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18391 POST THIS CARD NEAR FRONT OF BUILDING PEHMIT NUMBER CITY OF CUPERTINO 18391 • INSPECTION DIVISION JOB INSPECTION RECORD ^ � //�LC �� P6RN11T E PI AATON' I JOB ADDRESS �j G G UNIT# _LOT# J _ PERMIT EXPIRES IF WORK OWNER / i� �/�'L�����/ CONES CTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION NOTE: LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHMIT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. f CaJ _POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ((� PLUMBING 4 ELECTRICAL ED IN :ISSUANCE DATE MECHANICAL BLDG ELECT PLG MEC- o t ❑ ❑ LEI DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED a aBUILDING PERMIT INFORMATION WOOD FLOOR � s I VALUATION $JET. PLUMBING MECHANICAL PEHMII TO ELECTRICAL t FRAMING STORIES TYPE CONSTP, INSULATION . V-- I f-' ' DCC GROUP RES UNITS .PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO `T `Loon ARfTA TOTAL ACREAGE I�. DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES INTO CON PB 011— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE ❑ ❑ D E-1 ASSESSORS PARCEL NO ROUGH SAN,# PLUMBING ELECT.ENERGY TRACT,NO PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY Pik MECHANICAL MECH.ENERGY stn . ACC DATF. ACC.FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST ZONING ENG SITE NO. INSULATION PLUMBING GAS TEST GAS FIRE SPRINK ENERGY T-]a MECHANICAL ❑ NE] v ❑ NC] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.L UC. EXTERIOR SHEAR ELECTRICAL RELEASE ❑ N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING ���� ,/•^I `wYA I SCRATCH GOAT ELECTRIC PLAN CH CK cFEE GAS NO TAPE OR PLASTER.UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ELI ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ~O� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL i :p IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE \ TOTA_L___o CALLING FOR FINAL INSPECTION. J_ OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT I PERMIT NUMBER 228 -. "skoAEss /� Q A,MeectA11 (]40 lij ROS 18391 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL E' OWNER'$ r x PLAN CHECK VALIOA "AME h TI N P/ (?NI�1 I y k 7 QTY. ELECTRIC PERMIT FEE 409 CONTRACTORSPHONE NAME ' UTLETS-SWITCHES-RECEP 10.00/1.00 VJ(V NA LIC,No. LIGHTING FIXTURES 10.00/1.00 ADDRESS oR's PPLIANCES-RESIDENTIAL 4.00 CONTRACTORS E55 PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT R.,`� • PLAN CHECK FEE P.C.NO, T COI% INC. PANELS (OVER 200 AMP) 20.00 ENGINEER LIL.NO. 7 SIGNS.TRANS. 3.00 ADDR.SS ENG. Po.�11 Poo SPECIAL CIRCUIT 5.0Q PERMIT VALIDATION ADDRESS I� 5 p zIP9 I EMP.METER OR POLE INS. 20.00 APPLICANTS Z9 { 63�� G1%OO _ MOTORS SEE FEE SCH. ADDRESS `G SERVICE CHANGE 20.00 0 0 o LICENSED CONTRACTORS TECLARATION 4 v sus 1 hereby affirm tial I am licensed under provisions of Chapter 9 ISSUANCE DATE w (commencing with Section 7000)of Division 3 of the Business and BLOQ ELECT. PLG. MECH. wi Proessions Code,and iffy license is in full force and effect. z o w- License Class Lie Num her 9 en o Date Contractor `a y E t BUILDING PERMIT ¢ ar w 4 OWNFR-It UILDER DECLARATION INFORMATION " MISC.- REFER TO ORD w 3 LL I hereby affirm film I am exempt from the License u o a Law for the following reason.(Sec 7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. � -0 Code:Any city orcounty which requires a permit to construct,alter, a ¢o improve,demolish,or repair an structure,prior to its issuance,also ELEC.CONTR. LIC.NO. p' y s ELEC. / u - requires the applicant lot such permit to file a signed statement that TOTAL PERMIT TO n w m he is licensed pursuant to the provisions of the Contractor's License rzi Law(Chapter 9(mmmencingwith Section 7000)ofDmision3ofthe kLiZ))S10A-) ¢ Rosiness and Professions Code)or that he is exempt thercfiom and QTY. PLUMBING PERMIT FEE ¢ c the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. u ; m by any applicant for a permit subjects the applicant tort civil penalty ALTER-DRAIN -WATER (EA.I 5.00 of not more than five hundred dollar,0500).): - ❑ I,as owner of the property.or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00 their sole compensation,will do the work.and the structure is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Codc:'file Contractor's License Law does not apply to an owner of ,emptily who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AfAA TOTAL ACREAGE himself or et into his own employees,provided Rtal such ins building L{1 mvselfoor air through his or offered employees, or provided that r.suhebulding GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 �p��p� or'improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 x-8&& builder will have the burden of proving that he did not build or int- BUILDING USE Prove for Purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Umar ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:'f be Contractor i License Law does not apply to an owner of property who builds or improves thereon.and will) LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a contracmAs)licensed pursuant to the Coutraetor's License Lan.'. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO. ❑ lam exen,pt older Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEMACC.DATE ACC.FILE NO. WORKIiRS'C'OMPEN'SATION DECLARArToN WATER TREATING EQUIP. .00 I hereby affirm that I have a certificate of consent 1l)set Finsura. ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereat(Sce.3800,Loh.C.L Policy No. Company O ❑ Certified copy is hereby furnished. ,q� 111 FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. - REFER RD. O MISC. Y Applicant ❑ N❑ Y ❑ N❑ jrT CER'I'I Irl CATE O F FX EM PITON FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.G. LU > COh1I'F.NSATION INSURANC17 PLG.CONTR. LIC.NO. PLG. OL o 1'I'his section need not be completed if the permit is for one TOTAL Y❑ NE] Y ❑ N❑ D Z hundred dollar'(S 100)or lessI U O 1 certify that in the Performance of the work for which this per. OTV. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I shall not employ any person in any mannerso as to U become subject to the Workers'CompentatrOn Laws of California. '�! .� W Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING (C' } tin NOTICE'10 APPLICANT: H',after making this Certificate of Ex. p H Z clnplion,You should beconm subject to the Workers'Compensation APPLIANCE 5.00 PLAN CH CK 5,7 •^0 provisions of the Labor Coda, you must tortbwith comply with FEE .)( U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 Q CONs7RUC1 ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6 0 SEISMIC FEE 3D D 1 hereby affirm that there is a construction lending agency I'.. EXHAUST HOOD (WITH DUCT) the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) Lender,Nulnc HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. n�HAIIVEAL abuve-mentioned property for inspection purposes. ,(WO agree to save, indmnnify and keep harmless the City of MISC.- REFER TO ORD. Q upertino against liabilities,judgments, costs and expenses which CONST.TAX nay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 1 1 rantin Of this permit. MECH.CONT. LIC.NO. MECH.% /1 r Q TOTAL L D/101r Si re o(A ' Date 1101 OFFICE COPY WOOD DESTROYING PESTS AND ORGANISMS INSPECTION REPORT This Is an Inspection report only-not a Notice of Completion. 1 ADDRESS OF PROPERTY INSPECTED BUILDING NO. STREE- CITU ZIP COUNTY DATE OF NUMBEROF CODE INSPECTION PAGES 22840 (MERCEDES ROAD CUPERTINO 00000 43 08/22/91 2 Affix stamp here on Board copy only J.H. STEFFENSON TERMITE CO. A LICENSED PEST CONTROL l 11 Oaks Ave. OPERATOR IS AN EXPERT IN 195 E. SUl Y HIS FIELD. ANY QUESTIONS Campbell, CA 95008 RELATIVE TO THIS REPORT (408) 379-5245 SHOULD BE REFERRED TO HIM. REGISTRATION# PR0386 REPORT# 002080 BM STAMP# 569822R I ESCROW# Ordered by: FOREST CARROLL 22840 MERCEDES ROAD, CUPERTINO, CA 00000 ReportSentto: BROTHER JOHN HASTER, P.O. BOX A. C. CUPERTINO, CA 95015 Property Owner: Party in Interest: ORIGINAL REPORT LIMITED REPORT IZ SUPPLEMENTAL REPORT*' REINSPECTION REPORT�'A' *STAMP #L GATE LAS I N F 5 D F O D E F C E S N O U U R U T A A A E X H General Description: LIMITED TO FRONT BATHROOM. A T R B Y N H M R U L c 0 C T T W G E P T L L E W C I H E O U R W H T U S E E N E R O S O Y L S R S S R R '0 W O W O 1 S P A 0 O 0 0 G S V L I E I N T R O 0 R E E E B C N E E D T 0 A A L T S A R D E D 0 M K E E P N M R P R C E E O S Inspection Taos PGated: SUBAREA D E I Y E M o e 1 A C T T S I N L R S R T E E R T T T E I T E 1 R S 0 5 E A V S U Ether Inspection Tags: A O M T S C E R S N I T L E T S E S 1. SUBSTRUCTURE AREA 2. STALL SHOWER 3. FOUNDATIONS _— — 4. PORCHES...STEPS 5. VENTILATION 6."ABUTMENTS 7. ATTIC SPACES 8. GARAGES 9. DECKS... PATIOS 1o. OTHER...INTERIOR 10A X X X 11. OTHER... EXTERIOR DIAGRAM AND EXPLANATION OF FINDINGS(This report Is limited to structure or structures shown on diagram 13 P /?3y/ APPROVED IN ACCORDANCE WITH THE CRP O6 CUPERTINO CODES AND.ORDINARCES • OA TE Q,—q--q glMED ' —c 47 � , ffifa aft of plans and specificatio g� nd it is im' iewlumake any chaW kW On the job at nges ortimes aalteration s 70 • on 99m0 without Written permission from Q Md budding Dept., City of Cupertino. ihd litOmpirig of this plan and specification 3NALL NOT be heal to permit or to be an 1PROV01 of the violation of any provisions f AnY City Ordinance or State Law. � n INSPECTION j DEPART Inspected by Benny Myers License No. 6423 Signature YOU ARE ENTITLED TO OBTAIN COPIES OF ALL REPORTS AND COMPLETION NOTICES ON THIS PROPER FILED WIT HE BOARD DURING THE PRECEDING TWO YEARS UPON PAYMENT OF A$2.00 FEE TO STRUCTURAL PEST CONTROL BOARD,1422 HOWE AVEISACRAMENTO,CA 95825-3280.