04120024 (4) CITY OF CUPERTINO
BUILDING DIVISIONPER �� '`'1C.I(tACTC7J�fNF',,RNT 4,
Bu1wINGADDRESS: EARTHQUAKE READINESS PERMIT NO 04120024
1062
NEWS NAME: PERMIT ISSUE DATE
IRONY GREENBERG236 STANFORD RROPPTMr
NE: SANITARY N0. CONTROL NO. -
650 324-3322
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 = a
ling LICENSEDCONTRACT'onOR'SDECLATION Il , \�`� _
F 1 hereby effort that I am licensed uM�cr 9ro inions of Chapter 9(commencing
'uj with n y effo t That[ o fico red mus)lod Profc ions Codcsnd m..cnscis
>„ term. dement. ��SFy �17 OLLUNTARY SEISMIC UP
Liccnac leas Lic.p
Dau Cnntmter DEC 2004
ARCH! CI's DEhe
tun a� yp na sput hlN usfd es PubltmcnNs N
o LicdnscI encs inml "IA BUILDING■ �I L®I■ �G
q S OWNER-BUILDER DECLARATION U
R e Z 1 mann affirm on 11. exempt from the Contractor's eLicense Ac Law for the
Re p which ng reason.Permit
to]onstr,Business and Professions Code:Any city as county
x m which requires a permit reconstruct,elle improve,demolish,ore a sir ed statement
re"ra that
pnorm c,alaopti.the No,itkocantforsuch PermiuoiLaw(Cha mem
p�p�< (carbonlicensed Pursuant tae the of Division
of the Contmnessa License Loons Code)
Sq.Ft.Floor Area .. Valuation
y+2Fp
(commencing wiM Section]BndtoDiaiiion3 the alleged
Business and Professions Any
Cade)of
i�$
that he is exempt shcrcfiom and Ne basis for the ellegctl cxemptlon.Any vlala0on of
Section 7031.5 by any applicant for a permit subjects On applicant o u civil penalty of 1\TENu* lerU 0 Occupancy Type
not more Nan five hundred dollars(5500).
❑1,as owner of Ne property,or my employers with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business
and Professions ciel The Commseft rb License Law don not apply N an owner of Required Inspections -
propeny w ho builds or im provu thereon,a nd wbo does such work himself or through his
awn employees,provided thatsuch improvements an not intended oro@red formic.If,
however,the building or improvement is sold within one year of completion,the owner
builder will have Ne burden of proving that he did not build or improve for purpose of
sale.).
❑I.as owner of the properly,am exclusively contracting with licensed contrncmrt to '
c...Rum the project(Sec.7044,Business and Professions Cade:)The Cmunicrer's Li-
comm Law does not apply to an owner of property who Wilds or improves thereon,and '
who contents for such projects with a commemons)licensed pursus.nt in the Conmecsar's
License Law.
❑I ase exempt under Sec. .B�&P C for this numn
weer Dare
WORKER'S COMPENSATION DECLARATION
_ I hereby a from under pemlty of perjury one of the following chclentions:
1 have and will maintain a Certificate of Consent to self-insum for Worker's Cooper.
author,an provided for by Section 3700 of Jte Labor Code,for Ne Performance of the
work for which this permit is issued.
❑1 have anj will maintain Worker's Compensation Insurance,as required by Section
3100 of Ne bot Cotle.for Meperformanee ufthework r which this permit is issued.
My Work s e seuon I.re on carrier and Polity n r a
Came d ('r,' Policy Na.: <)Q
CERTIFICATEOFEX FDONFIR RS'
COMPENSATION 114SU CE
(Thu section need.mbecon,loted lithe permit lsforone hundred dollars($100)
or less.)
I certify,that in the performance of the work for which this permit is issued.l shall not
employ any person in any manner so as to become subject to the WorkersCompensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must ,
,JO forthwith comply with such provisions or this permit 11h.11 In deemed revoked.
"7„J DiCONSrRUC ICN LENDING AGENCY
'tr Ihereby affirm Nat More is a construction lending agency for the performance of
On work fur which Nis permit is leaned(Sec.3091,Civ.C.)
QLendcr's Name
P z Lender's Address
U Q 1 cenify that I have mad this application and aisle that the above information is
IL H crosem l agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorize mprescroadves of this city to enter upon the (
W alove-menduned progeny for inspection Purpaus
(s ju agree to govt,indemnify end keep harmless the City of,against s against
ith liabilities I.saw,
and expenses and ex may inenyway ac of Cupertino
against
City ✓q`///
V z in consequence of the antin6 of t u permit. r ri
" APPLI,IICANT INDE�JJ�It ANDS D WILL COMPLY WITH L ON-1.POINT Issued by: Date
SOUhCfi-REGULAT[t� s.
