02050125 CITY OF CUPERTINO —f-. ,�, .• -' -.I,-- � "rvr,X :
BUILDING DIVISION ppRnl :iCONTRACTOR'INFORMAI
'1f9'9t?M660 HALE PL PERMFP NO. 02050125
m
Z'R Ab't1EN MILLER W�5T Ab°5`j`2°llj'" DIU-2
PHONE: SANITARY NO. CONTROL NO.
oil 4 610-5 Ck
45030
O O ARCHITECTIENOINEER: BUILDING PERMIT INTO
�40
S / / �[ BLDG ELECT PLUMB MECH
�i / /
H z LICENSED CONTRACTOR'S DECLARATION
;z_� Iherebys(firmthnlvmlicenseduntlerprovisionsofChapur9(commencing REPLACE SHEETROr*PWKAM'DRG AT SHOWER/TUBBA
,kite with Section V0W).f Divislo.3ofthe Hmmassend Professions Codc.and my license
uf_ is is full force In IT .y ,
f Odea License Class
Lic.Netsh Ol �'NAL D
1 11
a.a-a Dal` A HITECT'S DECLpkQ
AR N
st, 1 emend my s shat a oscd bli .coeds
.e _ — JUN 0 6 200
. Lic 2
pC o OWNER-BUILDER DECLARATION
W hereby.(firm that 1 1. exempt from the Contractor's Chi e:Any a Law for the $3900
y gk 1
t?Q whichfollowingrtres.Permit t to construct,
er, and improve,
demolish.
Chile:Any city.r county BUILDING
f O which rcquims ti permit re comwcc elmr,improve,demolish,ore a repair any structure
$ matte slicenadprink-art am dar.requiras thespillns cso fmmchpemdnoiver.Law
aatemrnt -... . .
mhthactain with
pwection 7" of Division
the th B limit.
License lawmis Code)
' F a I Valuation
(commcgcis attempt
abort 9000)°f a basis o t the Bpgineu anQ abri. y vi C°de) } �,
or that Section
Is 3 1 S
b sae0hm and r,basis forme ell the egem)aibd.Any it perai.n
of not mar 90han vesrundreapplicant f.r apamdt subjmz the epplicennoecivil pcmiry APN Occupancy Type
of not more Then five hundred dollars(5500).
°I,as owner of the property,°,my employee with wagca.a mei,a°le eompensnii^n, 102 — PIERS
will do the work,and me structure is not intended or of(ertd for .In(See:]044, UFEIZ—
Business and Professions Code:The Convector's License Law does not apply to an Required Inspections
owner of property Who wild.or impmra memo.,and wit.does such work himself 104 — REBAR
or thmugh his own employees.provided Net such improvements are not intended or 105 — ANCHOR BOLTS
or
for We.IL however,the building'or improvement is sold within one year of -
compinion,theowner-builderwill have the burden of proving that he did not build or 106 - SEWER & WATER
improve for pmpom w seta.).
202 ..-. UNDERFLOOR. PLUMBING. - .. .
Chatme''as h,t(pep(Sec.7.anteusinissandmmatmgwith de:)TheContractor'suamRto 203 - UNDERFLOOR MECHANICAL
Chat me'
the aw does
no(Sec.]1144,owner o and Pm/eaiob Code:)The ,eon,
License commucsnotapply manownerof propeaywho buildsmimproves e,to da, 2+ — — UNDERFLOOR _FRAME _
.end who convecu far.mch projects went a cvmrmmr(s)licensed pursoult m Ne ._.
Con,memraLicenseLaw. 205 - UNDERFLOOR INSULATION
❑tont exempt arta.,sec. .Ba"cfor mea moa°^ 301 - ROUGH PLUMBING '
Owner Data
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
f (hereby M.order prosily of perjury one of the following declarations: 303 — ROUGH MECHANICAL
t ° 1 have end will emeriti.o Canificete of Consent to selLimure for Worker'. 3 04 - ROUGH ELECTRICAL
Compensation, u provided for by Section 37M of me laver Code, for he 305 - FRAME
Performance of the work for which this permit is issued.
