29661i APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - ELECTRICAL.
BUH,DING DIVISION APPLICATION/PERMIT PLUMB ING-MECEANICAI
I I BUILDING PROJECTIDENPIFIC,
OFFICE
FEE
..- 29661
NITARY NO.
APPLICATIONSUBMITTALDATE
CONTACT. PHONE:
06157000
❑ Consultant Fees Paid by Applicant (Initial)
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under Imovi,ions of Chapter 9 (commencing
witection70booI'D.,sim3ofthe Bir,mats:md Pndexxitum CMe,und mylicemeis
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in full force and effect.
License Claes 1.ie.a
Darefootman,
QTY ELECTRIC PERMIT
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PERMIT ISSUANCE
APPLIANCES - RESIDENTIAL
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
PANELS
UP TO 200 AMPS
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Licenmd Embossment
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 tan exempt from the Contractor', License Law for the
milnating reason. (Section 7113).5. Bu.ines, and Professions Code: Any city ar county
e canswn. forrsu, demolish, ar repair any suucmre
which require, permit requires
the thanapplicantisinfor mchpemiuoicensrile ae Law LCaremeat
bantam on 7") provisions (if the the Cirromener'License Lew(Chap¢r9
'hathesibissuance.esedpursuant it,
(cmineislice with
ionapth Sereirom a fB of Diaiii for theof al eged exe anion. Any vi Calc)or
'hat he is and or basis for the alleged exemption. Any violation of
Sec he ix exempt ibc applicant mit suhjecn the applicant toacivil penalty of
Section W31.5hy
201-1000AMPS
IIgp AMPS
SIGNS ELECTRICAL.
SPGCIALCIRCUIT''/MISE.
'TEMIt METER OR POLE INS'T.
POWER DEVICES
Www
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=Q
F
L 3 �
delta ($50d
not mare than five hundred Jo11an (550111.
hundred
01, us owner of the pmpcny, nr my employees with wagesu theirvde contbenmte'N,
will dothework, and the he Cam ixnm intannal i w doesbut a ply 111) a older
pro erty who a Cute: The Contmcmr'. License laws s:x nm apply m tan owner n(
or through
are not iyearof ar oleo oil for
his own who builds or improves thereon, pr who aces such work intended or
his own employeese building that such improvements
SWIMMING POOL ELECTRIC
OUTLETS - SWITCHES-FIXTURLS
NEW RFSIUF.NTIAL ELECTR SQ FT.
is %ol v
sale. IL however, the inrymvcmcnl i. sold within one year of completion. the
the
bur
owner -budder will hove the harden of proving that he did not build or improve for pur-
hive
i
pose of sale.).
❑ L as owner at the property, am exclusively contracting with licensed cannot to
TOTAL:
crmsuum the project (Sec. 70,14. Business and Pmfessians Calc:) The Contractors Li -
name law does not apply to an owner, of pmpeny who builds or Improve therm.,and
QTY. PLUMBING PERMIT
who contracts for such projects with a continental.) licensed pursuant to the Contractor's
PERMIT ISSUANCE
License Law.
I um exempt under Sec. . B & P C for this reason
ALTER - DRAIN & VENT- WATER (EA)
Owner Dalt
BACK PLOW PROTEC`F DEVICE
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of,injury one of the following declarations:
❑ I have and will nwinmin a Certificate ofComenuo self -insure for Workers Compen-
DRAINS- FLOOR. ROOF, AREA, GOND.
section, as provided for by Section 3710 of the labor Cade, births, performance of the
work for which this permit i. ikond,
FIX'I URIES - PER TRAP
❑ I have and will nomencir Worker's Compensation Insurance, as required by Section
3710 of the Labor Code, for the performance ofthe work for which this permit is issued.
GAS - IIA. SYSTEM -I INC. 4 OUTLETS
My Worker's Compensation Insurance carrier and Policy number are:
Currie,. Policy No.:
GAS - EA. SYSTEM -OVER 4 (HA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
GREASFANDUSTRL WASTE INTERCEPTOR
GREASE TRAP
(This seenion need not be completed if the #s nit is mrsue hundeeddollar.(S I no
or less)
SEWER - SANITARY -STORM EA. 200 FT
Z
O O
of the enork mwhijM1tho the W rkers' ompen.
