27480 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BOMBING- ,I,E. RI Al, PERMITNO. O
APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING DIVISION BUILDING PROJRC'1'IDRN'TIVICATION
BUILDING ADDRESS �/��I.��� SANITARY NO. APPLICATION SUBMITTAL DATE
tootb Vim✓J I UNIT- LOT- l S
�OWNERS NAME: PHONE: CONI CPOR'S NAME.: LIC NO: NIC CONTROL Is
ARCHITECI'/EiNGINF.F,R: LIC NO: AlpSSSS: ❑
CONTACT: PHONE: Vf/'V
QT'Y. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
PERMIT ISSUANCE Ill
� El 1:1 11
LICENSED CONTRACTORS DECLARATION APPLIANCES-RESIDENTIAL �I' I C
p0Z Ihereby 700mofDivision amlicensed underprovisiom.mus Cml.md mmecense with `�fIT/ygl^M/k�Sl^
Fs100 fullhaeand of Divisinn]ofthe Business and Professions Code,and my license is in PANELS
FID�F... fullhareClas effect. UPIC200AMPS
<c. License Class Lt..p
m=y Date Contractor 201-I"AWS
ZOy� ARCHITECTS DECLARATION OVER 11100 AMPS SQ.FT.FLOOR ARG S/SQ.FP.
O Z—D 1 undersand my plans shall be used as public records.
P `0 Licensed Profcssi.nal SIGNS ELECTRICAL
�ry��peC OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
{ii�((O LF I hereby nlfim.that 1 um exempt from the Cono.ams License Law for the
.+13 rim following reason,(Se,,mm 70313,Business and Professions Cale:Any city or county TEMP.METER OR POLE INST.
which requires a Person to construct,aper,improve,demolish.or repair my structure
fY� prior to its issuance,also requires the applicant for such permit to file asigned statement POWER DEVICES
i g A p that he is licensed pursuant to the provisions of the Convectors License Law(Chapter
IM,
e 9(commercing with Section 70W)of Division 3 of the Rosiness and Professions Code) SWIMMING POOL ELECTRIC
VALUATION
p�IM, .,that he is exempt therefrornal the basis Pathe alleged exemption.My violadonof OUTLETS-SWITCHES-Fl%TURFS I �ZO
ZQ, Permit Section 7031.5 by any applicant for a peit subjects theapplicmno a civil Penalty of
Wimnot more than rive hundred doll.rs($500). NEW RESIDPNTIAI,ELECIR _SQ.Fr.
❑ I......erofthe property,or my employees with wages as their sole compensation, STORIES TYPI?CONSTRU 'ION
a3� will do the work,and the strvcwre is not intendedoraffer>d formic Soc.]044,Business
and Professions Code:The Contractors License Law does not apply to an owner of
property who builds or improves thercoo,and whoicassuchwmk himselforthrough his OCC.GROUP RES.UNITS
own employees,provided that such improvements ate not intended or offered for sale.If,
however,the building or improvement is sold within one year of rompletion,the owner. TOTAL:
builder will have the burden of proving that he did not build or improve for purpose of
rale.)_ QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
❑ Les owneroect( pe yysearnexulusis and nifessigwith de:)Too
Contractors
mrwa the project(Sec. ..Business and Professions Code:)The Comramra
whocontracts
o tawd.asnm applymanownerofpropeny who
sed puaimprovee m<reonmd PERMIT ISSUANCE
whence La ufavuch projects with acommctor(s)lianxd pursuant Contractor's ALTER-DRAIN&VENT-WATERG
License Law. r ( ) FEE SUMMARY
❑ 1 em exempt under SCe. ,B&P C for thio reason BACK FLOW PROTECT.DEVICE EG�DINGFFJE
Y N
Owner Da� RF.CEIPfp
RAINS-(LOUR,PPF.ARG,LONG.
WORKMAN COMPENSATION DECLARATION / AX YN
❑ Iberebyaffrm that lhnvescenifcaleofconsentioself-insum,oraceniftcateof RF.CEIPI'p
Tuxes- r RA
Wnrket%Cnmpensation Insurance are certifiedeopythermf(See.3BW, bC.) Y_N
ravers all employee's undar his penal.. YSTL+M-I INC.4OU7LEfS RECEIPT-
Poliry- BUILDING DIVISION FEES
13 Cay .SYSTEM-OVER 4(EA) K FEE
❑ Certified copy ie hcreM1y famished.
