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S 1345 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POIN i PEN ONLY' II CITY OF CUPERTINO '�- BLIP-ANG-ELECI'RICAL a• '' ph IFNO. BUILDING DIVISION + APPLicATIONQrERMIT PING R OJECTEp11ANIFIC • 1345 BUILDING PIt(1,IRCP IUI?LPfIFIL'ATION BUILDING ADDRESS: SANITARY NO. APPLICADONSUBMITTALDAI it ao SaN1'A �RES� p2►u� (oln ''WNER'S NAME PHONE: CONTRS ORFFAMN$CM ?ER E 11C N PIRti:i gG R. G11B��S'r 8 aucN1t>>v p1 IT NIC NTROLa AIdCH1'1'ECI'ANKHNEER: LIC NO: ADDEE'S ❑ 1 95 E.SMN + O ISSAPJE 4'fi �"Gtl. CONTACT: PHONE: ' BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(initial) PLDG ELECT PLUMB MECH LICENSED CONT'RACTOR'S DECLARATION 1j ❑ � ❑ I herebyaffirm that l am licensed under ns of Chapter 9(commenting QTY ELECFRIC PERMIT FITC• a prnlaio p _>' JOB DESCRII''1'ION aZ with Section 7(xxpofnivkion 3of1he Basin-laud Prom,A... Code,andmyliearsa,, RESIDFNTIAL: 00 in full force and effect [I SFDWL [D Ki FCHF�REMODEL 1'IE(MI'1'ISSIIANCE aVV Date Class Contractor APPLIANCIS-RESIDENTIAL, []ADDITION [I PLUMBING RE-PIPIT �<a Date—Cono-a<tnr ARCHITECTS DECLARATION ❑MULT.UNIT ❑STRUCTURAL I TAN rn N�:l.� ZOy7, lundvmmnd my plm,s shall he used as public records MODIFICATION OZ-0 UP TO 200 AMUS ❑INTER[OR ❑CHIMNf;Y REPAIR 1:..N..F.a L.iccmed Pndesxional 201-1000AMPS IMPROVEYIENT C]SWIMMING POOLS �.y OWNER-BUILDER DECLARATION - OVER IOOn AMPS BATH RIiMODI'.l YNR DH LI'T'TON KK 1 herchy affim,that 1 am exempt from the Contralor's Liwme'Luw for If;. 'f"� X O a V following reason.(Section 7031.5,Rosiness and Prefassiom Code:Any city u..county SIGNS ELECTRICAL ❑OTHER sel3 O I~ which requires a panni,num ,consm ,amol ger.improve,deish,or le-i,any aromatic�.�+y� prior to its N%ace,also rcgthrestheapplicant fasuch perm)'v.:...osignetl amtenmm SPECIAL CIHCUITIMISC. an �} that hell lirensed pursuanIto the provisions of lh.r.,•.h ,mils License Law(ChaPter9 ul�a0 (commencing with Semon 7mOpa Ui mond, o.Rusin,., nd Pmfa,siurs C,de)nr 'TEMP.METflR OR PoLIi INS'1'. COMMERCIAL' C,D.an C that he is exempt therefrom and the basis for the alleged evamption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION Wray Salina 7131.5 by any applicant for a permit subjects the applicant hs a civil penaltyof POWER DEVICES nm more Orn risehunthcA dollam f&500h ❑TENANT [I FOOD S17RVICE ZGIMPROVI?MF.N'I' Las ownor of the Pmpeny,or my en,ployces with wage un their sole cnmpcnsvtinn, SWIMMING POOL W.ECHtIC will do the work,and the ewcmre is nam imended oroHered for sale(See 7(H4,Best.,,W ❑OTHER and Professions Code:'[be Con,racmr's License Law does not apply tit an miner of OUTLETS-SWITCHES-FIXTURES pmpcny who h tilds....,proves thereon,and who does such work hitmelf or through his own empinyecs,pmvidwl that,such impmvcnwnts arc not intended nr offered for NI?W RESIDENIf[At,EI'liC'B SQ FI', sale.lf,howcver.the building or improvement is sold within one year ofeempletinq the FLOOR AREA VSQ.ET. owner builder will have the burden of moving that he did not(wild or improve for pnr- pose of yule,). [-1L as own,,or that pmpcny,ma cxdusively cialow ing with limus"I a,mramn o-, 'r0'rN.: .k O j(�QR1 omtmn,he pmjem(Sea.70G.Ravines,and Pmfenlons Cale:)The Commcmr'v