306 - HOLDOWNS
have and will maintain Workers Compensation Insurance,as required by Section
3 of the Labs Code,for the performance of the work for which this permit is 307 — INSULATION
issbed.MyWorker's Coilemeation Insurance Center and Policy number art:- - 308 - SHEETROCK.-
Csodh4it Ljk/41oV� liry N..:IUC —1 0 0'
CER, Fn M-s, OF ON FROM WURKEss,. (�09 %_ ,EXTERTInOR iTLTATvH,
COMP SATIONINSURANCE"•.•.� -__...- ,... .310 ... 1NTFRiVR_.M�sTs{_...... . .......... .. .. _ ...__. ...
This mn(dn need nm be Compleie'd if the permit is for 0.1 hundred dome. 3 11 — SCRATCH COAT . . -
fslaq.rleu.) 313 - ROOF NAIL _
1 certify that in the performance ohne work for which this psmam is issued,1 501 - FINAL ELECTRICAL -ENERGY - -
ahallnotemployw.ofCaoninanymannersomtobecome mbjectmthew.ram' 502 - FINAL PLUMBING ENERGY
Comps t empl laws of,son i niany Data ma
Applicant
NOTICE TO APPLICANT If.after making his carifiaste of Exemption,you should 503 = FINAL MECHANICAL ENERGY'
0 Z become subject 1.the Workers Compensation provisi.softhe Labor Code,you must 504 - FINAL BUILDING ENERGY(,
0 forthwith Comply with such provisions or Nis permit shall be deemed....ked.
z 505 - -FINAL ELECTRICAL
CONSTRUC130N LENDING AGENCY '
1 hereby affirm that there is a Convection lending agency for the per(orinsuce 506 - GAS TEST
'the work for which this permit is issued(Sec.3097,Civ.C.) `
0.Q ndC,'.Name 507 - FINAL PLUMBING
Ianaer'a Aaama 508 - FINAL MECHANICAL
U'0 1 certify Nat I have read this application and state that the awve information is
w C Correct.I agree 1.comply with.11 city and county oridinmce,and pate Iowa mining 509 _ FINAL GRADE
O. tobuildingconstrootion,andherebyamhorieemprtsenutiveaofthis city toenter°pan 510 FINAL PLANNING
}�s W the above-mentioned property for inspection purposes.
Fi L (We)agree tosave,indemnify end keep haredess the City of Cupertino against 514 - FINAL PUBLIC WORKS
W liabilities.judgments,costs and expenses which may in any way set egaina said
V City in emmaquence.fthe grommil.fthispermit. _ '�
OPLIC GNDns S WILL P WITHA ONC-0 Issued by: r Date
Signe Appian o veno - Dem Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building oecupam am or handle her^Npu.aerial .Type of Roof
as defined by the Cupertino M al Code.Chapter 9.12,and the Health sod Safety
Code.Section 255J2fe19 - '. t r - •.
All roofs shall be.inspectedp aot.to any.roofing material being_installed. _
Will the applicant or future Wilding necupent use equipment or devices which If a roof is instal]ed without first obtaining an inspection, I agree to remove
emit haseadous air contaminants
as defined by the Bay Area Air Quality Management g P
Dis.ct°Yes CEN. all new materials for inspection. Applicant understands and will comply.with
!� all non-point source regulations: '
t I have read the haaadous materials requirements ander Chapter 6.95 of the
Cslif.mla Health As Safety Code.Secti.m 25505.25533 and 25534.1 understand that
if en buil 'ng doesnotcunently Nve stenet, et it is my rtsponsiWliry to notify the - -
hoeupen f the raquiremenu which n prion. sumce o(a Cenificam of
oeenp Y. '�� S_ignature of Applicant Date '
-. a "tad agrnt Dem All roof coverings to be Class"B"or better
OFFICE-
:.,
fau-LN OITY OF CUPERTINO 0 p �.5-
CITYOF PERMIT APPLICATION FORM
• CUPEIiiTINO
APN# Date:
Building Address: /0(,,5w-
(,,5 � !/a& plQ
Owner's Nam : 69 c�ePhone#:
Contractor: License#:5-W=RA2 PEST�'4t��
f PC-5T
Contact: _J_
0/kzr Ct_/ 0__S i Phone#:
Applicant/Contraptor: Fax#:
39 - 79 3
g Permit Info:
.Bldg Elect Plumb Mech