(certify that in say
nm employ by person in vny mnmmr xo as m become object m the Workers' Compm-,
satim"vesof CulilbmW, Date
WATER HEATER WNENf/ELECTR
n
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Uleader's
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Applicant
NOTICE TO APPLICAT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Cade, you must
forthwith comply with such provision, or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
l hereby offirm that there is a conswction lending agency for P,Thmmmce of
the work for which this permit i. issued (Sec. 30?7. Civ. C.)
Name
WATER SYSTEM/TREATING
WATER SERVICE
NEW RESIDENTIAL ?LMB. SQ. PT.
TOTAL
lender's Address
1 fmily that 1 have read this application and ,are that the above information i.
correct. l agree to comply whhdl city and county urfrob s and stale law, aelalmgm
QTY. MECHANICAL PERMIT
Uz
buildirr,bronuctier, and hereby aathome representatives ofthis city former upon the
PERMIT ISSUANCE,
aMn mmeptioned property for inspection purposes
(We) agree to save, indemnify and keep hamdcss the City of Cupertino against
Iinhilities,judgments. costs and expenses which may in any way accrue against said City
ALIERORADDTOMECH.
eemequence oft gntram,of this roof
AIR HANDLING UNIT (TO 10.000 CFM)
APPL!'ANT ON S TAN S A WILL COMPL 'H ALL NON -POINT
S RCF RE MONS. /J
AIR HANDLING UNIT (OVER 10,000 CFM)
•'`,
J{ 7
EXHAUST HOOD(W/DUCT)
anon of pp icamlCon tar Uam
HIiA'TING UNIT (TO IW.000BTU)
I1Ato UOUS MATERIALS DISCLOSURE
Willy applicant orfuture nt material
hhoealth
12. and thead
as defined by the Cupcnino Municipal Code, Chnpmr 9.12, and the Health and Safety
Municipal Code,
CMu. Section 25532fu)'!
HEATING UNIT (OVER IIXk110g0 BTU)
❑ve, Fl No
VENTILATION IAN (SINGLE RESID)
Will the applicant or future building occupant me equipment or devices which
emit hm.film s air etmbrand an as defined by the Bay Arca Air Quality Management
BOILER -COMP EIRP OR I00.000 BTU)
BOILER-COMP(OVER IOO.WOBTU)
District?
Cl Vex Fl No
AIR CONDITIONER
I have read the htrudousmaterielsrequirements under, Chapterfi95nf the Cali.
NEW RESIDENTIAL MECH. SQ. PT.
(omit, Health & Safety Code. Sections 255115. 25533 and 25534. I understand that if the
building docs trot curremly have a tenant, that it is my m.Inmsi ilitym ratify the occupant
of the taluimomnu which must be met prior In Issuance of a Ceni feat, of Occupancy.
OFFICE
FEE
JOB DESCRIPTION
RESIDENTIAL
❑SFDWL ❑ KITCHEN REMODEL
❑ADDITION ❑PLUMBING RF. -PIPE.
❑MULTI -UNIT [I STRUCTURAL
MODIFICATION
C) INTERIOR ❑CHIMNEY REPAIR
IMPROVEMENT
BATH REMODEUREPAIR ❑ DEMOLITION
DOTTER
COMMERCIAL:
E3 NEW BLDG/ADDITION ❑DEMOLITION
❑TENANT ❑ FOOD SERVICE
^ IMPROVEMENT
VSQ. 14'.
g� A
PEE�, Eg 5 l996
PL`ANCHECKFF;E I V l
ENERGY FEE
GRADING FEE
SOILS FEET\ NT,
PAID
Date Receipt#
BUILDING TEF.
FEL SEISMIC FEE
LLECIRICPEE
PLUMBING FliE
MECHANICAL. FEE
CONSTRUCFIONTAX
HOUSING MITIGATION 12121.7
PAID
[)are Rcacipt0
TOTAL:
..- 29661
NITARY NO.
APPLICATIONSUBMITTALDATE
N/C
CONTROL#
BUILDING PERMIT INFO
BLDG
ELECT' PLUMB MECH
❑ ❑ ❑
JOB DESCRIPTION
RESIDENTIAL
❑SFDWL ❑ KITCHEN REMODEL
❑ADDITION ❑PLUMBING RF. -PIPE.