Li- cense Taw dross not apply On an owner ofpmpny who builds or improves duration.and QTY. PLUMBING PERMIT Fli. ;l who contracts for such pntjems w an a anntrartm(a)licensed rumaout to the Contractor's License Law. GILT r -Vurrn ` :II I am exempt under Sea. ,B&P C fmthis reason I'IiNMIT ISSUANCE ALTER-DRAIN&VENT'-WATER(EA) VALUATION finer Date WORKER'S C(IMI'FNSMION DECLAIN'I'ION BACK-FLOW I'RGTEC'I',DEVICE I hereby affirm under penalty of perjuryone of thc following decluntiuns: !, I have and will maintain a Cenifcam of Conwatto self-insure mTWaea`%Camper' DRAINS-FLOOR.ROOK AR G,GOND. STORIES TY PE CONS FRUCTI� Salton,as provided for by Section 3701 of the Labor Cale,fill the perronnave of the work for which this Peanut is isu,ad, I:IXTURES-PER TRAP ❑1 have and will nrai not n Worker's Compensation Insurunoq as meyulrul by Semlon 3700 of the labor Calk.(or the perlimnmea of the work far whieh rbis permit is issued. GAS-EA.SYSTEM-I INC.4 OUT..FTS OCC GROUP APN My Workers Compemmi, lnsurmcc comer anA l'nli<y num�M1.l� ' Otrrier: !SrA e� JZQjU1n- Policy No.: n '�e79� 97 fins-EA.SVSTEM-(IVEk4(EA7 CERTIFICATE OP EXEMM(ON FROM WORKERS' COMPENSATION INSURANCE GREASE➢INUUSTRL WASTE INTERCEPTOR BUILDING DIVISION FEES (This genion head nm be,completed ifthe permit is faane hundred dollars(SIW) GREASETRAP -- — or IeasJ PLANCHIiCK FEE I certify than intbcpertonnaoccar the work for whlchlhia permit lx Issued..shall SEWER-SANITARY-S ORM PA.2nd FI'. no,employ any person in any manner so as to become subject In the Workers Compen- ENERGY FEE 0 Z nation Lows of California.Dam WATER HEATER WIVENT(ELEC1'R GRADING IEE z C) Applicant I NOTICE'I'0 APPLICANT:IL ahct ranking this Cialme tm of E,enuto n 0,you ahoolA WATER SYS'IEM/rRIiAIING a; become.ablect m the Worker,Compensation Ptnvieion ol'the labor Code,you nw5t SOILS Flit! W forthwith comply with,aOh pmvisiol,or his permit shall be deemed revoked. WATER SERVICE 0. Q L'ONSTRUC'I'ION LENDING AGENCY NEW RESIDENTIAL.FINE, SQ.Erg PAID U O Ihereby affirm(flan there is a condmnion lending agency for the lerrmmanecot 1)Oil p the work fill which this permit is kwiod(Sec.3017,Civ.C.) 0 F' Lender's Name4CV TOTAL: 0 d Imdur',Address TOTAL: BUILDING FEE 1 celllfy that I Love road this application and sfae. uththe abuse ialimnatim,Is � ti correct l agree to comply with an city and county ordinances and sham laws relating to QTY. MECHANICAL PERMIT FEE Llz building Onetrotien.and herebyamhodee repamiamvesadthis city menm,upon the SHISMIC FEE ahmwnn,emioncd pmpcny for iagmction pugwms. (We)ngree my:ue,m1nouily and keep hatndeas nhc City ofpe Curtino.,niton PERMIT ISSUANCE IiLECTRIC EIP lmhditics,judgnems.costs and expenses which may in any way acerae against said City ATTER OR ADD TO MECH. PLUMBING FE in m'n pmaroe of the gmming of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNI r(TO lg(HNI CFM) 'Cfi REOULATIpN ee MECHANICAL t L AIR HANDLING UNIT(OVER I(I,IIW CPM) CONSTRUC'PION TAX Signamrc of ApplicvnOCommcmr Dare EXHAUST HOOD(WIDUC) HOUSING MITIGATION FEE V I INARDOUS MATERIALS DISCLOSURE Will the applicanto,boom bandit,maupmn vmc or handle hmadmu material HEATING[IN]'1'(1'0 I 10.000 RTU) �r m defined by the Cupcninu Municipal Cock,Chapter 9.12,and