escription: &Mote 4W/aez
Residential: k et�tc�a�- Commercial:
Sq.Ft. Floor Area: 4-t b",K- . $/Sq.Ft.:
-� 3100.00
Architect/Engineer: N Valuation:
*Tyype�of�Construction: Occupancy Group:
oo aL_&
QuantityFee ID Fee Description Fee Group
APTFEE EACH STORY OVER 3
HOTELFEE EACH STORY OVER 3
OFFICEFEE EACH STORY OVER 3
BAPPLOTHER Other Appliances MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX In d/O ff/C o mm/Q uasi 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
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BNEWMULTI New Multi-family Res ELECTRICAL
lof3
' ZG ( , 2.2
0
-'WOOD DESTROYING •TS AND ORGANISMS INACTION REPORT
This is an inspection report only -- not a Notice of Completion
ADDRESS OF PROPERTY INSPECTED
BUILDING NO. STREET, CITY, STATE, ZIP COUNTY DINSPECTION
ATE Of NUMBER OF
LODE PAGES
10658/60 Hale Place, Cupertino, CA, 95014 43 03/15/02 6
THRASHER TERMITE & PEST CONTROL Affix stamp here on Board copy only
A LICENSED PEST CONTROL
17427 Farley Road West OPERATOR IS AN EXPERT I1-1
LDS Gatos, CA 95030-3308 HIS/HER FIELD, ANY QUESTIONS
Ph: (408) 354-9944 Fax: (408) 395-7934 RELATIVE TO THIS REPORT SHOULD
BE REFERRED TO HIM/HER.
REGISTRATION # PR 0240 REPORT # 18288 STAMP # ESCROW #
ORDERED BY: Remax Real Estate-Carolyn Miller 19200 Stevens Creek Blvd #210 Cupertino CA 95014
REPORT SENT TO: Same - Above & Belo.ry
PROPERTY OWNER: Ken Graves Trustee for Ella Graves 4206 Bear Paw Court Rescue CA 95672
PARTY IN INTEREST: a
ORIGINAL REPORT N LIMITED REPORT ❑ SUPPLEMENTAL REPORT E]- REINSPECTION REPORT ❑* *Stampn#[ Date
N F S ❑ F O O E F C E 5
N O U U R U T A A A E X H
'ENERAL DESCRIPTION: One story wood framed duplex With A T R B Y N H M R U L C O
C T T W G E P T L L E W
stucco exterior. C NH E O U R W H T U 5 E
E E R O S O Y L S R
S P R R O O WO O G O L
S E A T R 0 O W R E V E
C N N E O T 0 A E E A
B T 5 E R O E ❑ D 0 M K
INSPECTION TAG POSTED: Subarea E E P N M R E R 0 E E O S
OTHER INSPECTION TAGS: Thrasher Termite & Pest...10/24/00. A ❑ c T 'r R T M 0 E R S
R T E E O T N I T
E I R 5 T ^' E T V S U
A O M S A ER
S N I C E E
T T
E S
1. SUBSTRUCTURE AREA See Report See 1A-1 E X X X
2. STALL SHOWER See Report See 2A.-2F X X
3. FOUNDATIONS Concrete
4. PORCHES -- STEPS Concrete
5. VENTILATION Appears Ade nate
6. ABUTMENTS None
7. ATTIC SPACES See Report See 7A X
8. GARAGES See Report See 8A X X
9. DECI(S-- PATIOS Concrete
10. OTHER -- INTERIOR See Report Seel OA-101 X X
11. OTHER-- EXTERIOR See Report See11A
DIAGRAM AND EXPLANATION OF FINDINGS (This report is limited to structure or structures shown on diagrarhr ll
O
j�' Al MAY 2 12005DIAGRAM NOT TO SCALE FF1 E CUT BY_
APPROVED St11 1A
SOI
IN ACCORDANCE VJITH THE CITY IF. Sox
CUPERTINO CODES AND ORDINANI ESS OH1OO 1Oc 1013
OA
•ATE 1' 2— / — 2C
---- 0 2E2F ID 10 2A
SIGNED IA18 1E 10 2B
This set of plana and specifications IUST 7A 2D IOD
be kept On t joy at all times and it 3 Uri 1A
lawful to Itldke any changes or alter, tions
on same wdlinut written permission from
the building Uepi., City-uf Cupertino. 11A
The stamping Di this plan and specifics ions eA BA
SHALL NOT be held to parmit or to b an
approval of the violation. of any pravi ianr
of any City Ordinance or State law,
_ FRONT
Inspected by James Brusseau License No. FR 16969 Signature
NOTE: Questions or problems concerning the above report should be directed to the manager of the earn any Unresolved questions or problems with
services performed maybe directed to the Structural Pest Control Board at (916) 561-8708, or (800) 737-8188.
