21867 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
(' a Building Project Identification - PERMIT NO.
mild Ing Addm,a: a/ ^ 21867
7`I O a
one: /LDALL
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CITY OF CUPERTINO-BUILDING DIVISION —y';7 1
Contractor's Name: Llc,Nu APPLICATION I PERMIT ((((
• 3ce' M /ltm BUILDING MFICTRICA4PLUMBINGMECHAMCAL CATEGORY CONTROL M
Architect/Engineer. Lie No:
QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO
Address:
lL . CONTRACTOR'SDECLARATION
PERMTISSUANCE
l hmthatIa Bcmunder rosl e Chapter9 APPLIANCSRESIDENRTAL
Inth5mi..70DO).fDiv3.ftheBusiendProfml=sCade,"dmy ❑ JOB DESCRIPTION
DESCRIPTION
iceeosel.in ddfect' PAF (1Licen C LICM TiN/
.`l❑fV^.l
Dai a Contractorf —UP TO 2DO ANTS
ARCH ITF.CTS DECLARA ON XII-IODOAMPS
O ZO I understand my plane shall be used as public records. OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT.
Ft Licensed Proftnalmul SIGNS ELECTRICAL
<6 OWNER-BUILDER DECLARATION
�n a exempt SPECIALCIRCI)IT/MIST
02 owing mason.asorm Sectiom31.5,Bfromthe essad Professions
Llrenw Law fart he
qQ (.Ilowingichmq imsape Otto. mtmoand Professionse=lishnycity or
� 1"'u{ countywhich rcquircaa permit tocorutmct,alleq lmprove,dennlbh,.rrepalr TEMP.METER OR POLE INST.
4 7 anystructure pdorto it.Issuance,also requlreatheappilmot forsuch permute POWER DEVICES
000,
file a signed statement that he b licensed pursuant In the provisions of the
Ow Contractors License Law(Chapter9(eumrnencingwlth Section 7000)of Divi- VALUATION
1n SWIMMING POOL ELECTRIC
slon3 of the Business and professions Code)or that he Is exempt therefrom and
O x the basis for the alleged exemption. Any violation of Section 7031.5 by any
OUTLEISS W I'PC){FSFI%TUIiES
applicantfore perMtsubjMsthe applicant toe civil penalty of no marc than � s
$ five .aired dollars($500). NEW RESIDENTIAL ELECTRSQ.IR. STORIES TYPE CONSTRUCTION
L1,as owner of the property,or my employees with wages as their sole
compensation,will do the work and the structure is not Intended or offered for
qsale(Sec.7094 Businea and Pra(emions Code:The Contractors License Law
doesnotapply toan owner of propertywha Wild.orlmprovesthereon,and OCC.GROUP RFS.UNITS
whodaee such work hlmeel(or through his own employees,provided that such
Improvtmenb are not Intended oroff.md!.rule.If,however,thebuilding or TOTAL:
improvement bsold wlthinoneycarofcomplatlan,the mvner-builderwili have
ltlrjerrden of proving that he did not Wild or Improve for purpose of sale.). (M. PLUMBING PERMIT FEE
L� PI.aDDwn�E APN
1,as mucor of the property,am exclusively44,Busi contracting with limned PERMIT ISSUANCE
The Co tra to construct the project(See 7614,Business and Professions property
Co who
The Caor Impr*ffoves
es the Taw does not apply to an owner of property with
a ALTER-DRAIN k VENT-WATER(EA)
a Ilia t r Improvaa thereon,and who contracts ice such w.ojecta with a
co,p(Tactmexe plundermand ant Sm
the ContractorsLlcen¢Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY
UP FEES LI1 am exempt under Soo B k P C for this reasonOUTSI
DRAINS FLOOR ROOF,AREA,ODND. SANITARY Y N
Owner Date RECEIPT Ns
WORmthe,BMAN COMPENSATION DECLARATION FI%7l1RFS]'FR TRAP SCIi00L TA% Y N
❑I hereby ffi.rk ret that)have a legamee of.castor d self-insure,theurc,ora RECEIPT 0
certl0cate o(W/o�rken'Compevauon ln/s�uranm.racertlfled copy rhemo(6ec. GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE Y N
RECEIPT s
1'oliry M GAS EA.SYSTEM-OVER 4(EA)
Com any_Cf} � .195 BUILDING DIVISION FEES
�Certlfled mpybhercby(urnlehed. GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE
�CertRietl copy b(fled with the city Ivpectian division.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.MITE Dale Recti t#
(Thlssection need not be completed lithe Permit is forum hundred dollars
($l W)or lost.) WATER HEATER W/VENT/ELPCTR ENERGY FEE Y N
I camlythat in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the WATER SYSTEM/TREATING
Workers'Compen..Ban Lawsof California.Data PAID
ZZ Applicant NEW RESIDENTIAL PLMB._SQ.IrF. Date ReceI tN
O NOTICE TO P�'PLICANT:If,afterrwking this Certiflale of Exemption,you
should become subject to the Workers'Compensation provisions of the Labor TOTAL:
CCN Code,you=at forthwith comply with such provlai..or this Permit shall be BUILDING 'E 'VV
W > deemed revoked.
