22261 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification _ . . PERMITNO.,
Building Addrem:
.� a �� �c �? , �� • 22261
wnere ams.: one: . - - APPLICALIONSUBMIIIALD=
CA LJ ' - CITY OF CUPERTINO-BUILDING DIVISION tet. 1
t C°^ mraN.me: L .N : APPLICATION I PERMIT
LG sBUILDING-ELECTRICALPLUMBINC-MECHANICAL CATEGORY CONTROL p
tett/ gine.,.. LIc No:
QTY. : ELECTRIC PERMIT FEE BUILDING PERMIT INFO'
._� PE[jhITI55UANCE :❑ ❑ ❑
LICENSEDCO A Or DECLARATION.
I ithSy f(Irmt)ofDivsionsed 3ofthe under nemaions nd Pof cions 9 de,and c APPLIANCES-RESIDENTIAL m -JOB DE9CRIl'ITON _
Incense ISection 90W)afd effecn3of[he Bueinessand ProfselonsCode,and my
Rica.la in s force and df. PANELS
License C6m Lmert
Dare Comractor UP TO MO ANTS �ARCHITECTS DECLARATION 701-1000 AMPS -
ggqasXIunderstand my plain shall be used as public records. OVER I"AMPS SQ.
FT.FLOOR AREA $/SQ.FT.
00 . ,Pa
d 0 Licensed Professional SIGNS ELECTRICAL � MALE V ALE D IN
OWNER-BUILDER DECLARATION
In� FA SPECLILCIRCU(T/MISC ® rl a E
p„ Iherebya(flrmtlutlam exempt(romthe CoMnctor's License Law(w the
'\Y
following mum.mum.(Section 7!131.5,Business and Professions Code:Any city or .
T R
P countyTEMP.METER OR POLE INS!
which requires a permit to construct,alter,improve,demolish,or repair ,
any stmcturepriorWitsIssuance,alaorequimslheappgsnt(wmchpermit to POWER DEVICES �,•
VI file a signed statement that he Is licensed pursuant to the provisions of the DATE
3w . IL
Contractor.License Law(Chapter 9(commencing with Section 7W0)of Divi- SWIMMING POOL ELECTRIC
O:} skm3ofthe Buidnessand Professions;Code)Code)orthat he Isexempitherefromand .
O.•33 the basis for the alleged exemption. Any violation of Section 70315 by any OUTLETSSWITCHESFIXTURFS ^'7� oo a
(50
applicant fora permit aubject•the applicantto a civil penalty of not more than 7
five hundred dollars($500), -SQ.Fr.R NEW RESIDENTIAL ELFCTR STORIES TYPECONSTRUCTION
�n m I,as owner of the property,or my employes with wages as thele sok:
compSec.70 ,wWdoth¢wwkandthes Code:
rehe C intended orofferedfar
O Jule(Sec.9044,Buebress and Pro(embns Code:The Contractors License Law
dos not apply to an owner of property who builds or lmprovs thereon,and - OCC.GROUP - RES UNITS
whodossuchworkht s lforthwghhisownemployeesprodidedthatsuch
Improvements are not Intended oroffered formle.I(,hmvevegthebuildingw TOTAL:
Improvement bwldwithin oneyearofcompldiorytheowner buBderwillhave
tltmrden of proving that he did not Wild or Improve for purpose of cele.). CITY. PLUMBING PERMIT FEE FLOOD ZONE APN
u I,tie owner of the property,am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business and Pro(emlom Code: PERMIT ISSUANCE
The Contractors License Law does not apply to an owner of property who
Wilds or improves thereon,and who contracts for such plojeda with a ALTER-DRAIN&VENT-WATER IRA)
dor(s)licensed pursuant to the Contractor's License Law. FEE SUMMARY
o'baI am exempt under Sec. B &P C for this reason BACKFLOW PROTECT.DEVICE
OUTSIDE FEES
Owner
DRAINS FLOOR ROOF,AREA,GOND. SANITARY Y N
'" P
2r affiWORKMAN COMPENSATION DECLARATION
RECEIPT FIXTURES PER.TRAP SCHOOL TAX Y N
