbits iuuance.aisuseg0 Me lIMASIO am for such permit Licens.Lnntaoumcnl
53 (that lat cnumenchcvithSucwmmNepmviviomofof ftBuseur'.Licemelaw(Chaper9 Sq.Ft Floor Area 2100 Valuation
$ (commencing wish Section 7000)thf Divbion3 of the Budnw end Profrssithu Cnte)er
.. that he is exempt theWrom and the bub for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy Type
nut mart Nan five hundred dollars(3500). 3 6 917 0 0 6 .CTU-
1,u aww of die pmpwy,ser my wploym with wgns u their sob cmnpeuadon.
will do the A.and the structure is WE lnundW IXonemd for ask(Sec.70 t,Business
and Profe.W.Code:Tin Cthnmcura Lt..Lave dm mol apply in an ow cr or Required Inspections
property who Wilda orimproles thereon,and who doessuch workhimself or through his
own employee,provided Nu such improvements art no,intended oroRemd for We.If.
however.the building or Improvement is sold within on you of completirm.the owner-
builder will have the burden of proving Nat he did trot build or improve for purpose of
uk.).
. ❑1.u thaw of the property,am eaclueiwly contracting with licensed conuacters to
commact the project(Sea 7044.Business and ProksdON Code:)Tin Convector'.Ll-
cense Law dm not apply to u ower of property who Wilds.,Improves tome,and ,
who contracts for such projects with•cenvactor(s)licensed Pursuant to the Contractor'.
License Law.
❑Iamuemprunder See .B&PCforthiamuon
w
Data
WORKERS COMPENSATION DECLARATTON
1 hereby affIm under peWly of perjury,aro.[MO following dcelaratiIXlc
ham and will maintain a Certificate of Consent he self-Wum for Worker's Camper,
s on,as provided for by Section 3700 of the Labor Code.for the performance of the
work for which this pemlit is issued.
0 I love and will maintain Worhers Compenution Wmrance,u required by Section
3700 of the lather Code.for the performance or the ark for which this permit is iuuc4 '
My workers Campenseden Luurana aria and Policy number m:
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ties,section sent not he cmepkted If the permit Tat...hendral dollen($100)
fir I u)
I cer ifv Met in the Perform unC of ort fIX whuh this permit In issued.1091 con
emPloy my person in any mYcthme sebjact ro the Workers'Competmdart
Laws of California.Date XX
Applicant
NOTICE T'0 APPLICANT:If, net making this Certificate of Exemption.you should
become subject in the Worker.Compensation provisions of do Labor Cede,you mute
.JO forthwith comply with such provision.IX permit this peit Mail W doemed molted.
,zy CONSTRUCTION LENDING AGENCY
[—� Ihemby.111.Out Nem 1....marummo lending agency for the Ferimmawur
ai the work for which Nb Permit is Wood(Sec.3M,Civ.C.)
W�A Lender Name ,
7z Lembes MOsss
U Q 1 certify Nn I have rod this appxeadw and sum,Out,the above information is '
(y correct.I agree in cmnply with all city and county oNinances and sero laws misting th
0 Wilding construction,and hereby sutWdre represrrunim of this city to emmupen de
W abort-mendmed property for inspection purposes.
p•1, (We)agree to save,indemnify and keep harmless the City of Cupertino almost
W liabilities,judgments,cone and expenser which may In any way mc=agsina Wd City -
V z In consequence of the granting of this permit.
F-t APPLICANT UNDER NDS AND WILL COMPLY WITH ALL N N-POINT Issued by: Date
sOUr¢,JT G 0 2 II
IYt Re-roofs
Sigwum of AppliwH; tractor Date
xA DOUs MATERIALS DISCLOSURE Type of Roof
Will the applicant fuum building excumucre or handle hazardous material
u de0nod by the Cupertino Municipal Code.Chapter 9.13.and the Health end Safely
wk,Oyu 25532a)? N All roofs shall be inspected prior to any roofing material being installed.