❑ Certified copy is Gled with.he city inspection division. ORGSFIINDUSTRL WASTE INTERCEPTOR CERTIFICATEOFE%EMP ION FROM WORKERS' GREASETRAP
COMPENSATION INSURANCE
This sectionnacAnot he,completed if Ne permit is forone hundred dollars($100) SEWER-SANITARY-STORM G.201JFT. ENERGY FEE
or less.)
r' I certify that in the performance ofthe work for which this permit is issued,Ishall WATER HEATER W/VENT/ELECfR
not employ any person in any m as m become mhject to the Workers' PAID
z Cmirpensad.nlawsaf California. Data so WATER SYSTEM/T'RGTING Dam Receipt#
Applicant
z� O NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ.IT. TOTAL:
!—I CCO)-ahaeme subjectto the Workera Compensation provisions of the labor Cade,you must BUILDING FL'E
� > forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY SMSMICFEE
tL•^J�, z Ihereby shirts that hem is a construction lending agency for the performance of 'TOTAL: ELECTRIC FEET
O the work for which this permit is issued(Sec.3097,Civ,C.)
Lenders Name PLUMBING FEE
O U Leaders AddressQTY. MECIIANICALPERMIT FEE
1 certify that I have mud this application and state that.he above information is
aronin.l agree to comply with all city and county ordinances and state laws relmin to MECHANICAL FEE
Un 6 PERMIT ISSUANCE
inswe-rai.lding ..dianand harcbyamhoiureoses, Ives of miscity to emcrupon the
(� z abuv(We)agredpropenyfoeinify ad keep has, ALTER OR ADD TO MECII. CONSTRUCTION TAX
(We)agree rt save,indemnify and keep harmless the City.f Cupcdino against
inco ities ucnce e I e,mond expeisspemit, may many way mcrueageinstsaid City AIR IIANOLING UNIT(TO Ig000 CPM)
in ran acnes of the granting is permit,
AIR HANDLING UNIT(OVER 10.000 CFM)
mreof Applicant/Contmnm Uma EXHAUST HOOD(W/DUC ,
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Data Receipt#
Will the applicant or furore building occupant mare or handle hazardous msurnal
as defined by the Cupmina Municipal Code,Chapter 9.12,and the Health it Safety HEATING UNIT(OVER I W,000 BTU) TOTAL:
Cale,SermonYes, ❑No
x)?
11Yes VENTILATION VAN(SINGLE RESID)
BOILER-COMP IMP OR I Ip,000 BTU) ISSUANCE DATE
Willtheappliwmorfumrebuildingoccupmt uuequipmentordevices whichemit p�
homrdous air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(OVER 100,000 BTU)
Ma13W I]
io? Yes ❑Na NEW RESIDENTIAL MECH. SQ.FTA.
I have rend the hamrdous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533 and 25534. 1 understand that
ifthe building docs mal currently have a mount,that it is my responsibility a notify the �s Y I
occupant of the requirements which amt be met prior m issuance of a Cenificme of yl Uh �'/,e`\? xg
Occupancy. V
Owner or eahurized agent Data TOTAL: ISSUED BY:
OFFICE
r
®,
10300 Torre Avenue
(,I I t t f Cupertino, CA 95014
Cupertino Building Division
(408)777-3228
(408)777-3333 (fax)
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
--I have and will maintain a certificate of consent to self insure for worker's compensation,
as provided for
--I have and will maintain workers' compensation, as required by section 3700 of the
Labor Code, for the performance of the work for which this permit issued. My workers'
compensation insurance carrier and policy number are: // 2 S'O
(this section need not be completed if the permit is for$100.00 or im)
• --I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so at to become subject to the workers' compensation
provisions of Section 3700 of the Labor Code, I sh II forthwith s�gjmp�ly with those
provisions. Date %- 7 G Applicant: (2,J.la�r;eS—
by Section 3700 of the Labor Code for the perf ance of the work for which this permit
is issued.
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ($100,000.) DOLLARS IN
ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED IN
SECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES.
PrGnrrl on Hrcvrlrrl Pnprr
R
r>
WOOD DESTROYING PESTS AND ORGANISMS INSPECTION REPORT
This is an inspection report only-not a Notice of Completion.
ADDRESS OF PROPERTY INSPECTED
BUILDING NO. STREET CITY ZIP COUNTY DATEOF NUMBER OF
CODE INSPECTION PAGES
10010 MOSSY OAK CT. CUPERTINO 95014 43 01/17/95 3
AmK#tamp hereon Board copy only
ABLE EXTERMINATORS, INC. A LICENSED PEST CONTROL
P.O. BOX 5339 OPERATOR IS AN EXPERT IN
SAN JOSE, CALIFORNIA 95150 I I HIS FIELD. ANV OUESTIDNS
PHONE 408 251-6500 - FAX# 408 251-3652 ASSOCIATION RELATIVE TO THIS REPORT
( ) ( ) � SHOULD BE REFERRED TO HIM.