(� hereby rm that I have a certNste of consent to self-Insure,ora RECEIPT it
certificate mWorkers'Compensationlreurance w a certified mpythemof(Sec. GAS EA.SYSTEM-11N'CAOUTLETS PARKFEE Y N
Lab CJ - RECEIT
Pollry p GAS EA.SYSTEM-OVER 4(Fi1)
Cam any ,,((' BUILDING DIVISION FEES
LCertl ed copy her 'fume . GREASE/llVDUSCAL WASTE INTERCEPTOR PLANCHECK FEE
� e Ifled copy is filed with the city inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS' GRE-ASE TRAP PAID
COMPENSATION INSURANCE $EWER-SANITARY-STORM EA 200Ff Date Recei t#
(ThI..c1Ion need nM becomp(ded lithe permit Is re
forone hundd dollars
($10D)or less.) WATER HEATER W/VENT/FS.FOTR ENERGY FEE- Y_ N_
I certify that In the performance of the work forwhich this permit Is Issued,
I shag not employ any person in any manner w as to become subject to the WATER SYSTEM/TREATING
Workers'Compenmtlon Laws of California.Data PAID
O Z Applicant NEW RESIDENTIAL PLMB. SQFC. Date Recei t#
Z 0 NOTICE TO APPLICANT$after ,.king thin Certglonmm Exemption,you
should Wmm.subject to the Workers'Compensation provisions of the Labor - TOTAL:
F N Code;ym,mu at forthwith comply wlthauch provlslmiawthi.permit shall tie 1p
W j deemed revoked. - 13UILDING FEE t
CONSTRUCTION LENDING AGENCY SEISMIC FEE
1 I herebyaf(Irm that there Is a construction lending agency forthe perform ELECTRIC FEE
Q ancomthewmi,forwhichthis permit Is Issued(See.3097,CIv.C.) TOTAL:
Lender'.Name n
PLUMBING FEE
LL F ' Lender'.Add.m QTY,' MECHANICAL PERMIT MECHANICAL FEE '
OWIcerldythatlhavereadthisapplicationand statethatthe above Information
1 iscomed.I agreem comply with all city and county ordinances and state laws PERMIT ISSUANCE FEES PAID:
N relating to building construction,and hereby authorize representatives of this cl to entero n the abovcmentiowd rofwW ection • ALTER OR ADD TO MECH.ty pO ppfhar p p"rpO9e' Date Recei t#
(We)agree to Jude,Indemnify an d keep harmless the In a of ayace hoegalrys llabillBea,judgments,cwteand expenses which may In anywayacdue AIR HANDLING IRJIT(TO 10,000 CFM) � SUBTOTAL:
against mid City in consequence of the granting of this permit. AIR HANDLING UNIT(OVER tO,WOCFM) CONSTRUCTION TAX
Signstumof Applicant/Contractor Data EXHAUST HOOD(W/DUCT) CONSTRUCTION TAXPAID:
HAZARDOUS MATERIALS DISCLOSURE -
Willtheapplicantorfuturebuilding occupant store or handle hazardous HEATING UNIT(TO 100,000 BM "Date Recei t#
material as defined by the Cupertino Municipal Code,Chapter 9.17,and the
Health and Safety Code Section 25532(.)? HEATING UNIT(OVER 100,000 RTU) TOTAL: 163 ,50
❑Yea u No
Will the applicant or haure building occupant use equipment or devices VENTILATION FAN 6INGLE RESID) ISSUANCE DATE
which emit hararelous so contaminants as defined by the Bay Area Air I
Quality Management District? BOIL MP(3HPORI00,OWBTU)
Yea ❑❑No
a avereadtbebazardouamaterialsmquimmnmunderChapter6.95of BOIL 0W fOVER 1W, BTU)
the Callfwnla Health&Safety Code,Sedlons 15505,25533 and 25534.I
understand that if the building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.FT.
rsP..fbW to notify the occupant of the requirements which must be met
prior to n fO ry.
