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.