❑MULTI -UNIT [I STRUCTURAL
MODIFICATION
C) INTERIOR ❑CHIMNEY REPAIR
IMPROVEMENT
BATH REMODEUREPAIR ❑ DEMOLITION
DOTTER
COMMERCIAL:
E3 NEW BLDG/ADDITION ❑DEMOLITION
❑TENANT ❑ FOOD SERVICE
^ IMPROVEMENT
VSQ. 14'.
g� A
PEE�, Eg 5 l996
PL`ANCHECKFF;E I V l
ENERGY FEE
GRADING FEE
SOILS FEET\ NT,
PAID
Date Receipt#
BUILDING TEF.
FEL SEISMIC FEE
LLECIRICPEE
PLUMBING FliE
MECHANICAL. FEE
CONSTRUCFIONTAX
HOUSING MITIGATION 12121.7
PAID
[)are Rcacipt0
TOTAL:
WOOD DESTROYING PESTS AND ORGANISMS INSPECTION REPORT
This is an inspection report only -- not a Notice of Completion
ADDRESS OF PROPERTY INSPECTED
fRDTLQiA�N0.
Ila 3
S1RLtI
NORMANDY WAY
Lflr
CUPERTINO
"'
95014
COOC ''
43
INSPECTION
02/14/96
PAGES
3
F
Affix stamp here on Board copy only
ANTIQUE TERMITE, INC.
A LICENSED PEST CONTROL
684 South Second Street
OPERATOR IS AN EXPERT IN
A
San Jose, CA 95112HIS/HER
FIELD. ANY QUESTIONS
-em REPORT SHOULD
(408) 995-6300 (408) 995-0517 FAX
RELATIVE TO THIS
U
R
BE REFERRED TO HIM/HER.
IREGISIRAIIUN N PR1187 Ixcruni M 8158E 2964435T I
ORDERED BY:
REPORT SENT TO:
PROPERTY OWNER:
PAR 11 in
ORIGINAL REPORT ❑ LIMITED REPORT[3 SUPPLEMENTAL REPORT ®* REINSPECTION REPORT O*
pp aa
*SiaA�pga 2878775T Date 01/19/96
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GENERAL DESCRIPTION:
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see original report
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INSPECTION TAG POSTED: see original report
INSPECTION TAGS:
D
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O
EFT
LBER
original report
A
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NC
RE
M6
TTES
T
A
E
LS
SE
S
RU
1. SUBSTRUCTURE AREA
2. STALL SHOWER
3. FOUNDATIONS
4. PORCHES -- STEPS
5. VENTILATION
6. ABUTMENTS
7. ATTIC SPACES
& GARAGES
9 -- PATIOS
-DECKS
See1W,1CIC
10. OTHER -- INTERIOR
111. OTHER -- EXTERIOR
DIAGRAM AND EXPLANATION OF FINDINGS (This report is limited to structure or structures shown on diagram)
� FD
EB 15
19g6
Cl Nsa ryOP�� FRTjN�T'fFNT
OFFICE COPY
Inspected by MICHAEL R. MEEK License No. OA8038 SignatuFe/��1�I
NOTE: Questions or problems concerning the above report should be directed to the manager of the campany. Unresolved questions o problems with
services performed may be directed to the Structural Pest Control Board at (213) 897-7838, (415) 557-9114, or (9161 263-2533.
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, 1422 Howe Ave., Ste. 3, Sacramento, California 95825-3280.
,ird ,_PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
7583 NORN11ND1' %%'AY CUPERTINO
BLDG. NO. STREET CITY
• 29644501' 02/12/1996 81581)
STAMP NO. DATE OF INSPECTION CO. REPORT NO.
THIS IS A SUPPLEMENTAL REPORT IN CONJUNCTION WITH OUR ORIGINAL REPORT
#8158A DATED 2/6/96 BEARING STATE STAMP #2878775T AND SHOULD BE MADE A
PART THEREOF. NOTE: IT SHOULD BE REALIZED THAT BID GIVEN ON THIS REPORT IS
IN ADDITION TO BID GIVEN ON OUR ORIGINAL INSPECTION REPORT.
S' H E
Item 2C: t the request of interested parties the following bid is given to
tear out all tile at the master bathroom shower, and existing backing,
install new waterproof sheetrock and new standard grade ceramic tiel
throughout the master bathroom shower area. Re -Install the existing
° t shower enclosure.