� 3 � Re-roofs
Bi, of APPlican .macro, em
a HAZARDOUS MATERIALS DISCLOSU Type of Roof ,
Will the applicant arfuture building oceupawstom or handlebar nonmaterial
a defined by the Cupenino Municipal Code,Chapter 9.12,and the Health and Safety
Code,section 25532(a)7 �t All roofs shall be inspected prior to any roofing material being installed.
n Yes Na
I If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hamtdous air conuminan,an defined by the Bay Arca Air Quality Managementall new materials for Inspection.
District? CC,,
❑Yes f11No
I have read the haasolotTTTTo"'''marerials requirements under Chapter&95of Ne Califon
nice Health&Safety Codc,Sections25505,25533 and 25534.1 undersand Natif the building
Joel not cuncmly ave a tenant that it u my responsihiliry m nhtify.IBc up t of the
rcyvircmcros whtc must be mcLrgr� missulnm ofa Cc"fcam of Oce ancy. Signature of Applicant Date
L/ ✓✓I��� j9' �` G All roof coverings to be Class"B"or better
�, Owner or amhnrixed agent am
*CITY OF CUPERTINO*
_ PEIrLTINO PERMIT APPLICATION FORM Z 6z Z�
APN# Date: 3
�— 0
Building ddress: Mailing Address if difterent from building address):
6 0 merrimsviGV art c-A ISO
Owner's Name: Phone#:
eve-e vAef- yob- 6 -0 y 7q
Contractor: License#:
E-as 4014 ,,-- 656 $ y o
Contact: Phone: " Cupertino Business License#:
Fax:
Building Permit Info:
Bldg ❑, Elect ❑ Plumb ❑ Mech ❑
Job Description: V0_ U� 0/-
Residential ® .,� ..e` �, p Commercial ❑
Sq.Ft. Flo�,Arrea: \ $/Sq.Ft.:
Cost of roject: SOS } Occupanc roup: ✓ �/
T e of truction: Please eck this ox if the oject is a
ig
Vo U a.r E?;SuW;a tjQ.- second-st
Project Size: Standard ❑ Laze ❑ Major ❑
.Quantity Fee ID-` "°�- Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERl Boiler<-- 100,000 Btu MECHANICAL
= BBOILER2 _�« Boiler> 100K to 500K Btu MECHANICAL
- - BBOILER3 Boiler>SOOK to 1M BtuMECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax "BUILDING
BCONSTAX hid/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
• k BENERGY Energy . BUILDING .
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of 3
. - VOLUNTEER SEISMIC UPGRADE
' ID - IvorEs
+I`p H.P. 1. M draw; la a schematic representation f i ' n
-LtSoo
o TAT ' �8 rep o thebuild ng Actual conatrucgo
tv/*` detul and locations oTplates, bolts and straps will be finalised in the field as t �
v5a9 ! f needed and as unique features of the building mquire. W '
2. All bolts connecting mudsills or plates to concrete will be set in epoxy, unit" W p3
!!� pro-poxy 200 or Simpson equal. a
3. Simpson plates to be installerd as per manufacturers recommendation. Typically,
8:4
new foundation anchor plates and bolts to be set at 4 feet on center spacing unless Z Q
otherwise poted.
4. Shear panel plywood to brace cripple walls to be structural grade # I with 10d = fn
nails 4 inches on center at edges and 6 inches on center in the field. If cripple
'r = -_- a' j
a Gj'�AF F•�-r' watt is less than I2 inches in height a solid block will be installed in the stud
channel with no air Doles. Air Moles to be installed top and bottom when cripple '
wall height is 18 inches or more. ,,N
° ` �W/� �. �X� `T w 4� SCracks in concrete to be repaired using epoxy bonding adhesive, unitex pr--poxy � C).
4 'tN 200 or equal. tv
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�1 M#i�N N34R DEC 03 4=4 t- - c E
L t f Ilo�d C1N OF CRE O f
!d eAIl2 t-i'N
150b WWI
�•
I M = APPROVED
C _
,N ACCORDANCE WITH THE CITY Of..
CUPER�. C SAND RDtNA ES �
i
(� l r )ATE
i ': a ,40'0• �w iIGNED { I
y • This se s and specifications MUST s
oe kept on the job at all times anQ it is un
lawful to make any changes Ot attentionsr
• I on same without written permission frow s
he building Dept., City of Cupertino.
the stamping of this plan and speaficadom;
se�1�7eQ�r ;HALL NOT be held to permit or to be x. f '�
±art ' e +� provaCity Ordinance or ate leProvr�
ve
l
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PATION
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