You are entitled to obtain copies of all reports and completion notices on this property filed with the Board during the preceeding two years upon
payment of a $2.00 search fee to: The Structural Pest Control Board, 1418 Howe Ave., Ste. 18, Sacramento, California 95825-3204.
• 3rd PAGE OF STANDARD I• •
INSPECTION REPORT ON PROPERTY AT:
10658/60 Hale Place, Cupertino, CA, 95014 03/15/02 18288
BUILDING NO. STREET, CITY, STATE, ZIP INSPECTION DATE REPORT NO.
SUBSTRUCTURE AREAS:
Item 1C: FDIDING: Leaks were noted at the main line in two locations.
RECOYMRMTION: A licensed plumber should be employed to check and eliminate
all leakage as needed.
****** This is a Section 2 Item ******
Item 1D: NOTE: We found evidence of past subterranean termite activity at the
substructure. Others have performed a past treatment. We will assume no
responsibility for work completed by others. The absence of subterranean
termite activity is no assurance that future infestations will not occur.
Preventative services should be rendered, and periodic inspections are
advised in order to control subterranean termite activity. Please feel free
to call our office if you have any further questions.
********** Infoirnation Item **********
• Item IE: FINDING: Damage from subterranean termites was noted to the girder in the
subarea.
RECOMMENDATION: Reinforce this damage by installing additional wood members.
****** This is a Section 1 Item ******
STALL SHOWER:
Item 2A: FMING: An excessive moisture condition was noted at the hall bathroom
tubback in unit #10660. Moisture has entered causing fungus damage to
the sheetrock backing. Concealed damage may be revealed.
RECONIINQMTION: Remove the complete existing tubback to include the ceramic
tile and sheetrock. This will expose the wall framing and we will check for
concealed framing damage. If no framing damage is found, new sheetrock will
be installed at the tubback walls, taping and sealing all voids. We will
then install new ceramic tile throughout the complete tubback area. The new
tile will be set close-joint, in a mortar base. If any further damage is
found during the course of our repairs, a Supplemental Report will be issued
with our additional findings and cost.
****** This is a Section 1 Item ******
Item 2B: ADDITIONAL
RECOMMMTION: At the time of the repairs we will remove the existing
fixture and install a new anti-scald guard fixture, properly plumbed. The
• new fixture will be a single-handled chrome fixture. Any other type of
fixture will be considered an'upgrade and extra costs will be incurred.
****** This is a Section 1 Item ******
Item 2C: ADDITIONAL
RECOPMgTIDATION: Remove the existing enclosure and install a new safety glass
enclosure, silicone sealing all voids. The new enclosure will have chrome
colored metal framework and obscure glass. Any other type of metal or glass
• will be considered an upgrade and extra costs will be incurred.
****** This is a Section 1 Item ******
MAY 2 1 2005
[
3y. -___- ---
TfIRASHER TERMITE & PEST CONTROL---License No. PR 0240
• 4t11 PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT: •
10658/60 Hale Place, Cupertino, CA, 95014 03/15/02 18288
BUILDING NO. STREET, CITY, STATE, ZIP INSPECTION DATE REPORT NO.
STALL SHOWER:
Item 2D: FINDING: An excessive moisture condition was noted at the master bathroom
stall shower in unit #10658. Leakage was also evident beneath the stall
shower. Moisture has caused fungus damage to the sheetrock tile backing and
wall framing. Concealed damage may be revealed.
s
RECOMMENDATION: Remove the conplete existing stall shower to include the
enclosure, ceramic tile, sheetrock and fiberglass shower pan. All fungus
damaged framing will be removed and we will check for concealed damage. If
no further damage is found new framing materials will be installed as
needed. Next, we will reinstall the same shower pan, properly plumbed.