REGISTRATION# PR0178 REPORT# 063139 JJ STAMP# 2021473T • ESCROW#
Ordered by: Kathy Stakey/Coldwell-Banker, 20100 Stevens Creek, Cupertino, CA 95014
Report Sent to:
Property Owner: Mr. McGrogen, % Agent,
Party In Interest: _
.IGINALREPORT LIMITEDREPORT[R SUPPLEMENTAL REPORT[]* RE INSPECTION REPORT O* STAMPSL 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 % H
GeneralDescription: This is a limited inspection to the A T R B V N H M R U L C O
exterior of a 2 story townhouse and the c T T W D E P T L L E w
C I H E O U R W H T U E E
detached garage Only. _ a N E R D $ O V L 9 R
S a R R D W O W O I
a P A O O D 0 0 a V L
I E I N T R O 0 R E E E
--- B C N E E D T ❑ A A
L T S A R ❑ E D ❑ M K
-- --- E E P N M R P R C E E 0 S
Inspection Tags Posted: Garage D E I Y E M o B I
A C T T S IN L R S
R T E E R T T T E IT
E I R S 0 S E A V S u
Other Inspection Tags: A o M T s C E R
S N I T L E
T a
E
S
1. SUBSTRUCTURE AREA Not inspected. _ X X
2. STALL SHOWER Not inspected __ X _________--
3. FOUNDATIONS Not inspected. -__ _ X
4. PORCHES...STEPS Not inspected. __ X
5. VENTILATION NOt inspected_ _ __ X
6. ABUTMENTS Not inspected. _. __ X __ ____ _ _
7. ATTIC SPACES Not inspected. _ _ _ _X
a. GARAGES Not inspected.
9. DECKS... PATIOS Not inspected.
10. OTHER...INTERIOR Not inspected. __ X
11. OTHER ... EXTERIOR InS where practical See IIA-11F X X X X
DIAGRAM AND EXPLANATION OF FINDINGS(This report Is limited to structure or structures shown on diagram)
• 11D
C
O W
GARAGE M A
M L
O L
N eel,
11E 11F
PATIO 11FI 6
11F �/!, ✓,9� ���
Cys�°F �6
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11C 11C L
FRONT 11A
Inspected by—James_D.�Qhnson_ uDenaeNo._RC783� SignatureYou are entitled to obtain copies of all reports and completion notices on this property filed with th board during the ptgdeding w years upon payment
of a$2.00 search fee to:The Structural Pest Control Board, 1422 Howe Avenue,Suite 3,Sacramento,California 95825-3280.
NOTE: Questions or problems conceding the above report should be directed to the manager of this company. Unresolved questions or problems with
services performed may be directed to the Slnlcti ral Pest Control Board at(213)897-7838, (415)557-9114,or(916)263-2533.
-c
ADDRESS OF
PROPERTY
INSPECTED _10010 _ MOSSY OAK CT. CUPERTINO _
BUILDING NO, STREET CITY
2021473T 01/17/95 063139 JJ
STAMP NO. DATE OF INSPECTION CO. REPORT NO.
At the request of Kathy Stakey/Coldwell Banker this is a limited inspection
to the exterior of the townhouse located at 10010 Mossy Oak Ct. only.
It is recommended that the entire structure be inspected. We were only
able to inspect the second story eave areas visually from the ground.
WE GUARANTEE TREATMENTS 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. FUMIGATIONS ARE GUARANTEED FOR TWO
YEARS FROW THE DATE OF THE FUMIGATION. WE CANNOT GUARANTEE WORK DONE
BY THE OWNERS OR THE OWNERS' AGENTS. WE MAKE NO GUARANTEE AGAINST
FUTURE INFECTIONS, ADVERSE CONDITIONS OR CONDITIONS PRESENT BUT NOT
• EVIDENT AT THE TIME OF OUR INSPECTION. IT IS POSSIBLE TO SECURE A
RENEWABLE WARRANTY THAT WOULD COVER NEW OR CONCEALED INFESTATIONS.
CONTACT OUR OFFICE FOR DETAILS.
NOTE: THIS COMPANY WILL REINSPECT WORK PERFORMED BY OTHERS FOR A
REINSPECTION FEE OF $100. 00. OPEN WALL AND OPEN FLOOR
INSPECTIONS ARE REQUIRED IF A CERTIFICATION IS DESIRED FROM
THIS COMPANY. REINSPECTION WILL BE PERFORMED WITHIN FOUR
MONTHS OF THE DATE OF THE ORIGINAL INSPECTION AND MAY REQUIRE
AS LONG AS TEN DAYS TO BE MADE.