the Health and Safety _ Code,Sectio 25532(a)'t HEATING UNIT(OVER IIpA00IfTO) ❑Yes I Nn VFN'II LAI ION FANS INGLE RUS lip PAID -- Dam Receiptp Will the aim alum infurore building by the use equipment or devices which Onit air nm,atninanumdcfined'by the Bay Arca Air Quality Management ❑OILER-CDMY(lHl'Ok I00,00 HTL) '1'OTA L: Ulstrim1 E]Y" BOILER-COMP(OV IIR IIIft 111 GO IRNu I have most the haevdouus maerids,equi¢norms under Chapter 6.95 of the Cali- AIR CONDI r10NER ISSUANCE.DATE homis Health&Safety Cale,Section 25505,25533 and 25534.1 understand that if the NEW RESIDENTIAL.MECIL SQ,TO. battifialtdoa,nia currently haven out,that itoolym, sibility to noddy the navpam of 'migairemenrc which most hemen prior to Emance of a Cenificamof Occupancy. ( nrUr uuthnrixd agent Date TOTAL ISSUED BY: OFFICE __ __ WOOD DESTROYING PESTS AND ORGANISMS INSPECTION REPORT This Is an Inspection report only-not a Notice of Completion. ADDRESS OF PROPERTY INSPECTED . '.DING NO. TSTREET `� CITU21P COUNTY DATEOF NUMBER OF" CODINSPECTION PAOE811190, ANTA TERESA DRIVE CUPERTINO 95014 43 02/17/98 5 Affix stamp here on Board copy only J.H. STEFFENSON TERMITE CO. A LICENSED PEST CONTROL 195 E. Sunnyosk3 AVe. OPERATOR IS AN EXPERT IN Campbell, CA 95008 HIS FIELD. ,ANY QUESTIONS Campbell, CRELATIVE TO THIS REPORT I 45 SHOULD BE REFERRED TO HIM. REGISTRATION N PR0386 REPORT« 008017 BM STAMP 0907383V ESCROW« Ordered by: SUSAN SULLINGER * COLDWELL, 12029 SARATOGA/SUNNYVALE ROAD, SARATOGA CA 95070 Report Sent to: Propertyowner: MR. GILBERT BROUGHTON, 11190 SANTA TERESA DRIVE, CUPERTIONO, CA 95014 Perry In Interest: ORIGINAL REPORT LIMITED REPORT[] SUPPLEMENTAL REPORT* REINSPECTION REPORT❑* *ORIGINAL. STAMPp DATE I N F S 0 F 0 D E F C E S N O U U R U T A A A EX H - General Description: 1 FAMILY 1 STORY STUCCO & WOOD A T R e Y N H M R U L C o C T T W G E P T L L E W FRAME DWELLING c I H E O U R W H T u S E E N E R 0 S 0 Y L S R S S R R D W O W 0 1 S P A 0 0 D O a S V L I E 1 N T R O O R E E E B C N E E D T D A A L T S A R D E D D M K E E P N M R P R C E E O S oection Tags Posted: GARAGE a D E T I Y s M N L e s R T E E R T T T E I T E IR S O S E A V S U Other Inspection Taps: A 0 M T S C E R S N 1 T L E T 8 E S 1. SUBSTRUCTURE AREA lA THRU 1F X X X X _-XL X _ 2. STALL SHOWER 2A 2B X ' X 3. FOUNDATIONS 4. PORCHES...STEPS S. VENTILATION 6. ABUTMENTS 7. ATTIC SPACES S. GARAGES BA - -- _---_------ X -- --- -_ 9. DECKS... PATIOS 9A ___ X _ X 10. OTHER...INTERIOR 10A THRU l OE _ 11. OTHER...EXTERIOR 11A 11B X X X DIAGRAM AND EXPLANATION OF FINDINGS his report Is limited to structure or structures shown on dla ram 11A 11B D 11BFPATIO I 9A A 1F 9A 9A 11A G 1C 1C 1C R A lA 1D M (;fA) 10B 1F 1B 1F N 0 T OD10A IOC T 10D MAR 10 1998 S 1G,INSPECTION D A YOF EPARI'ItkNT CUPERTINO E FRONT 0 pocted by Benny Myers License No.642-3 Signature You are entitled to obtain copies of all reports and completion notices on this property filed with the boardng the procedi o years upon payment of a$2.00 search fee to:The Structural Post Control Board,1422 Howe Avenue,Suite 3,Sacramento,Ce ornia 95825-326 NOTE:Questions or problems concering the above report should be directed to the manager of this company. Unresolved questions or problems