Install new sheetrock to the shower walls, taping and sealing all voids and
install new ceramic tile throughout the stall shower. The new tile will be
set close-joint, in a mortar base. If any further damage is found during the
course of our repairs a Supplemental Report will be issued with our
• additional findings and cost.
****** This is a Section 1 Item ******
Item 2E: ADDITIONAL
RECOMMaIDATION: At the time of the repairs we will remove the existing
fixture and install a new anti-scald guard fixture, properly plumbed. The
new fixture will be a single-handled chrome fixture. Any other type of
fixture will be considered an upgrade and extra costs will be incurred.
****** This is a Section 1 Item ******
Item 2F: ADDITIONAL
RECOMMENDATION: Remove the existing enclosure, clean it and then rehang it,
silicone sealing all voids to help eliminate further leakage. The homeowner
must maintain this enclosure in the future. If upon removal, it is
discovered that the enclosure is deteriorated or it is immmpractical to
reinstall, a bid for a new enclosure will be issued on a Supplemental
Report.
****** This is a Section 1 Item ******
ATTIC SPACES:
Item 7A: NOTE: A limited inspection was made of the attic area due to insulation.' ,We-
inspected the attic as practical. However, we will assume no responsibility D
for any inaccessible area that has not been inspected by our firm.
********** Information Item ********** i1'-qy_ MAY 2 1 2005
GARAGES:
• Item 8A: FINDING: A limited inspection was made of the garages due to_storage=aiui—
enclosed wall framing. We inspected the garages as practical. However, we
will assume no responsibility for any inaccessible area that has not been
inspected by our firm.
RECOMMENDATION: After the owner has cleared the storage from the perimeter
of the garages, we will perform a FURTHER INSPECTION at the previously
inaccessible areas. Our findings will then be issued on a Supplemental
•
Report.
****** Unknown Further Inspection Recommended ******
OTHER - INTERIORS:
Item 10A: FINDING: An excessive moisture condition, fungus activity, and fungus damage
were noted at the kitchen sink bottom in unit #10600. The moisture condition
is originating from the plumbing.
RECOMMEDATION: Remove the fungus damaged sink bottom and replace it with
new materials. We will cover the new sink bottom with vinyl for added
protection against moisture intrusion.
****** This is a Section 1 Item ******
Item 1013: ADDITIONAL
RECOMMENDATION: Upon coupletion of the repairs outlined above, the homeowner
is to engage the services of a licensed plumber to,correct any leakage.
****** This is a Section 1 Item ******
THRASHER TERMITE & PEST CONTROL --- License No. PR 0240
THRASHER TERMITE & PEST CONTROL"'
17427 Farley Road West
Los Gatos, CA 95030-3308
i Ph: (408) 354-9944 Fax: (408) 395-7934
s
WORK AUTHORIZATION CONTRACT
Address of Property: 10658/60 Hale Place Cupertino, CA. 95014
Inspection Date : 03/15/2002
Termite Report # : 18288
State Stamp # :
Title Co . & Escrow # : None Al This Time
SECTION 1 SECTION 2 UNKNOWN FURTHER INSP .
1E : 185 . 00 1A: S 105 . 00 8A: $ 85 . 00
2A: 1820 . 00 1C: Trades
2B : 280 . 00 1OD : 90 . 00
2C : 350 . 00 10E : 90 . 00
2D : 2085 . 00 1OF : rades
2E : 280 . 00 10G: Trades
2F : 160 . 00 1OH: Trades
1OA: 180 . 00 10I : Trades
1OB : Trades 11A: Trades
10C : $ 160 . 00
•
We Authorize the Following We Authorize the Following We Authorize the Following
Section 1 Items to be Performed. Section 2 Items to be Performed. Items for Unknown Further Inspection.