Note: Should it be found that linoleum has to be removed in order to
facilitate repairs at the shower, an additional cost of $240.00 would be
• required to cover installation of new standard grade linoleum.
****** This is a Section 2 Item ******
•
If it is found that during the course of repairs, damage and/ or infestation
is found to extend into previously inaccessible areas, a supplemental report
will be issued outlining findings and costs for any additional repairs or
treatments.
ANTIQUE TERNIITE, INC. --- License No. PRI187
A'NT]QUE TERMITE, INC.
684 South Second Street
San Jose, CA 95112
(408) 995-6300 (408) 995-0517 FAX }-
Address of Property:
Inspection Date:
Termite Report #:
State Stamp #:
Title Co. & Escrow #:
SECTION 1
.e Authorize the Following
Section I (tents to he Perionned.
WORK AUTHORIZATION CONTRACT
7583 NORMANDY WAY CUPERTINO, CA. 95014
02/12/1996
8158D
2964450T
SECTION 2
2C: $ 2200.00
We Authorize the Following
Section 2 Items to be Perforn ed.
Proposed Cost Section 1:
Proposed Cost Section 2:
Proposed Cost Unknown F.I.:
Inspection Fee:
Total:
ANTIQUE TERMITE, INC. AGREES:
UNKNOWN FURTHER INSP.
We Authorize the Following
Items for Unknown Further Inspection.
1: PROPERTIES FOR WHICH THERE IS NO BUYER REQUIRE 1/3 DOWNPAYMENT PRIOR TO REPAIRS AND THE BALANCE IS DUE WITHIN TER (10) DAYS
OF COMPLETION.
2: To guarantee all repair completed by this company for one year from date of notice of completion, except for plumbing, grouting,
caulking, and re -setting of toilets, which will be guaranteed for (30) days. We assume no responsibility for work performed by
others.
3: To be bound to perform this work for the price quoted in our cost breakdown for a period not to exceed (30) days.
4: To use reasonable care in the performance of our work but to assume no responsibility for damage to any hidden pipes, wiring, or
other Mcilities or to any shrubs, plants or other life.
OWNER OR OWNER'S AGENT AGREES:
1: To pay for services rendered, including upon notice of completion of work.
2: To pay for service charges 1/5 % per month or portion of any month beyond the (30) days after completion of work by our company..
3: Owner grants to Antique Termite, Inc. a security interest in the above described real property to secure payment of the sum fo;
work and inspection fee completed.
4: In case of non payment by owner, reasonable attorney fees and any costs of collection shall be paid by owner, whether suit be
0 ed or not.
H PARTIES AGREE:
If additional damage is discovered by Antique Termite Inc. in the performance of the work, Antique Termite agrees to notify
ner or agent of the amount of the damage and the amount of the additional work necessary to be performed at an additional cost as
per supplemental report.
2: The above additional work to be perforated will not be done without written authorization from owner or owner's agent.
NOTICE TO PROPERTY OWNERS: (Section 1018 of the California Contractors License Law, Business and Professional Code Div. 3. Chap. 9)
Provides under the Mechanic's Lien Law 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 the court officer and the proceeds of the sale used to satisfy the indebtedness. This
can happen even if you paid your own contractor infull,if the subcontractor, laborer or supplier remains unpaid. To preserve their
right to file a claim or lien against your property,certain claimants such as sub -contractors or material suppliers are required to
provide you with a document entitled " PRELIMINARY NOTICE" is not a lien against your property. Its purpose is to notify you of
persons who may have the right to file a lien against your property if they are not paid.
NOTE: This document is not to be used until all funds due to ANTIQUE TERMITE,INC. as outlined above are in escrow and supplied with
full authorization for release by all contented parties. If there is not the total amount and /or there is not authorization for
full release by both parties, this completion/clearance is to be returned to ANTIQUE TERMITE, INC. immediately. To use this
completion/clearance if the above stipulations are not met is to assume direct legal responsibility for the entire amound due to
ANTIQUE TERMITE, INC.
I Have Read This Contract And The Termite Report It Refers To.
SIGNED WORK AUTHORIZATION CONTRACT MUST BE RECEIVED BEFORE WORK WILL BE SCHEDULED.
1 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
ANTIQUE TERMITE, INC.