aCy CONSTRUCTION LENDING AGENCY SEISMIC FEE
Ihembyaf'fi that there is a construction lending agency for the perform- ELECTRIC FEE
0 once of the wmkfor which this permit is issued(Sec.3097,Civ.C.) TOTAL
Lenders No PLUMBING FEE
LL H Lendee.Addrees QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW lomifythatl have read this appllcationand sbtethatlheaboveinformation
IL iscorrect.I agree to comply with all city and cos my ordinances and state laws PERMIT ISSUANCE FEES PAID:
>. N relating to building mmtruction,and hereby authorlu representatives of this
(— city to enter u Pon the above-mentioned property for inspection purpose. ALTER OR ADD TO MOCK
U)
_ (We)agree to save,Indemnify an d keep harmiess the City of Cupertino Date Recei tM
against liabilities,jidgments,mate and expenses which may In anywayacaue AIR HANDLING UNIT CFO 70,000 CFM) SUBTOTAL:
against said City in consequence of the granting of this permit.
AIR HANDLING UNIT(OVER I0,000CFM) CONSTRUCTION TAX
Sigmture of Appilcant/Contractor Data IXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HA3A R DOUS MATERIALS DISCLOSURE
Willtheapplim of or future building occu pant store or he nd to hazardous HEATING UNIT(TO I 0O,000 BTUI Date RCCeI tM
mateplaI as defined by the Cupertino Municipal Code,Chapter 9.1 3,and the
Health and Safety Cod,Section 25532(a)? HEATING UNIT(OVER 100,"BTW TOTAL:`
❑Yes No
Will theappliosm or tum building...plot useequlprorm or devices VENTILATION FAN(SINGLE REED) EAWNCE DATE
which emit hamrdous aircontaMmntea,de0ned bythe Bay Area Air
Quality Management District? BOILER-COMPQHPOR 100,0(IO BTU) �eP 1991
4 Yet No L 9,6
have read the bazar ou..tcriaisrequim"ntsunderChapter6.95of BOILER-COMP(OVER100,000 BTU)
t the Californbllmlthh Safety Code,Sedi.n,35505,25533and35534.1
understand that l(lhe building does not comently have a tenant,that it is my NEW RESIDENTIAL ME.CIL S'Q.F (�P1I rttp
r6ponaibility to fy the occupaolo(Ihe ulrcmenb Ich must be mM - "`-'.
prior toIrl
C, eCe etc Ottvp
01er or authorized ent ata
TOTAL: ISSUED /LG�t
OFFICE COPY
e r
!� STANDARD STRUCTURAL PEST CONTROL INSPECTION REPORT
(WOOD•DESTROYINC PESTS OR ORGANISMS)
This is an inspection report - not a Notice of Completion.
ADDRESS OF BLDG. NO. STREET CITY Cupertino
PROPERTY
;. 95014 DATE OF IN PECTION
INSPECTED 7990 Woodlark Way CD. CODE 43 01
FIRM NAME AND ADDRESS Affix stamp here on Board copy only
• +, J & M TERMITE CONTROL, Inc. A LICENSED PEST CONTROL
159 N. Whisman OPERATOR IS AN EXPERT IN
Mountaiin View, CA 94043 HiS FiELD. ANY QUESTIONS
y.: Phone: (415) 969.5556 RELATIVE TO THIS REPORT
FIRM LICENSE NO. OA7990 CO. REPORT NO. 5367A STAMP NO. 028325R SHOULD BE REFERRED TO HIM.
