02060153 (4) CITY OF CUPERTINO
BUILDING DIVISION PEROT CONTRACTOR INFO ION:
BU1LDfNGADDRESS: PERMIT NO.
862 E ESTATES DR EARTHQUAKE READINESS 02060153
OWNER'S NAME: APPLICATION SUB DATE
MICHAEL TAERLEY 236 STANFORD SHOPPING CENTER 06/24/2002
•PHONE: SANITARY NO. CONTROL NO.
(650) 324-3322
O O ARCHITECTiENGINEER: BUILDING PERMIT INFO
to BLDG ELECT PLUMB MECH
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i LICENSED CONTRACTOR'S DECLARATION Job Description
O Z—o I hereby oRra:l am licensed under previsions of Chapter 9(commencing
f,_�WW wnhS do 7000)of Division3oftheB iness and Professions Code.and myliccnx SEISMIC UPGRADE.
<e:tz is in ful rce sand of `
z s z a License lav Lie.p IO
LL0 D e pRCHRECI"S on LARATION � / '
N<5 I understand my plans shall be u. public rsords
dp O licensed Professional /\
OWNER-BUILDER DECLARATION
1 hereby vlRrm that 1 am exempt from the Contractor's License Low for the /
t Zs following reason.(Section 7031.5,Business.,it Professions Code:Any city or county
$15400
2 F O which regrmto m
wrcs.peit cronwhi site,.improve,demolish,or repanny urucre.
ts6w73�' priortosuissuance,also requires Neapplicoot forsuch permitm filessignedsmtemem
Nat heis liaa d pursuant tq thIF visions of the Contractors license Law(Chapter 9
(commctil ng wnh.Section 7000)of Division 3 of the Business and Professions Code) Or SS❑❑.� ppt 1 re a,. Valuation
. . ,-,(>.:.,
bit WIhe is exempnheieflom arW the basis for Ne alleeut exem%ion.AnY vinmdon '" — - • 3'6.9`�4'-011 �b_}a'..- •.--''.'t/.
rofS tion?031.5 by any appliconIforvpermitsubjectstheapplicanrtoaci.ilpenalty- NN mmhheei�
nun%tnnre than five no Bred ennars(ssoot 101 °PN FOUNDATION Occupancy Type
❑1,as owner of the property,or my employees with wages-1 their sole compensation.
"wdl'do the work,and the structure is no,intended or offered for sale(Sec.70,41,t'.
Business and Professions Code:The Commit.,x License Law does not apply no an 10 3 - UFER Required Inspections'' -
owner of propeny Who builds or improves:hereon,and who does such work himself
or through his own employees.provided that such improvements ort not intended or .1 4 _REBAR-
":offered for sale:IC ho mml.Ne building oilidpro.cment is'sold within one year of -- -
completion,the owner-Wilder will have the huMcn of proving that he did not Wild or 105 - ANCHOR BOLTS
improve r of thrposee
rsale.). 106 - SEWER & WATER
El 1. erofthep perry y gwlCM:)licensed Contcwnto 202 - UNDERFLOOR PLUMBING
construct the%o)ecs(Sec ]041,Business and Profession CMI:)
Contractor's
L:anxLowd«,notappy.o ownernfpropnywnnWilconrimprove,Nereaq 203 - UNDERFLOOR MECHANICAL
and who commas for such projec,with a commctor(s) licenxd putsuam.in the
Ccn smbLice
malaw" 204 - UNDERFLOOR...FRAME - . . ....__._..
olam exempt
undo see.' 'B eePcrormis reaxn Dole 205 - UNDERFLOOR INSULATION
- Owner , WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING
I hereby alFrtn under Penalty perjury one or she following declarations:, 302 - TUB & OR SHOWER
❑ 1 have and will maintain.Cmifeete of Conant in selbih ure for worker's 303 - ROUGH MECHANICAL
Compena%foes, as provldad for by Stttmn 3700 or the Libor Code. for the 304 - ROUGH ELECTRICAL
yetformarce of the werk for which this permit is Hued, 3 05 - FRAME
❑1 have and will maintain Worker's Compensation Insurance,as required by Section 306 - HOLDOWNS
3700 of she Labor Code,for the performance of the work for which this permit is
C
e S' ' into, cecamerandPoheynumberam: 307 INSULATION
. 7CERTIFICATIONO ..._. - .... ... ... .. . .. . ..... ............
issued.My Wnrkcrs Com,�rnsa:on 1
� erNn�aq-o21(nf{ ex��i 3,08...- .,,SHEETR( , .;. . .