Proposed Cos` Section 1 : $ 5500 . 00
Proposed Cost Section 2 : See Above �� MAY l 1 ZUU9
Proposed Cost Unknown F . I . : See Above By
Inspection Fee : 225 . 00
Inspection Fee Paid: -225 . 00
Total : 5500 . 00
TERMS AND CONDITIONS
A LIEN WILL BE FILED ON THE PROPERTY 60 DAYS AFTER NOTICE OF COMPLETION IS ISSUED. THE LIEN WILL BE RELEASED ONCE THE BILL IS PAID.
It is understood that these corrections are recommended on the basis of visibly determined surface examination. In the course of
work being performed on the basis of this contract, conditions may be revealed which were not evident at the time of inspection.
This contract is limited to that which was visible at the time of inspection and of that, only these paragraph(s) herein specified
and contracted for. We assume no responsibility for concealed or inaccessible damage or infestation that was not observed by us
without excavation or opening timbers, watts, floors, ceilings, moving furnishings, storage, etc. We shalt not be liable for any
damage resulting from probing, cutting, opening, removal or otherwise, of timbers, walls, floors, ceilings or other parts of the
tiding inspected. Our liability for damages by reason of errors or omissions in the Inspection Report shall be limited to
e cost of the inspection and report. If additional work should be required by the City or County Building Inspector, such work
will not be performed under this contract. THRASHER TERMITE AND PEST CONTROL AGREES TO FURNISH ALL LABOR, MATERIALS, SUBCONTRACTORS
(if required), and compensation insurance to complete the repairs as accepted above. THRASHER TERMITE AND PEST CONTROL AGREES TO
USE ALL DUE CAUTION IN THE PERFORMANCE OF OUR WORK, but in no way will we be held responsible for damage to property, plants, or
animal life caused by the use of chemicals, gas or equipnent-in.conjunction with these repairs.
It is agreed that the contract price shall be paid to THRASHER TERMITE AND PEST CONTROL upon notice of completion. It is understood
that service charges of 1.5% per month on the unpaid balance, or 18% per annum, will be charged on overdue accounts and if suit is
filed for collection of delinquent accounts the customer agrees to pay alt litigation costs.
0 least one signed copy of this contract must be returned to THRASHER TERMITE AND PEST CONTROL before work is started. This
ntract must be signed by THRASHER TERMITE AND PEST CONTROL'S representative to be valid.
NOTICE TO PROPERTY OWNERS : (Section 7018 of the California Contractors License Law, Business 8 Professonal Code Div. 3, Chap. 9
Provides under the Mechanic's Lien Law any Structural Pest Control Operator who contracts to do work for you, any contractor
subcontractor, laborer, supplier or other person who helps to improve your property, but is not paid for his work or supplies
has a right to enforce a claim against your property. This means that, after a court hearing, your property could be sold by a
court officer and the proceeds of the sale used to satisfy the indebtedness. This can happen even if you have paid you
contractor in full, if the subcontractor, laborers, or suppliers remains unpaid.
THRASHER TERMITE AND PEST CONTROL GUARANTEES CHEMICAL TREATMENT AND STRUCTURAL REPAIRS FOR 1 YEAR FROM THE DATE OF COMPLETION. WE
GUARANTEE GLASS AND FLOOR COVERING REPAIRS FOR THIRTY (30) DAYS FROM THE DATE OF COMPLETION. WE CANNOT GUARANTEE WORK COMPLETED BY
THE OWNER AND/OR THEIR AGENTS. ANY TYPE OF GUARANTEE SHOULD BE OBTAINED FROM THE PERSON(S) MAKING THE REPAIRS.
I Have Read This Contract And The Termite Report It Refers To.
SIGNED WORK AUTHORIZATION CONTRACT MUST BE RECEIVED BEFORE WORK WILL BE SCHEDULED.
I have read and understand the terms of this work authorization contract and hereby agree to all terms thereof.
APPROVED AND READ BY: DATE ACCEPTED FOR: DATE
THRASHER TERMITE & PEST CONTROL
CITY DPESIONO
SINPERMIT CONTRACTOR INFORMATION:
.
