(OFFICE USE ONLY) PERMIT #:
CITY OF PALO ALTO REC'D DATE: REC'D BY:
DEVELOPMENT SERVICES
CITY OF 285 Hamilton Ave. ISSUED DATE: ISSUED BY:
PALO Palo Alto, CA 94301
ALTO (650) 329-2496 BUILDING PERMIT APPLICATION
PLEASE PRINT CLEARLY
PROJECT ADDRESS: 439 Lincoln Ave, Palo Alto, CA 94301
PROPERTY OWNER APPLICANT ARCHITECT/DESIGNER/ENGINEER APPLICANT NAME: Vidhya Thyagarajan and Vivek Raghunathan NAME Arcanum Architecture / Tim Chappelle ADDRESS: 633 Coleridge Ave ADDRESS: 329 Bryant Street, Suite 3C CITY: Palo Alto ST: CA ZIP: 94301 CITY: San Francisco ST:CA ZP: 94107 PHONE: 217-721-6452 PHONE: 415-357-4400
[email protected] EMAIL: [email protected] CONTRACTOR LICENSE#: 820161 _APPLICANT AGENT (NOT TENANT) X APPLICANT NAME: Behrens-Curry Homes / Jon Behrens NAME: Arcanum Architecture / Cathleen Chiu ADDRESS: 585 Taylor Way #1 ADDRESS: 329 Bryant Street, Suite 3C CITY: San Carlos STiCA ZIP 94070 CITY: San Francisco STiCA ZIP: 94107 PHONE: 650-631-2909 PHONE: 415-357-5015
EMAIL: [email protected] EMAIL: [email protected] CONSTRUCTION COST (LABOR AND MATERIALS ONLY):
$15,000
DESCRIPTION OF WORK: Deconstruction of existing detached garage.
PLEASE FILL IN THE SQUARE FOOTAGES OF AREAS THAT APPLY:
ADDITION (SF): AREA OF REMODEL (SF): (N) STRUCTURE (SF): (N) GARAGE (SF): (N) BASEMENT (SF):
CHECK ALL THAT APPLY:
•(N) RES. STRUCTURE • (N) COMM. STRUCTURE •RE-ROOF (ONE STRUCTURE) X DEMO OF ENTIRE STRUCTURE •RES. ADDITION • COMM. ADDITION •MECH/ELEC/PLUMB ONLY L• COMM. INT. NON-STRUCT. DEMO •RES. REMODEL • PV/ELEC. CAR CHARGER •POOL/SPA [NEW OR DEMO] - PLEASE COMPLETE BOTH SIDES -
- In historic district
PROPERTY INFORMATION: ELECTRICAL WORK:
IS PROPERTY IN THE FLOOD ZONE? E YES DO NO DESIGNATION X AREA OF ELECTRIC WORK (SF) IS PROPERTY HISTORIC? YES E NO CATEGORY 01 02 03 04 SERVICE UPGRADE? AMPS RELOCATED? DYES •NO TOTAL NO. OF STRUCTURES ON PROPERTY 2 _LIVING UNITS 1 OTHER:
IS THERE AN EXISTING BASEMENT?•YES •NO CONDITIONED? DYES DINO PLUMBING WORK:
EXISTING GARAGE OR CARPORT: ATTACHED X DETACHED NONE AREA OF PLUMBING WORK (SF) RE-ROOF PERMIT INFORMATION: WATER/GAS METER RELOCATION OR UPGRADE? EYES •INO NO. OF SQUARES FIRE CLASSIFICATION: DA OB DC NONE WATER HEATER REPLACEMENT? YES DINO TANKLESS? • YES •NO NEW ROOFING MATERIAL: WATER/SEWER REPLACEMENT? YES NO TRENCHLESS? DYES ONO APPLIED WEIGHT OF ROOFING MATERIAL PER SQUARE FOOT NEW GAS APPLIANCES? YES DINO GAS LEAK REPAIR?• YES • NO WILL ALL EXISTING ROOF COVERING BE REMOVED?• YES • NO OTHER:
WILL NEW SHEATHING BE ADDED? YES • NO MECHANICAL WORK:
COMMERCIAL REQUIREMENTS: AREA OF MECHANICAL WORK (SF)
TENANT NAME: _ HVAC EQUIPMENT? YES DINO ROOF TOP? EYES ONO IS THIS A NEW TENANT? DYES • NO FLOOR/SUITE # FURNACE REPLACE/RELOCATE? DYES DINO NO. OF DUCTS CO. HEALTH DEPARTMENT APPROVAL REQUIRED? • YES • NO OTHER:
LICENSED CONTRACTORS DECLARATION WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations:
I hereby affirm under penalty of perjury that I am licensed under provisions of X_I have and will maintain a certificate of consent to self-insure for workers' Chapter 9 (commencing with Section 7000) of Division 3 of the Business and compensation, as provided for by Section 3700 of the Labor Code, for the performance of the Professions Code, and my license is in full force and effect. work for which this permit is issued.
820161
License Class License Number
_ I have and will maintain workers' compensation insurance, as required by Section 3/23/26 Contractor Behrens-Curry Homes 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Date
workers' compensation insurance carrier and policy number are:
OWNER-BUILDER DECLARATION
_I hereby affirm under penalty of perjury that I am exempt from the Contractors Carrier_ Everest Premier Insurance Company License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair Policy Number . 7600024313251 any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the (This section need not be completed if the permit is for one hundred dollars ($100) or less).
Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis X I certify that in the performance of the work for which this permit is issued, I shall not for the alleged exemption. Any violation of Section 703.1.5 by any applicant for a employ any person in any manner so as to become subject to the workers' compensation laws permit subjects the applicant to a civil penalty of not more than five hundred dollars of California and agree that if I should become just to the workers compensation provisions of ($500).) Section 3700 of the Labor Code, I shall forthwith comply with those provisions. !, as owner of the property, or my employees 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 code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work Date 3/23/26 Applicant Behrens-Curry Homes himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or CONSTRUCTION LENDING AGENCY improvement is sold within one year of completion, the owner-builder will have the I hereby affirm under penalty of perjury that there is a construction lending agency for the burden of proving that he or she did not build or improve for the purpose of sale). performance of the work for which this permit is issued (Sec. 3097, Civ. C). _ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Lender's Name NIA
contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed Lender's Address NIA pursuant to the Contractors License Law),
I am exempt under Sec. certify that I have read this application and state that the above information is correct gree to comply with all city and county ordinances and state laws relating to buildir construction, and hereby authorize representatives of this county to enter upon the above mentioned property for inspection purposes.
Carl
Signature of Applicant or Agent
3/23/26
Date Owner Date