with services performed may be directed to the Structural Pest Control Board at(213)897-7838,(415)557-9114,or(916)263-2533. ADDRESS OF PERTY WECTED 11190 SANTA TERESA DRIVE CUPERTINO BUILDING NO. STREET CITY 0907383V 02/17/98 008017 BM STAMP NO. DATE OF INSPECTION CO. REPORT NO. NOTE: If requested by the person ordering this report, a re-inspection of the structure will be performed. This request must be with in four months of the date of this inspection and there will be a re-inspection fee, Of $95. 00. Any further inspections or re-inspections must be paid at the time they are performed. ------------------------------AREAS NOT INSPECTED--------------------- The interior of hollow walls, and areas beneath and behind built in cabinets were not inspected since inspection of these areas is considered impractical. We did not water test plumbing over finished ceilings,roof coverings, or decks. Such actions were not performed because they are considered impractical without specific written authorization. We make no guarantee against infestations leaks or adverse conditions which may exist in such areas not inspected. No furniture or appliances were moved so no statements can be made regarding these areas. Further inspection of these areas will be made on request. ' The carpeting makes inspection of the flooring in these areas j impracticable. Further inspection of these areas will be made upon request. We are not responsible for floors or floor covering under carpets. J.H. STEFFENSON TERMITE & PEST CONTROL INC. does not move appliances or re-install after floor work is completed. The plumbing was inspected and only the leaks outlined in our report were found at this time. We assume no responsibility for leaks that occur after the date of this inspection. J.H. STEFFENSON TERMITE & PEST CONTROL INC. GUARANTEES ALT, REPAIR WORK COMPLETED BY THIS COMPANY FOR ONE YEAR FROM DATE OF COMPLETION EXCEPT FOR PLUMBING,GROUTING,CAULKING AND RE-SETTING OF TOILETS, WHICH WILL BE GUARANTEED FOR 30 DAYS. WE ASSUME NO RESPONSIBILITY FOR REPAIR WORK COMPLETED BY OTHERS. J.H. STEFFENSON TERMITE DOES NOT RE-TEXTURE, WALLPAPER OR PAINT ANY AREAS THAT WE HAVE MADE REPAIRS. NOTE: This inspection is to disclose actual infestations, infections, and conditions that are conductive to lead to infestation or infection. This is not a structural inspection. If any information concerning the electrical, heating, foundation, plumbing, roof covering and any other conditions beyond the scope of a termite inspection is desired the appropriate inspecting firm should be consulted. NOTE: We make no guarantee on work performed by others. Any guarantees desired should be secured from persons performing this work. NOTE: CAUTION - PESTICIDES ARE TOXIC CHEMICALS. STRUCTURAL PEST CONTROL OPERATORS ARE LICENSED 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 EVIRONMENTAL PROTECTION AGENCY. REGISTRATION IS GRANTED WHEN THE STATE FINDS THAT BASED ON EXISTING SCIENTIFIC EVIDENCE THERE ARE NO APPRECIABLE RISKS. IF PROPER CONDITIONS ARE FOLLOWED OR THAT THE RISKS ARE OUTWEIGHED BY THE BENEFITS. THE DEGREE OF RISK DEPENDS UPON THE DEGREE OF EXPOSURE SO EXPOSURE SHOULD BE MINIMIZED. IF WITHIN 24 HOURS FOLLOWING APPLICATION