00080186 FOW'
tTv or cuPERTtNo
BUILDING DIVISION PERP�IT CONTRACTOR INFORMATION:
LDING ADDRESS: PERMIT'NO.
N17R'S NNMI '- LHUNLIIH DR APPLICATIfI S I3 DATIi
Ri
ONE: PAYNE ZIL A AND SANfI'ARYN If u,
❑z z ARCHITECIYENGINEER: BUILDING I'IiRM TINFO
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I3LD(1 IiLEC'I' 1'LUNI1 MliCll
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FN LICENSED f-ON1RACIOR'SDECLARATION Job Description
O 1 bench,mann Bu;1 Bin licensed and,ploloionx of Chalua v Ienall l"mg
with Section 7"nifDivision 3 ofthe Business and Pref�en.in5C.da um`ll lylicena
zy^, IninliJl tirtacI'(. OS3'd lr .
5�` L"`"r-[Ct'' p �— " ITEM 8C TERMITE REPAIR
Dane 0, .� Comrann _ _�L -
5 a-n - ARCHI I EC'r'S DECI.AIt.CIIUN
NO 1 undcrsmnd my plain snail he used as public records -
ve z S= Licenfessianal
°'i z sed I'mOWNER-HUILDER DECLARAI'lON
v1 7 Ifbereby affirm Iba(1 a cnrpt tram the Contractor's L'cen,e I.aw for the
I-zQ following w..(Section 703IS.pasi... .ami Professions Code:Any Cita,county
_Z O which re9nhc,ever Penni(I cnnuruc(,ulmr,inTrnve demnlid.or repair,any donatire '
W s m prurotin,is.v.cc.al,rcv,i sthe applicant fursuch eraid loldexsignedaatement
mathely beenae pn�aanr to the pmvi,tansnnne emm�rtmr,uaena law,Cnaptnr9 Sq. Ft. Floor Area. Valuation
Icnl•Qtencing with Se,la Ta)o)of Ilivi.vio 13 id the Btwincvs and Prole.eion.Code)
or that he is exempt therefrom and the basis for the alleged exemption.Any violated _
of Seen 17031 5 by airy applican(tnr a permll subjects Iba apPlicnn(m a civil Penalty
of nm mom than,handled dollars($500). APN Number Occup' e
01.a net of the PrOpIrry.(It Illy mnploycea with Wilkins as their late cmnpeasmion. `
will do n A d the fracture ;t intended or ciffered f I (See 70111,1
Bt, d P II C in:l1 C m a . L L d : t p,Iy t ar c aired Inspections
livirse,.1 prepert,Who build,,,, p e Ificoun,and who does sh walk lonaveli
nr through his mph y c provided th t such improvements are not imeaded ar
uttered I 11 however.❑ h l I' t p- v Iwithin' n' of 101 — FOUNDATION
mmpld fill Inc oIt, bewill have the M,nhen of proving that did net boild or
in.pn,ve for purporcut ado.). 102 — PIERS
01.a,ownertdthe pmpeny.am exclusively contracting with licensed contmctocs to 103 — UFER V
Lmr.lrnet me project(lex.7044.Hmna�sv and Pm@nv alv Cude.)The Cnmm,m„ 1.04 — REBA R
icense Law does not apply to an nx net of properly who builds or improves thereon.
and who etmtma far pmjeetn with a mmrecterl.) livened pursuant 137 the 105 — ANCHOR BOLTS
Central License Lax, '
❑lam exernpttnrderS«. .B&PCB,rthisrea`o" 106 — SEWER R' WATER
Dx""rDa" 202 — UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DECLARATION t—
Iherebaninnunderpenaltyof„equryonconne nalowdngdecamriva,. 203 — UNDERFLOOR MECHANICAL
have and will maintain a Certificate of Conant In self insum lot Worker's 204 — UNDERFLOOR FRAME
ap.,r.alian, provided rnr by Seelion 3700 of the Labor Cade, for the 2205 — UNDERFLOOR INSULATION
b. Ilednnnanec of ore work for which this unil is n.eueil.