Will el
Me applicaor future Wilding occuptto.equipment ordevices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hamsomm,air cm uminanu n defined by the Bay Am.Air Quality Management all new materials for inspection.
District?
❑Yes `$tea
I ham rest the husrdmu metedW mquiromm us un$r Chapu ti.95 of 0u Califor.
ma Hralthk Safely Cade,Suctimu255WX533and 25534.1 undcrsord thnif de Wilding
Jm mol cunentiy hem•tcoant the It o my mpomihilily b twdry der occupant fir pct
requirements wconn t uuco safe on"" "thr Lion Signature Of Applicant Date
z ��
Owner or auththdxed genl Dau
All roof coverings to be Class"B"or better
e ' '
CITY'7F CUPERTINO �,a « �" �r * � �� "` �"'��' -
BUILIni1NGDIVIS:ON PERMIT C'UNTRA ` 'O RINE`(?uM+'1'�Idk�T
� y �q
PERMIT NO.
BU1LDyNO�aP"MRTLEWOOD DR TBD - TO BE DETERMINED 08020054
NEbRSS NAME: FERMITISSUEDAIS
NARAYANAN SUWDARAM 02/11/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHr1ECrIENGINEER: BUILDING PERMIT INFO
BLDGI� EO � MECH
(� 0
Sop LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby aiBrm that 1 am limina d under provisions of Chapter 9(commencing
m ' wide Section 70(11)of Division 3afthe Business sad Profession,Code,mad my]fees u SVC CHH 200AMP FLUSH MNTD PANEL, REPLC 100 TO
< in full fame and efQct.
License Clan Lie.g 200AMP
'W
D&W_Contractor ARCHITECTS DECLARATION COURTESY ELECTRIC PD FOR BUS LIC 2-11-08
u.3p 1 mWemund my pins Asti be used as public reeodis
�y
tea Licensed Professional
7
OWNER-BUILDER DECLARATION
9 a f 1 hereby.afford(Smi that 1 1. exempt from Joe to nlrsumr'a e:License Law for the
p O (allowing moon. Pani'h]sl]L5,Boniness and PrafcedeR Cole:Any city m county
$ which mquissuance.a eomb reconsthe alter,impose,dPermit,ore a sig any nactmo
prior m its ensedpassn alrequires,tethe inion o for such ennui'm Ole signet sutement
xxD
that
commeningwJpunuanuotheofDivision3olCanwnessniceescLaw
onChaPmr9 Sq.F[. Floor Area Valuation
F$ (eommendngwimionfousandof basison3ofdeeBusmenandon.MyonaCMe)of $2100
that he b ewmp'cuere(ram end the bub for me alleged exemption.My violation of
Section 7031.5 by any applicant for a Permit subkets the applicant to a civil penalty of �rppp Number Occupancy Type
no,mom Jure five hundred dollars($500). 3 6 917 0 0 6:'C/U'
0 l.wowmrofthopmperty.mmymploymwithmrAna ckmlecompewdon, -
wflldothework,and the eWctumisnot Intended oroffered for ask(Sec.70M,Business Required actions
and Professions Code:The Communes License Law does m'apply To e ns an owner of q P
property who builds or improves demon,add who does such work himself or through his
own employees,Provided that such improvements are not iourrded moRered for sale.if,
however.the building or Improvement is mid within ow your of completion,The owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
0 1.as owner of the property,am exclusively contracting with licensed mentioned,m
construe'dee project(Sec.7W,Business and Professions Code:)The Cwtrm mar's Ll-
cocoa Law does not apply an an owner of property who builds or improves themes,and
who contracts for such projects with a cwuusurds)licensed pur m nt in the Contractor's
Lioewe Law.
O lamesemp'underSee ,B&PCfothismaon
40 nm Dasa
WORKER'S COMPENSATION DECLARATION
I hereby alum under penalty of perjury one of cue following decimations:
0 1 have and will mainssin a Cerffinmof Cawent m self-imam for WarketsCompen-
setion,as provided far by Section 37M of the laboe Code,for deo Performance of the
work for which this permit is issued.