s
,r.,inspection Ordered by (Name and Address)Seville Properties 161 S. San Antonio Road A2 Los Altos CA 94022 Dolores Shaw
. Report Sent to (Name and Address) First American Guaranty 161 S San Antonio Road 84 Los Altos CA 94022 Irma
.Owner's Name and Address .lerard Lawless 7948 McClellan B2 Cupertino CA 95014
' Nage and Address of a Party in interest
Orlglnal Report Fxj Supplemental Report O Limited Report Reinspection Report Ej No. of Pages,4
YE ODE I SEE DIAGRAM BELOW YES CODE SEE DIAGRAM BELOW I YES CODE I SEE DIAGRAM BELOW IYESI CODE I SEE DIAGRAM BELOW
S-Subterranean Termites B-Beetles-Other Wood Pests I IZ-Dampwood Termites I A2LIEM-Excessive Moisture Condition
K-Dry-Wood Termites FG-Faulty Grade Levels SL-Shower Leaks I IIA-Inaccessible Areas
F-Funaus or Dry Rot EC-Earth-wood Contacts CD-Cellulose Debris I XXIFI-Further Inspection Recon.
1. SUBSTRUCTURE AREA (soil conditions accessibility etc. ) Dry. Seel-3
2. Was Stall Shower water tested? Y-1 Did floor coverings indicate leaks? See4
3. FOUNDATIONS (Type Relation to Grade etc . ) Concrete See5
Sri=. . . STEPS. . . PATIOS Concrete
TION (Amount . Relation to Grade etc . ) Mesh/adeguate
6. ABUTMENTS Stucco walls columns arches etc None
7. ATTIC SPACES (accessibility, insulation etc, ) See6
8. GARAGES (Type. accessibility, etc. ) See7 8
9. OTHER S"ee9
DIAGRAM AND EXPLANATIONor t:INI)INGS (This report is limited to structure or structures shown on diagram.) -
General Description One story residence - stucco exterior - composition shingle
roof, Inspection Tag Posted .(location) garage
Other Inspection Tags _None noted.
SEE ATTACHED DISCLAIMER and GUARANTEE
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u glaads pu< ue,d s,ql to ?u+dwels aql EM/F11 FGF—&
-ouq,adn3 In Alto "lda0 Hwp,inq oqi a—� EM/F ((
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,w,ile alie to sa?uega hue a5 ew o) In}Mei K T
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331,1HNIO80 .ONV 53003 ON1183dnO • • • • • • • • I D
n. v1 A1:;: 3N1 i ! MI 30NV08000V NI FEB G ec
f:60161991
ALDG. INSPECTION DEPARTMEML
������ COPY CITY, 0&(3(D��q�
inspected by__J1,t0 Darling License No. R9729 Signature } 5•",
vl
YOU ARE ENTITLED TO OBTAIN COPIES OF ALL REPORTS AND COMPLETION NOTICES ON THIS PROPERTY FJLED WITH THE BOARD DURING THE PRE-
CEDING T110 YEARS,UPON PAYMENT OFA =2.00 SEARCH FEE TO STRUCTURAL PEST CONTROL BOARD. 142l�,[OWE AVE, M3 SACRAMENTO, CA. 95825.
2nd PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
cawr
{ :• 7990 Woodlark Wuy Cupertino
BLDG. NO. STREET CITY
02832SR 01/19/1991 5367A
STAMP NO. DATE OF INSPECTION CO. REPORT NO.
Y
fi«
y THIS INSPECTION IS LIMITED TO ACCESSIBLE AREAS ONLY AND DOES NOT INCLUDE
INACCESSIBLE AREAS SUCH AS INTERIOR OF HOLLOW WALLS, ROOF SOFFITS, AREAS
i , BENEATH FLOOR COVERINGS, AREAS BENEATH OR BEHIND APPLIANCES, FURNITURE OR
Vis+ PERSONAL BELONGINGS, ETC. FURNITURE AND OTHER PERSONAL BELONGINGS (IF
Y PRESENT) NORMALLY WILL NOT BE MOVED FOR INSPECTION PURPOSES. ALSO, NO
PROBING OF FINISHED MATERIAIAS WILL BE DONE.AS DEFACING MAYRESULT. WE DO NOT
INSPECT ROOF COVERINGS AS WE DO NOT FEEL QUALIFIED TO MAKE SUCH INSPECTIONS.
INTERESTED PARTIES ARE ADVISED TO CONSULT A LICENSED ROOFER FOR FCOF
h INSPECTION WHETHER RECCIDATIONS AND/OR NOTATIONS CONCERNING THE ROOF ARE
MADE ELSEWHERE IN THIS REPORT.