Xhave and x;d tnaialeill Wilkes ctnn,ti,a0mr Insm:mec,a,rc,iurd b,Scctin„ 301 — ROUGH PLUMBING
374)of the Labor Code,for the perfommnee or he walk fm xlach this pefmit i. 302 — TUB & OR SHOWER
Carted.n wnrkuf.ctnnpyyyenr.annullm`Ir:Inaea`rie`a"aPt+Bfytyylmngare: -0 303 — ROUGH MECHANICAL
Carrier" IQIEy7Sn.�0l ��bb 3 s'1
EIrrI1BCAl'IUNIIIa EX.MPI9ON I� (IM WORKIiRS' 304' — ROUGH EL.ECTRICRI_
COMPENSATION INSURANCE 3055 — FRAME
rI his action need not bCeomplead if he pcmth i,lot...handled dollar, 306 — HOEDOWNS
(Slag is ls”)
1 cedify that in the perrnmeance of the work nor which this penult i,issued,1 307 — INSULATION
shag inn employ an,Ia',v.in any,.inlet.n a,ro neaane whicu l'I'be Workers' ;508 — SHEETROCK
Compen,an er Law.of California.Date
Appl1cant
Nail'ICE'1'OAPPLICANn11,uliermakinp this Cenilie"e of l',c,a,a it. .should 309 — EXTERIOR LATH
' . yocame subjectn the W'orker's Compensation provisions of the labor Code.you must 310 — INTERIOR LATH
Z
Q. became
fnnhwllll comply wih wpm
( elt vi+inn.nr this permit nhall Ndcenm.revoked.
CONSTRUCTION LENDING AGENCY 311 SCRATCH COAT
I hemp,chiral that there i,a n o,weliun leaning aguney IDI he p.uninant'n 31.3 — ROOF NAIL
fine N far which his Mrtnit is issnN(Sec.30M97.Civ.C.) 501. — FINAL ELECTRICAL ENERGY
d p LeMe,'s Nam.
= Z hcneerI Addre that
.
O Ieeralym:nmhave read III aappdeutinllland'late o,ntmalmtweinlora+amrri. 502 FINAL F'LUMAING ENERGY
O0 E. correct.1 agree to comply with all citand county ordinances and state laws relining 503 — FINAL MECHANICAL ENERGY
U (o hauldln, lau,n olu.and bcrehyamhon7c reprenematives onhis city to enter upon
y o- he ad,vcmembned proper y for m•,celion lulow, 504 FINAL BUILDI.NG ENERGY
F„I
Z. (Wc)agree it)nave,mdcnmnfy and keep harmless the City of CuPcrado against
m liabilities,jueganem..en1e.
.,and ,pea,e,winch may hi any wa,accrue as;dn,now —
505 FINAL ELECTRICAL_
U z City in con equena of the gmming of peoult.
ti
APPLICANT
UNDERSTANDS ANO WILL COMPLY WITH ALL NON-POINT 506 — GAS TEST
SOURCETIssued by: Date
Signature of Appnem12m+trarnr nate Re-roofs S08 — FINAL_ MECHANICAL_
1IASARDOUS MATERIALS DISCLOSURE
will d'eapplicanlo.future hadd"rgntnnpantslomurhandle hamrdoavunderlaid Type of Roof 509 — FINAL GRADE
as delince by the Cuperlino Municipal Cade,Chapter 9.12.and he Hall,dad Safety
Calc Section 25532OL - NNC�V
❑Yea 0N All roofs shall'ba1PpectefflJAArr�o aF bI' A Ging installed.
'Wiulheapplinmrnrrunaebaddingocoup:mtuscclapmemorde.menwn1e" If a roof is instafldd4withogti �bt i{ ad its �fbii, agree tOremove
nit hamrdm
ous aircenminams a,defined by the lay Arca Air Quality Managemmut
,oder, _ all new materials for inspection. Applicant understands and Will comply With
11 yes ❑Nn all non-point source regulations.