J PPPCCCXXXEMPT10N FROM WORKERS:,
cOMPENSATIO INSURANCE 309 '_EXTERIOR LiATH
` (Th se^r ed tbo mple:d f:h R it is n hundred 310- .- ' INTERIOR*LATH
(slop) t 311 - SCRATCH COAT
lardy that in 6c perforiamole ofth work for n h this permit is x. d'i ' 313' - ROOF NAIL:
,n n not play any 1= ^ y ma a t x n)e I t me worker' 501 - FINAL ELECTRICAL ENERGY
ApplCo pc .mon Laws r cal f D¢
y� ,NOT rant 502- --FINAL- PLUMBING ENERGY-
'NOTICETOAPPUCANTIfC n.,i.. . rYfcteolE rep: de,you oust
becomehcomuomew rk< C mpenmt i p it hall
hound you must 503 — FINAL MECHANICAL ENERGY
,trim such provisions arm.,permit znaE bo deemed rczveea.
- 504 FINAL BUILDING ENERGY
t forthwith comply
' CONSTRUCTIONLENDINGAGENCY 505 - FINAL ELECTRICAL
rear which
ih t mine cunt (Set.
nding.tgency for perfomtan.e v
W
of di work f which this% : issued(S i09],Civ.C.) -
� Lend .N .- . . .. .. . . '
506 GAS TEST. .
Cd Z Lewe,AZdteu 507 - FINAL PLUMBING ,
L6 Cd -, laedifrmatlnmemad:hi.appfirmlonandntetWttheaviseinformationis 508 - FINAL MECHANICAL
O [-N Conte.I agree to comply with all city and county ordinances and state laws relming
U+ to Wilding construction.and hereby aulnri:erepes,reheexnnni,ri:cmenter gmo 509 - FINAL GRADE
ry rex bmentionedproperty de inspection 510 - FINAL PLANNING
E+ 1 IW16 ym sj andk ph,rml sthe Cly fC pe Lino vg inxt
Vi Cit lines. against said U'Z city )qg o'.f 1w d'ny fm which ) �n'1nY r ` 514 — FINAL WORKS
APPLIC,, .N ER5 f5NDS'S.D%%IL1_CO%TPUi WITH ALI I O\- GI1 ' Issued : J
OVRCE _G LATI'. 5. L ��
vC�t7y(oiM•krv� 6 U2.. Y —`-� 'C- --�_ Date
-1 Signature or Applican nmrannr Dare Re-roofs '
HAZARDOUS MATERIALS DISCLOSURE
Will the applisa io future'building acupam store or handle haiatdme mate 6.l _Type Of ROOF...
as defined by(he Cupen N n pal Code Chapter 9.13 and the Health and Saey
Cod Section 25532(.)
All roofs shall be inspected pnor_to any roofing material being.installed
lO 11 the air contaminants
o t furore Wilding by the nt use BaY Ami, pate : it Marei agemen If a roof is installed without first obtaining an inspection, I agree to remove
cloth No .arcnm mmannadcfoed by Bav Arca AvQ airy Managcmem e
Di,tnrt: all new materials for inspection. Applicant understands and will comply with
Cl Yes _ - ❑No
all non-point source regulations,.,
1 have laud the Safety
Codedoemnteri,lx 505.25requic33 a d 255 Cha%cr understand
of the
Ghe buil ing dos of cty Code Sections ant.that
it is and25531.I understand that
if the building g does not currently m raven,.mantis myssuancsibf a Cerificat the _
occupant of the rcquircmentz which must W me prior to issuance or a Certificate of
Occupancy.
I'- /ZyYQZ Signature of Applicant Date
1'r- Date All roof coverings to be Class "B"or better
.. - OFFICE
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9�2 E. 15STATEs � �
A conatruntlon Cardu lft,' lsll>tinnln Seland¢ r ea NUMBER:
( , General Contractor 0858640 236 Stanford S/C,0126,Palo Alto,CA x1304
-w e-mail ckinney®quakeready.com http:/lwww.quakeready.com D
(650)324-3322 Fax (650)324-2402 �a1�
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CITY OF PERMIT APPLICATION FORM
CUPEkTINO
APN# Date:
qa
Building Addr ss:
Del u�5 -e QO
Ow 's N
ne e:e//. 7-a6/ I
C �ac Uq l�SI� Liceps
Coned: CS
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A plican ontractor: Fax #:
ala k.e, Leo 61,VQe
uilding Permit Info:
ldg Elect Plumb Mech
Jub-Description:
kesidential: D/U Se S I rgdP Commercial:
Sq.Ft. Floor Area: $/S
00
Architect/Engineer: Vajjuation:
46 Type of Construction: Occupancy Group:
Quanti Fee ID Fee Descri tion Fee Group
BAPPLOTHER Other A liances MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/ ,,as; BUILDING
BCONSTAXBQ Con. Tax for Rn 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 EnerEy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housin Mit. Fee BUILDING
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BNEWMULTI New Multi-family Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL `
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
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