RYIILDINGADft `6660 HALE PL PERNUTN0' 02050125
VlJ.7 tS� 111 m
AAMYN MILLER
16 J-D PHONE: SANITARY NO. CONTROL NO.
404 �So 3d
O-O ARCIi1TECr/ENGINEER: BUILDING PERMIT INFO
x BLDG ELECT PLUMB MECH
y=� 5 — R9 � o I-1
;zy i LICENSED CONTRACTOR'S DECLARATION
�� Iherebyoffirmthe,Ino licenxdush,NovisionsofChapter 9lcammcncing REPLACE SHEETROL0kP5KPMPRG AT SHOWER/TUBBA
yFaj with S.,rr7000).f Division 3o1'the Bosinemand Profloarro Codeandmyli¢nx
m
y:3 is m full forte an R p
:s R! License Class d. _ Lica T O. F'NALE13
Date
1 3 d.y Date Commcmr FINALE
13
CHITECT'S DECLAR N
LL O g I erstand my s seal [nsedW bli rtcords
E5 Lie — JUN 0 6 2002
o OWNER-BUILDER DECLARATION
a. hereby atiinn tom 1 am exempt Examine Canwetor's License Law for the $3900
L'$a followingreturn.(Senioa7031.5.Business and ProfexsionsCode:Any city orcounty BUIL®ING
u,F O which ox,nnes a permit ro construct.almq improve,demolish,or repmr uny strunurt
w pr t n Bunce,alsomauvesthe applicant for such rental file a signed statementis. .- .. -....._....___...... .- . _
.... .. .
then he ]andel put# a she pro is Division
the the Buji s anal
Laukars Code) ,t Valuation
(commenc g 'th Section 9!x10)of Da ision 3ofthe BuSmes,S5 and P,rofeuaons Codd
or Sectio as exempt any
appli and the bac s(nr the alleged etempnt t Any mo natty "
-of Section a than iv any applicant fora permit xubjttu the applicant m e civil penalty
Tr not more man live hundred aminm 1s5no> APN ._ a � Occupancy Type
❑1,as owner of the norm employees with woes as their sole cont 102 - PIERS
nrnp= r r= p r s compensation,
will do the work,and the structort is not intended or affirmed for sale(See:7044, -
Baslnes.s and Pnd'asions Code:The Contractor's License Law das not apply to an Required Inspections': . ..
owner of prci Who builds or improves thereon,and who does such work himself 104 — REBAR
or through.his awn employees.provided flat such improvements am not intended or —1"0 5— —...ANCHOR- BOLTS .
_..._._--
cfferedomple(on sale.If.w however,e the Wilding or urden ocment nsold within one build of ,
improve
for the owner-builder will have the burden of proving that he did not build or 106 — SEWER & WATER
improve for Purpose of sale).
property,—_ ... .. . ._.. . ._... _. .. ....... . .. ......._.__ _.___. .._. .. .. . ..._._..2.02--=. UNDERFLOOR-.PLUMBING..-..
co L as owner Tithe (SeaTam exclusively d Podt..i with licensed contractors m ",i -
cTnmmamepoejeetcape.7844,owner o ahaertywo buildsho cod e:)Toeves morror'a 203 - UNDERFLOOR MECHANICAL : „
- -' Llcenx hwdoes acts ot applyfr-suc toajects wT(a camucalicense puraamto she 20_4 — UNDERFLOOR FRAME
mad who contracts Law. h.pmjecu with a.contmeror(s}IicensW pumuanLto she _._. __..-._ .. ._.__...
Contractors Lleand,Law. 205 - UNDERFLOOR,- INSULATION
❑Iemexempt under Sect- `;a&P C for this mason 301 - ROUGH PLUMBING `
Owner' : WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
IneabyafrmunderpenahyofPerjuayareofthefollowingdeclarations:- 303 — ROUGH MECHANICAL
•o 1 have and will maintain a ccaireaia of Consent to sur-insure for Worker's 304 - ROUGH ELECTRICAL
Compensation, as provided for by Section 37M Tr the Labor Coda for me 305 — FRAME
perfomnnnaonnewnrkfarwmchmisperautitissuea, 306 — HOEDOWNS
1 have and will maintain Worker's Coinyenrimion Insurance,us rc{uimd by Section
3 of the Lator coda for the parformance of the work for which this permit is 3 07 - INSULATION
iss dMy Workcrsf aipc uatinn lmma ' mer and fidamy beam, 3,08,._ .SHi•.'.•ETRO(-aK .,, .---.- . .