NOTE: THIS IS A SEPARATED REPORT 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 THE INSPECTION AND
CANNOT BE DEFINED AS SECTION I OR SECTION II .
(11) OTHER. . .EXTERIOR
11A. FINDING: Wood destroying organism damage was noted to the wood
• shingles, over the massard facade roofing. This area
was wet, due to the heavy rains recently and
identification was very vague at this time.
RECOMMENDATION: Remove all wood destroying organism damaged shingles
and replace with new material. If during repairs, we
find additional damages, we will issue a supplemental
report with findings, recommendations and costs for
corrections. SECTION I ITEM.
11B. FINDING: The Plywood, bat and board siding has been damaged by
fungus and drywood termites at the left side of the
structure, below the planter shelf.
RECOMMENDATION: Remove all damaged siding and replace with new
material. we will do no painting in connection with
this repair. If during the course of repairs,
additional damages are found, we will issue a
• supplemental report with findings, recommendations
and costs for repairs. SECTION I ITEM.
11C. FINDING: The 4x10 decorative planter shelf support beams have
been damage by fungus and drywood termites.
RECOMMENDATION: Remove all four (4) damaged support beams and replace
with new material. If during the course of repairs,
additional damages are found, we will issue a
supplemental report with findings, recommendations
and costs for repairs. SECTION I ITEM.
11D. FINDING: Fungus damage was noted to the trim at the right side
of the big garage door, next to the jamb.
RECOMMENDATION: Trim off the damaged portion and fill in with mortar.
SECTION I ITEM.
Page 2 of 3
ADDRESS OF
PROPERTY
INSPECTED`10010MOSSY OAK__CT_ _ CUPERTINO
BUILDING NO. STREET CITY
_2021473T O1 17 L95 _ _ 063139 JJ
STAMP NO. DATE OF INSPECTION CO. REPORT NO.
11E. FINDING: Earth to wood contact was noted where the soil is
touching the wood siding at the left rear side of the
garage.
RECOMMENDATION: Owner should grade the earth in this area to
maintain an earth level below the top of the
foundation and providing proper drainage away from
the structure. SECTION II ITEM.
11F. FINDING: The fences attached to the structure create earth to
wood contacts.
•RECOMMENDATION: Separate the fences from the structure by installing
metal flashing between the fences and the structure.
SECTION II ITEM.
NOTE: If a complete certification is desired from this
company, all Section 1 items would have to be
completed.
NOTE: "State law requires that you be given the following
information: CAUTION-PESTICIDES ARE TOXIC CHEMICALS. Structural Pest
Control Companies are registered and regulated by the Structural Pest
Control Board, and apply pesticides which are registered and approved
for use by the California Department of Food and Agriculture and the
United States Environmental Protection Agency. Registration is granted
when the state finds that based on existing scientific evidence there
are no appreciable risks if proper use conditions are followed or that
the risks are outweighed by the benefits. The degree of risk depends
upon the degrees of exposure, so exposure should be minimized. "
"If within 24 hours following application you experience symptoms
similar to common seasonal illness comparable to the flu, contact your
physician or poison control center (408) 299-5112 and your pest
control company immediately.
"For further information, contact any of the following: Your Pest
Control Company (408) 251-6500; for Health Questions-The County Health
Department (408) 299-5822 ; for Application Information-The County
•Agricultural Commissioner (408) 299-2171 or (415) 364-5600 and for
Regulatory Information-the Structural Pest Control Board (916)
263-2533 located at 1422 Howe Avenue, Sacramento, Ca 95825 .
•
Page 3 of 3
60clixof,
Cup e th1 o
10300 Torre Avenue
Cupertino,CA 95014
Building Division
(408)777-3228
Fax(408)777-3333
November 29, 1995
Resident
10010 Moss Oak Court
Cupertino, CA 95014
Subject: 10010 Moss Oak Court Permit# 27480 - Termite Repair
Dear Resident,
According to our records the above mentioned permit has never been finaled by a
City Building Inspector. A permit is considered to be valid only six months from its
last inspection date. If your permit shows that the final inspection has been completed
please send a copy of the permit, along with this letter to 10300 Tone Avenue,
Cupertino, CA., 95014, Attention Building Department.
If your permit has not been finaled, please contact the Building Department by
calling (408) 777-3228, so that we may arrange to extend your permit, and schedule a
final inspection.
In an effort to control the number of expired permits, the City of Cupertino
requires a response in ten working days from your day of receipt of this letter. If we do
not hear from you, the City of Cupertino's Building Department will have no
alternative but to resolve your permit as expired and discard the records.
Thank you for your assistance.
Sincerely, 1
City of Cupertino
Printed on Recycled Paper