4vy�
Owner trauthor dagent Date ISSUED BY:
TOTAL:
OFFICE COPY
WOOD DES 'OYING PESTS AND ORGANISM, NSPECTION REPORT
"•I his is an Inspection report only-not a Notice of Completion.
ADDRESS OF PROPERTY INSPECTED
AdEL
ILDING NO. STREET CITY 21P COUNTY GATE OF NUM BE:RO
CODE INSPECTION PAGES
10540 CHACE DRIVE CITY
195014 43 05/15/91 4
Affix stamp here on Board copy only
HOMEGUARD EXTERMINATORS, INC. A LICENSED PEST CONTROL
1430 TUII Road — Suite 408 OPERATOR IS AN EXPERT IN
Y HIS FIELD. ANY QUESTIONS
San Jose, CA 95122 RELATIVE TO THIS REPORT
(408) 993-1900 FAX (408) 993-1944 SHOULD BE REFERRED TO HIM.
REGISTRATION. PR 1452 REPORT. 007539 RG STAMP. 0463232R I
ESCROW•
Ordered by: JOHANNA POGUE, CORNISH & CAREY, 19400 STEVENS CREEK BOULEVARD,
CUPERTINO CA 95014
Report Sent to:
Property Owner. SUSAN RINSKY 10540 CHACE DRIVE, CUPERTINO, CA 95014
Parry in Interest:
ORIGINAL REPORT ® LIMITED REPORT SUPPLEMENTAL REPORT* REINSPECTION REPORT�* STAMP* sL DATE
—
I N F S D F O D E F C E S
N O U U R U T A A A E x H
General Description: 2 STORY 1 FAMILY, WOOD FRAME A T R e Y N H M R u L C O
C T T W G E P T L L E W
RESIDENCE WITH WOOD BIRCK AND STUCCO EXTERIOR C I H E o u R W H T U s E
E N E R O 5 O Y L S R
S 5 R R D w O W O 1
S P A O O D O G S V L
I E I N T R O O R E E E
e C N E E D T D A A
L T S A R O E D D M K
AML E E P N M R P R C E E O 5
action Tans Posted: SUBAREAD E I Y E M L R 5
o e I
A C T T 5 I N
R T E E R T T T E 1 T
E I R 5 O 5 E A V S U
Other Inspection Tags: NONE NOTED s N M T s C E E
T 5
E
5
1. SUBSTRUCTURE AREA DRY/ACCESSIBLE/SEE 1BELOW
2. STALL SHOWER TESTED/SEE 2 BELOW __ _
3. FOUNDATIONS CONCRETE BLOCK _
4. PORCHES...STEPS CONCRETE AND BRICK ___ —
5 VENTILATION ADEQUATE/ABOVE GRADE/SEE 5 BELOW __ --
9. ABUTMENTS NONE _
7. ATTIC SPACES INSPECTED
9. GARAGES 2 CAR/ATTACHED
9. DECKS...PATIOS CONCRETE -----�--- ---
10. OTHER... INTERIOR SEE 10 BELOW
11. OTHER ...EXTERIOR SEE 11 BELOW
DIAGRAM AND EXPLANATION OF FINDINGS(rhis report Is limited to structure or structures shown on diagram)
w
OFFICE Sia s
w� 13
2
pLO� P
'�'NINC
dA
Inspected byRonald Griesinger ucense No. FR12895 signature /q17hj V,
YOU ARE ENTITLED TO OBTAIN COPIES OF ALL REPORTS AND COMPLETION NOTICES ON THIS PROPERTY FILED WITH THE BOARD DURING THE
PRECEDING TWO YEARS UPON PAYMENT OF A$2.00 FEE TO STRUCTURAL PEST CONTROL BOARD,1430 HOWE AVE,SACRAMENTO,CA 95925.