,
ce rVICLftA1nV leyrv�: WC- " D p" 30,9•? EXTERIOR, +LATH
CERTIFICATIO OF EMPTIONPROMWOR ER$ t :01
•� t
COMPENSATION INSURANCE,N __ __ 3.1 0__.=.. I-N•.mso.R1•O• R_.L
ATH._._....._... .. . ...
(This:acfloi ars! of Is,campideBlf hepermit isfor..ahandled dollars 311- = SCRATCH COAT ,:n • • ,
. a .. �' 111-: _.:313„ -, ROOF-_NATL,-
t mi toy any me p[tr m,ana Tnn for which this pema t s norm l 5 01 - FINAL ELECTRI CAL-:ENERGY
shall not employ ony'pc son m any manner soles to become subject m the Worken' '
compensation Law,ofcaliflimia.Data 502 - FINAL PLUMBING ENERGY
A I'cl .. .. . . . ._.. .._ _ __ ...._. .
NOTanICETOAPPLICANT:If,aftermakl ;th CmificamofExmpbonyou should 503 FINAL`MECHANICAL' ENERGY_. ,
M1ecomesubjea to the Worker's Compenem n previsions of the Labor Code.yoa most 504 - FINAL BUILDING ENERGY
Z 0 forthwith cum IwilFsuch rovisinns or this ked.
CONSTRUCrlOced NDI3n97AGENC .. .._ __..50.5. _- ..FI-NAli'-ELECTRICAL 1. ... '. .. .
Ili by affima that th - conswctinladngsticic frthe thin [ 506 - GAS TEST
B 8 Y P
fin ofth kfar which rots permit is
yp let,arxNarne-' - 507 -- FINAL PLUMBING _.
U..O LendprsAp 1—. `., . . —
508 FINAL MECHANICAL
—
I conify that I have rad this application and state that the above information is
4as-[•a corset 1 gra t comply with all city and county ordinances d state laws relating 509 - FINAL GRADE
1. 1 In,consruction,and hereby uniform representaiivcsaflhucity1.crcrupon 510 - FINAL PLANNING
W the ahme-mcntioned property for inspection purwaes,_, ,.
.w (We
)agree lostindemnifydndkeep harmlast1mCityofCupninoegdnm 514 — FINAL PUBLIC WORKS
h liabilities,jutlgmems,costs end expeme,which.they in any way ec a against said
V.MI City in consequence of the Stunting onhis permit.
APPLICAI. UNDERS 4,'DSA WILL P WITHAL ON�POINT •
so .G' Ani N s, Issued by: Dale
Signa < AP i an o racto .. - "' Dam
HAZARDOUS MATERIALS DISCLOSURE Ke-roofs
W1,the op,limma h bilding cupantmrtr harWlnazvETus material .Type Of Roof.. __
- as d flood!by the Caftan n M c I Cod Ch pt 9 12 and theHealth and Safely - - - " '
C«le S❑cYcn 75532(el I No lt.,i; fir 1 T -". r� t I ,Cit s Lf,' `s; 1 d s �.j
I'
3f All roofs stiall be inspected prior.to.any roofing,matenal being installed.
t Will th ppl ca t o f t, building occupant use equipment r devices which If a roof is itisttilled without first obtained an:ins ection I a ree to remove
,m h card cont ¢as Aefined b the es A Management
g P g
Dm all new materials for inspection .Applicant understands and will comply with
... Y B .. ......... ...
�J ) Be,y Quality once e
°Ya N all oon-poin['sourceregulauons
I'have lad the haamdou, m,i.al2 305, emems under 4.1 un b95 0(the s
irsha mice HenBh&of . Cola aeaions 75505:75537 and 25534.I understanding
ops not currently hevcamnam m tic my iespo iblly t-notify the
worm f Ihm rtquir mems which el prior to s f a Certificate of
'n Signature ofApplic_ant Date
C� � OS al-o�
a == ag[nt Date All roof coverings to be Class "B"or better
-- .- :�;' r . . .OFFICE. . .,._. ..._ ....... . . .....