I have rad dile ha,ardmu,m:acoul,myulremcnn under Chapter 6,95 of nal
California Health Safety Code Sectinnn 25505,25533 and 25534.1 understand(I,:,, n llD
overrate of t ere.not eunently which
a vI be ales 1)t is my retance atl ay m or the �� o (� t/�
ccuryvn(of the rev n:lt c nv wbleh must he met prior a+Inumnce m':t to or cine al �—
Signature of Applicant Date
and a cal Da All roof coverings to be Class "B" or better .
zT
OFFICE
WOOD DESTROYING PESTS AND ORGANISMS INSPECTION REPORT
This is an inspection report only -- not a Notice of Completion
ADDRESS OF PROPERTY INSPECTED
e' ING NO. STREET CITY ZIP 1COUNTYIDAT E OF NUMBER OF
CODE INSPECTION PAGES
5 Lauretta Drive Cupertino 95014 43 07-10-00 1 5
mr
FRANZ TERMITE CONTROL CORPORATION Affix stamp here on Board copy only
4041 Transport Street A LICENSED PEST CONTROL
P OPERATOR IS AN EXPERT IN
Palo Alto, CA 94303 HIS/HER FIELD. ANY QUESTIONS
(650) 493-0445 (650) 493-64(18 FAX RELATIVE TO THIS REPORT SHOULD
BE REFERRED TO HIM/HER.
REGISTRATION # PR 0938 REPORT # 19213 STAMP # ESCROW #
ORDERED 00: David Payne 21175 Lauretta Drive Cupertino CA 95014
REPORT SENT TO: David Payne 21175 Lauretta Drive Cupertino CA 95014
PROPERTY OWNER: David Payne 21175 Lauretta Drive Cupertino CA 95014
PARTY IN INTEREST: a
ORIGINAL REPORT ❑ LIMITED REPORT ❑ SUPPLEMENTAL REPORT ®• REINSPECTION REPORT ❑' •Stamipt nal Data 03-13-00
I N F S 0O F O O E F C E S
y y N O U U R U T A A A E X H
Two StOY
GENERAL DESCRIPTION: , single family residence, 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
stuco with wood trim, brick veneer exterior. C N H E o U R W H T U S E
E E R O S O Y L S R
S P R R O O WO O G O I L
5 E 1 N T R O O W R S V E
C N N E O T O A E E A
B T S E R O E O O O M K
I CTION TAG POSTED: Stilbarea L E P N M R E R O E E O 5
C INSPECTION TAGS: Fran 03/13/2000 A O C T T R 51^ O L R S
R T E E O T T N E 1 T
E 1 R S T '' E T V S U
A O M S A ER
5 N I C L E
T T
E I 5
1.SUBSTRUCTURE AREA See 1E I 1xi
2. STALL SHOWER See original report
3. FOUNDATIONS See ori incl report
4. PORCHES --STEPS See original report
5. VENTILATION See original report
6. ABUTMENTS See ori ]nal report
7. ATTIC SPACES see original report X
8. GARAGES See 8C X X X
9. DECKS -- PATIOS See original report:
10. OTHER--INTERIOR See original report I I ix
11.. OTHER --EXTERIOR see ori incl report 1XI JXIX! X X
DIAGRAM AND EXPLANATION OF FINDINGS (This report is limited to structure or structures shown on diagram)
r
AUS 2
50000
l=tl G
• Q
n
Jac --------- �W���
Inspected by Oreo LOVe License No. )R 27248 Signature
NOTE: Questions or problems concerning the above report should be directed to the manager of the company. Unresolved questions or problems with
services performed may be directed to the Structural Pest Control Board at (916) 263.2533, 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 tee to: The Structural Pest Control Board, 1418 Howe Ave., Ste. 18, Sacramento, California 95825.3204.