DRESS OF
PERTY
_ PECTED 10540 CHACE DRIVE CUPERTINO
BUILDING NO. STREET CITY
0463232R 05/15/91 007539 RG
STAMP NO. DATE OF INSPECTION CO.REPORT NO.
AREAS NOT INSPECTED PLEASE READ
We did not inspect the interior of finished walls or behind installed
finished cabinet work. We did not inspect the areas immediately under
furniture or appliances. This structure contains slab flooring, and in
slab floor type construction, it is possible for Subterranean Termite
infestations to be concealed and not evident at the time of our
inspection; the we assume no liability for any infestations
that are not evident at the time of our inspection. Our inspection
does not include inspection of the electric, heating, or mechanical
systems in the structure. We did not inspect the roof covering for
leakage. Our inspection will not detect building code violations. If
any information is desired about any of these mentioned areas, a
company which makes home inspections should be engaged. The plumbing
was inspected, but only the leaks outlined in our report were found at
this time; we assume no responsibility for leaks that occur after the
date of this inspection. This structure has carpet installed. Although
no adverse conditions were evident, we assume no liability for the
floor covering under the carpet unless we remove the carpet. The
inaccessible areas listed above which were not inspected will be
inspected upon the owners request and may be conditional to additional
inspection fees.
NOTE: WORK PERFORMED BY OTHERS WILL BE REINSPECTED BY THIS COMPANY
FOR A REINSPECTION FEE of $75. 00. OPEN WALL AND OPEN FLOOR
INSPECTIONS ARE REQUIRED IF A CERTIFICATION IS DESIRED FROM
THIS COMPANY. REINSPECTION MUST BE PERFORMED WITHIN FOUR
MONTHS OF THE ORIGINAL INSPECTION DATE; SCHEDULING FOR
REINSPECTION MAY REQUIRE AS LONG AS TEN DAYS TO BE MADE.
WE GUARANTEE CHEMICAL TREATMENTS AND FUMIGATIONS DONE BY THIS COMPANY
FOR ONE YEAR FROM THE DATE OF COMPLETION. WE GUARANTEE WATER DAMAGE
REPAIRS FOR THIRTY (30) DAYS FROM THE DATE OF COMPLETION. WE CANNOT
GUARANTEE WORK DONE BY THE OWNERS OR THE OWNERS AGENT. WE MAKE NO
GUARANTEE AGAINST FUTURE. INFECTIONS, ADVERSE CONDITIONS OR CONDITIONS
PRESENT BUT NOT EVIDENT AT THE TIME OF OUR INSPECTION.
A SEPERATED REPORT HAS BEEN REQUESTED WHICH IS DEFINED AS
SECTION I/SECTION II CONDITIONS EVIDENT ON THE DATE OF
INSPECTION. SECTION I CONTAINS ITEMS WHERE THERE IS
EVIDENCE OF ACTIVE INFESTATION, INFECTION OR CONDITIONS
THAT HAVE RESULTED IN OR FROM INFESTATION OR INFECTION.
SECTION II ITEMS ARE CONDITIONS DEEMED LIKELY TO LEAD TO
INFESTATION OR INFECTION BUT WHERE NO VISIBLE EVIDENCE OF
SUCH WAS FOUND. FURTHER INSPECTION ITEMS ARE DEFINED AS
RECOMMENDATIONS TO INSPECT,AREA[S) WHICH DURING THE
ORIGINAL INSPECTION DID NOT ALLOW THE INSPECTOR ACCESS TO
COMPLETE HIS INSPECTION AND CANNOT BE DEFINED AS SECTION I
OR SECTION II.
(1) SUBSTRUCTURE AREA
1A. FINDING: There was cellulose debris in earth contact in the
substructure area. This is an attraction for
Subterranean Termites.
RECOMMENDATION: Remove cellulose debris of a size that can be raked
from the substructure area.
************ ( SECTION II ) ************
�B. FINDING: Water stains were noted on the subflooring beneath
the kitchen.