0 1 have and will mammin Worker's Compensation Insurance,as required by Sccuon
3700 of the labor Cade,for me pefmm cce of he work forwhich cuts permit is issued.
My Worker's Compensation Insurance comes and Policy number sem:
Cartier, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITbsectloe need motxcompleted lithe permit is two=hundred dollen(SIM)
or leas.)
1 certify that in the performance of Use work for which this permit is Wood,I shall not
employ my person in any m umerse as to become subject to the Workers'Compewarlon
Laws of California.Dam
Applicant .
NOTICE TO APPLICANT.If, per making this Cenifncao of Exemption,you should
become subject in the Worker's Compensation provisions of the labor Code,you must '
0 O forthwith comply with such prevision m cub permit shall be domed revoked.
,Z.t CONSTRUCTION LENDING AGENCY
'C+ I hereby affirm that mere iso construction lending agency for the Performance of
DI
be work for which this Permit b issued(Sec.3097,Civ.C.)
6Wi Q Leader's Name
]z Lenders Addrea
V I certify mat 1 have mad this appilonan and sum that dee above Information is
Ig.E comlL I agree m comply with all city and county aNiname,and sum laws Totaling to
0 building construction,and hereby sumodx representatives of this city in enter upon she
{Ll thow-mentioned property for fnspetion purposes.
O. (We)agree m save,indemnify and keep harmless the City of Captain against
ti Vl liabilities.judgments.costs and expenses which may in my way accruc against mid City
in
of the
V rZ.
APPLICANT eUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature of ApplicanUComrDam Re-roofs
HAZARDOUS
S MAig MCUP DISCLOSURE Type of Roof
WIII the applicant iafotum busalingoccupantgame r9.1orand the
Health and
deOnM by cue Cupertino Municipal Code.Chapter 9.12.and me HCaIN anJ gaiety
e,section 25532(.)+ All roofs shall be inspected prior to any roofing material being installed.
❑Yes ON.
Will the applicant or future building occupant use equipment or do,[.which If a roof is installed without first obtaining an inspection,I agree to remove
emit WeaNnus air cmuminmu u defend by the Bay Area Air Quality Management all new materials for inspection.
Gimlet?
CYcs 0 N
1 haw real the hoardousmamdab mquimmcnu underChapmr6.95 of cueC lifor-
ma Hcaim&SafctyCodc,Safoos 25305,25533.x125534.1 undontsnd dentition building
does net comely haw a Into,that It u my responsibility m imnify the occupant of the
numberenu which mon be mel prior m issuance of a Certificate of Occupancy. Signature Of Applicant Date
Owner or eumerimdagen' Dam - All roof coverings to be Class"B"or better
o� oa 005
,Q._ CITY OF CUPERTINO
CUPERT�NO GENERAL BUILDING
PERMIT APPLICATION FORM
"
PN" 3 0 17 D O � , DU Date: 02 I 0
Building Address:
(, Q1 Q r �-�2�0D,�
Mailing Address (if differclit from building address):
Owner's Name: t4 Q I P Ay4 01Phone #:
/ -109 -S °� —/ 0 I 1
Contractor: Phone:
Fax:
Contractor License y r
® Cupertino Business License #:
Contact: Phone:
` , 4 eg-Soni-�n �7
M\1( V� 7.it 21� Fax:
Residential'W Commercial
Job Description: (�eYJ�c2in
C�atic�t 2�po WwP 1=�KS4 µ, o„nitd Pc ,•��,
Ke,VW e �OOAA AV -�o
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
I FR, IlFR ❑ 11, 111, VAHR ❑ 11, 111, 1V V-N L— ?,
Valuatio Square Footage:
• Project Size: Standard Large ❑ Major ❑
CITY OF CUPERTINO •
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1BTEMPPER Temporary Building Permit (good for B
30 days)
IBBOILER1 For the installation or relocation of ea M
boiler/compressor to &including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h 29.3kw
1BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
1BBOILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea •
absorption sys over 500,000 Btu/h to
&incl 1,000,000 Btu/h