YOU EXPERIENCE SYMPTOMS SIMILAR TO COMMON SEASONAL ILLNESSES COMPARABLE TO THE FLU; CONTACT YOUR PHYSICIAN OR POISON CONTROL CENTER ' 408/299/5112 AND YOUR PEST CONTROL OPERATOR IMMEDIATELY. FOR FURTHER INFORMATION THE COUNTY HEALTH DEPARTMENT 408/299-5955. FOR APPLICATION INFORMATION, THE COUNTY AGRICULTURE COMMISSIONER Page 2 of 5 ADDRESS OF _ OPERTY PECTED 11190 SANTA TERESA DRIVE CUPERTINO BUILDING NO. STREET CITY 0907383V 02/17/98 008017 BM STAMP NO. DATE OF INSPECTION CO. REPORT NO. 408-299-2171, AND FOR REGULATORY INFORMATION, THE STRUCTURAL PEST CONTROL BOARD 1-916-263-2533 , 1422 HOWE AVENUE, SUITE 3 . SACRAM NOTE: ADEQUATE PRECAUTIONS WILL BE TAKEN TO SEE THAT NO OCCUPANT WILL BE EXPOSED TO HAZARDOUS LEVELS OF THESE PESTICIDES. IF YOU FEEL THAT YOU HAVE BEEN EXPOSED AND ARE EXPERIENCING THE ABOVE SYMPTOMS PLEASE CONTACT YOUR PEST CONTROL OPERATOR AND THE POISON CONTROL CENTER IMMEDIATELY. WHEN PERFORMING THE ITEMS OUTLINED. BELOW WE PROPOSE TO USE THE FOLLOWING CHEMICALS. VIKANE & CHLOROPICRIN TRIBUTE Active ingredients: Cyano (3-phenoxypheny Dmethyl 4-chloro-alpha-(lmethylethyl) benzencacctate. TIM-BOR 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 RECOML%.ENDATIONS' TO INSPECT AREAS WHICH DURING THE ORIGINAL INSPECTION DID NOT ALLOW THE INSPECTOR ACCESS TO COMPLETING HIS INSPECTION AND CANNOT BE DEFINED AS SECTION I OR SECTION II . NOTE: The Structural Pest Control board has issued guidelines that water damage is not to be considered Section I unless there is visible fungus. It should be noted that in most cases water damaged floors contain fungus that is concealed. For this reason we strongly recommend that the buyer have the further inspection performed as outline in this report. 1B. FINDING: Minor debris was found on the subarea soil. RECOMMENDATION: Remove and dispose of all debris of a size that can be raked or larger. THIS IS A SECTION II ITEM. 1C. FINDING: Evidence of subterranean termites were found to be coming from the soil under the rear patio and patio room as indicated. • RECOMMENDATION: Drill a series of holes and pressure inject the soil with a registered chemical. THIS IS A SECTION I ITEM. (Chemical to be used is Tribute) . Page 3 of 5 ADDRESS OF - CRTY TED 11190 SANTA TERESA DRIVE CUPERTINO , BUILDING NO. STREET CITY 0907383V 02/17/98 008017 BM STAMP NO. DATE OF INSPECTION CO. REPORT NO. 1D. FINDING: Several infestations of drywood termites were noted in the subarea and patio room. RECOMMENDATION: Fumigate the entire structure with a lethal gas. NOTE: The building must be vacant during this procedure. THIS IS A SECTION I ITEM. THE CHEMICAL TO BE USED IS ( SULFURYL FLUORIDE ) TRADE NAME VIKANE. 1E. FINDING: Drywood termite pellets were found as outlined in Items 1D. RECOMMENDATION: Mask over or remove pellets as necessary to correct this condition. THIS IS A SECTION I ITEM. 1F. ) FINDING: Portion of the subarea was noted to have standing water. %RECOMMENDATION: Any person concern with this condition is advised to have a proper tradesperson check and make any revision deemed necessary to correct this condition. THIS IS AN UNKNOWN FURTHER INSPECTION ITEM PALL SHOWER 2A. FINDING: The standard water test reveals that the shower is leaking