RECOMMENDATION: The owner is advised to have this area periodically
inspected.
***** +****** ( SECTION II ) ************
S ALL SHOWER
2 FINDING: A standard water test was performed to the morter
stall shower and leakage was evident below the
shower. Fungus infections were noted.
Page 2 of 4
RESS OF .
r PERTY
SPECTED 10540 CHACE DRIVE CUPERTINO
BUILDING NO. STREET CITY
0463232R 05/15/91 007539 RG
STAMP NO. DATE OF INSPECTION CO.REPORT NO.
RECOMMENDATION: Break out and remove the entire existing stall
shower.Install a new waterproof membrane, install an
entire new ceramic tile shower using wire and mortar.
We will do no painting or wallpaper repairs in
connection with this repair. Supply and install a new
glass shower enclosure. If damage is found to
extend into any inaccessable areas a supplemental
report and bid will be issued.
************{ SECTION I }*************
2B. FINDING: The glass enclosure in the stall shower is not
tempered glass and the local building department will
not allow this unit to be reinstalled.
RECOMMENDATION: Remove and replace this shower enclosure.
************{ SECTION I }*************
(5) VENTILATION
5A. FINDING: There are several ventilator screens broken out
around around the perimeter of the structure.
RECOMMENDATION: Install new nail on ventilator screens.
************ ( SECTION II ) ************
10 .OTHQ. . .INTERIOR
10' . FINDING: The hall bath floor is fungus damaged adjacent to the
tub.
RECOMMENDATION: Remove the toilet, open floor to repair damage as
required install new underlayment install new
Standard Grade, neutral colored vinyl floor covering
over the bathroom floor area. Reinstall the toilet
using a new no-seep toilet seal. When the
underlayment is removed, if fungus damage to the
subfloor or walls is revealed or a cracked toilet or
damaged hercules ring is found, we would issue a
supplemental report and bid.
************{ SECTION I }*************
10 . FINDING: The master bathroom floor is fungus damaged adjacent
to the stall shower.
RwCOMMENDATION: Remove the toilet, open floor to repair damage as
required, install new underlayment, and install new
Standard Grade, neutral colored vinyl floor covering
over the bathroom floor area. Reinstall the toilet
using a new no-seep toilet seal. If when the
underlayment is'removed fungus damage to the
subfloor or walls is revealed or a cracked toilet or
damaged hercules ring is found, we would issue a
supplemental report and bid.
************{ SECTION I }*************
(11) OTHER. . . EXTERIOR
11A. FINDING: Earth to wood contacts were -noted at the plumbing box
cover. _
RECOMMENDATION: Remove and omit this box. Install wire mesh in place
of thsi box.
************ ( SECTION II ) ************
i
NOTE: In our opinion, items 2A, 2B, 10A, and 10B come
under Section 1.
NOTE: In our opinion, items 1A, 1B, 5A, and 11A come under
Section 2 .
NOTE: In our opinion, no items come under further
inspection.
NOTE: Our bid for linoleum is based on Standard Grade
Material. Any upgrade matQrial which may be desired
would be at additional charge.
NOTE: Homeguard Exterminators, Inc. does no texturing,
Page 3 of 4
DRESS OF
OPERTY
IIIIIIIIIIIPKspEcTED 10540 CHACE DRIVE CUPERTINO
BUILDING NO. STREET CITY
0463232R 05/15/91 007539 RG
STAMP NO. DATE OF INSPECTION CO. REPORT NO.
painting, or wall papering.
NOTE: Unless prior arrangements have been made, a neutral
color tile will be installed.
NOTE: If damage is found to extend into any inaccessible
areas, a supplemental report and bid will be issued.
Thank you for using HomeGuard Exterminators, Inc. If you have any
questions regarding this report, please call and ask for
Ron Griesinger.
If you require further assistance or wish to schedule work as
recommended in this report, please feel free to contact our office.
We are here to assist you!
i
Page 4 of 4