IBBOILER4 Installation/relocation of ea M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
IELECINSP Other Electrical Inspections (per hour) E
IMECHINSP Other Mechanical Inspections (per M
hour) •
IPLMBINSP Other Plumbing& Gas Inspections P
(per hour
1MEETINGIHR Application Meeting B
CITY OF CUPERTINO
• CUPEI�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL/Duplex New B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1 CHIMNEY Chimney B
1 CHIMNEYR Chimney Repair B
FENCES
1FENCE>6FT Non-masonry, over 6 ft in height B
1FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
IFIREPLMAS Fireplace Masonry B
1FIREPLFAB Fireplace Pre-Fabricated/Metal B
1FLAGPOL>20 Flag pole (over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1FOUNDREP Foundation Repair B
1PILECAST Pile Foundation Cast in place concrete B
1PILEDRIV Pile Foundation Driven (steel, pre- B
stressed concrete
3 of 5
4 CITY OF CUPERTINO
CUPEI�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group IGENRES or
l GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY
1RETSTN Standard (up to 50 ft) B
1RETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSP10 Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high(up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SIDING
1 SIDESTBK Siding, Stone & Brick Veneer B •
interior/exterior
1 SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
1 SKYL>10SF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 so B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st
ISTUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
•
4 of 5
'Q CITY OF CUPERTINO
• CUPEI�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quanti /Sf Fee ID Fee Description Fee Permit
t3' P Type
Group 1GENRES or
1 GENCOM
1 WINREP Replacement windows/sliding glass B
door ea 8 windows
1WINIv1EWSTR New Window-structural shear B
wall/masonry includes plan ck fee
IEPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMPLNCK Stand Alone Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no EAVP) B
when not over counter) hourly-stand alone
IBSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1TRAVDOC Travel & Documentation B
IBUSLIC Business License B
•
5of5
• CITY OFCUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36917006 . 00
DATE ISSUED. . . . . . . : 02/11/2008
RECEIPT # . . . . . . . . . : BS000003899
REFERENCE ID # . . . : 08020054
SITE ADDRESS 6397 MYRTLEWOOD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MIKE VALENZUELA
ADDRESS . . . . . . . . . . : 6397 MYRLTEWOOD DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : MIKE J VALENZUELA
CONTRACTOR . . . . . . . : TBD ' TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : -TBD -. TO BE DETERMINED
ADDRESS . . . . 1 . . . . . :
CITY/STATE/ZIP ,
TELEPHONE . . . . . . . . ..
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-------=-- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 2, 100. 00 0.50 0. 00 0.50 0. 00
1BUSLIC FLAT RATE . 1. 00 110. 00 0. 00 110.00 0. 00
IELECINSP HOUR 1. 00 122 .38 0. 00 122 .38 0. 00
1EPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00
1TRAVDOC FLAT RATE 1. 00 40 .79 0 . 00 40.79 0. 00
---------- ---------- --------- ----
TOTAL PERMIT 314 .46 0. 00 314 .46 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 314 .46 VISA
------------
TOTAL RECEIPT 314 .46
Community Development
10300 Torre Avenue
Cupertino CA 95014
" Telephone(408) 777-3228
4PUPCITY OF
EI�TIN� Fax(408)777-3333
fC I�1 Building Department
JOB ADDRESS: PERMIT# CPO
OWNER'S NAME: NE # A(O - oq-1017
GENERAL CONTRACTOR: -' A FAX #
I am not using any subcontractors: 2 + Jg
Si ture Date
Please check applicable subcontractors and comHrtetlie following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical mu� �eS IeC s;C Qo33`��
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
OwnerontraAor Signature Date