causing a fungus infection. RECOMMENDATION: Completely remove the base and wall tile. Install a new shower pan and re-install ceramic tile to correct this condition. NOTE: If any structure damage is discovered during the process of repairing the shower a supplemental report and bid will be issued. SECTION I ITEM. 2B. ) FINDING: The shower enclosure may need to be replaced if it cannot be reused. RECOMMENDATION: Install new enclosures. THIS IS A SECTION II ITEM . (8) GARAGES 8A. FINDING: The garage door jambs were found to be damaged by fungus. RECOMMENDATION: Remove and replace the damaged wood to correct this condition. THIS IS A SECTION I ITEM. (9) DECKS. . .PATIOS 9A. ) FINDING: Earthwood contact and subterranean termite infestation was noted at the wood screeds. RECOMMENDATION: Remove wood screeds and fill voids with concrete to correct. THIS IS A SECTION I ITEM (10) OTHER. . . INTERIOR 10A. FINDING: The floor covering in the hallbath was found to be water damaged. This is caused by splashover from the bathtub. Evidence of fungus infection was observed. RECOMMENDATION: Remove and replace all damaged underlayment. Chemical treat adjacent area to retard fungi activity. Install new linoleum based on $8 . 00 a yard material and reset the toilet on a new wax ring gasket. Toilet reset is guaranteed for 30 days. NOTE: If the subfloor is found to be damaged after removal of the underlayment a supplemental report and bid will be issued. THIS IS A SECTION I ITEM • 10B. FINDING:. The floor covering in the masterbath was found to be damaged by water leaking from the shower enclosure. Evidence of fungus was observed. Page 4 of 5 ADDRESS OF IWOPERTY PECTED 11190 SANTA TERESA DRIVE CUPERTINO BUILDING NO. STREET CITY 0907383V 02/17/98 008017 BM STAMP NO. DATE OF INSPECTION CO. REPORT NO. RECOMMENDATION: Remove and replace all damaged underlayment. Chemical treat adjacent area to retard fungi activity. Install new linoleum based on $8 . 00 a yard material and reset toilet on a new wax ring gasket. Which will be guaranteed for 30 days. NOTE: If the subfloor is found to be damaged after removal of the underlayment a supplemental report and bid will be issued. THIS IS A SECTION I ITEM. 10C. FINDING: The grout in the hallbath bathtub tile is loose and missing RECOMMENDATION: Regrout this area to correct. THIS IS A SECTION II 10D. FINDING: Swelling was noted to laundry bath floor at toilet. RECOMMENDATION: Remove toilet to allow for further inspection. Any findings, recommendations, and bids if any will be issued , in a supplemental report. THIS IS A UNKNOWN FURTHER INSPECTION ITEM ' 1.0E. FINDING: Water stains are evident front bedroom. This could indicate leakage through the roof covering. RECOMMENDATION: The owner should have someone in this line of work check and repair the roof covering as necessary. SECTION II ITEM. (11) OTHER. . .EXTERIOR 11A. FINDING: Fungus and drywood termite damage was noted at patio room posts. RECOMMENDATION: Remove and replace damage wood at this area to correct. THIS IS A SECTION I ITEM 11B. FINDING: Earthwood contact was noted at patio room posts with fungus infection. RECOMMENDATION: Install concrete base to correct. THIS IS A SECTION I ITEM • Page 5 of 5