IF ADDITIONAL DAMAGE OR INFESTATIONS ARE FOUND DURING THE COURSE OF ANY WORK
RECOMMENDED IN THIS REPORT, A SUPPLEMENTAL REPORT AND/OR ADDITIONAL ESTIMATE
WILL BE PROVIDED. NO ADDITIONAL WORK WILL BE COMMENCED WITHOUT
AUTHORIZATION. IF REQUESTED, WE WILL PERFORM A REINSPECTION OF ITEMS ON THIS
REPORT COMPLETED BY OTHERS AT A COST OF NO MORE THAN THE ORIGINAL.
;..•, INSPECTION. REQUEST FOR REINSPECTION MUST BE WITHIN FOUR MONTHS OF OUR
• ORIGINAL INSPECTION. J & M TERMITE CONTROL, INC. TO BE CONSULTED BEFORE
REPAIRS ARE DONE. J & M TERMITE CONTROL, INC. ASSUMES NO RESPONSIBILITY FOR
WORK PERFORMED BY OTHERS.
A SEPARATED REPORT HAS BEEN REQUESTED 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, INFECTIONS OR CONDITIONS THAT
HAVE RESULTED IN OR FROM INFESTATION OR INFECTION. SECTION II ITEMS ARS
CONDITIONS USUALLY DEEMED LIKELY TO LEAD TO INFESTATION OR INFECTION BUT
WHERE NO VISIBLE EVIDENCE OF SUCH WAS FOUND. FURTHER INSPECTION ITEMS ARE
DEFINED AS REC.'OMMEM- DATIONS TO INSPECTION AREA(S) WHICH DURING THE ORIGINAL
INSPECTION DID NOT ALLOW THE INSPECTOR ACCESS TO COMPLETE HIS INSPECTION AND
CANNOT BE DEFINED AS SECTION I OR SECTION II. NOTE: DUE TO (MANGES IN THE
STRUCTURAL PEST CONTROL ACT EFFECTIVE JULY 1969 WATER DAMAGE AND/OR LEAKAGE
MAY NOT BE CLASSIFIED UNDER SECTION I UNLESS THERE IS VISIBLE EVIDENCE OF AN
INFESTATION OF A WOOD- DESTROYING INSECT OR ORGANISM. PLEASE READ THIS
REPORT VERY CAREFULLY AS THERE MAY BE DAMAGE OR LEAKS WHICH ARE NOT THE
SELLERS' RESPONSIBILITY UNDER THE PEST CONPROL AGREEMENT OF YOUR REAL ESTATE
SALES CONTRACT.
THIS STRUCTURE WAS OCCUPIED AND FULLY FURNISHED AT THE TIME OF THIS
INSPECTION SOMEWHAT LIMITING OUR INSPECTION AS PERSONAL ITEMS ARE NOT
DISTURBED.
SUBSTRUCTURE:
1: Drywood termite droppings were found in this area. It appears that these
droppings have filtered out of previously infested wooden members as this
structure was fumigated for dzywood termites in the past. It is qur opinion
that this is not active evidence.
RECOMMEND: Cover or otherwise obscure drywood termite droppings for future
reference.
****** This is a Section 1 Item ******
• NOTE: The above statement is an opinion based on the evidence found at this
timer however, we assume no responsibility for possible active dxywood ter-
mite infestations anywhere in the stricture.
r - '
S,
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a
J &.M TERMITE CONTROL, Inc. --- License No. OA7990
PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
' • - 7990 Woodlark Way CuRertino
BLDG. NO. STREET CITY.
i 02832SR 01/I5/1991 5367A
STAMP NO. DATE OF INSPECTION CO. REPORT NO.
Item 2: Excessive moisture with fungus activity was found to sub-flooring beneath
master bath shower. This appears to be the result of leakage through mastic
set wall tiles of shower. water damage was also found to sheetrock adjacent
>:. shower curb in master bath.
aw
RECOMMEND: Tear out complete shower including molded shower pan - replace
>*, damaged wooden members as necessary - install new wallboard - replace drain -
' install a new three layer "hot mop" tar shaver pan and install new ceramic
• the set in mortar throughout this shower including floor and curb. Also,
"t install a new tampered glass shower door. Interested parties may have choice
v;: '';�• of tile color within our standard price range.
NOTE: We assume no responsibility for possible broken, loose or chipped
tiles and/or wallboard adjacent to area being repaired which may develop
< during this repair. Possible necessary paint and/or wallpaper repair to be
f' done by owner.
****** This is a Section 1 Itan ******
Item 3: Excessive moisture was found to sub-flooring beneath back wall area of hall
• bathtub. It appears moisture may be coming through walls over tub as there
is a shower head in tub, but no sheetrock wall protection (only one row of
the around top of tub) .
RECOMMEND: Open sheetrock wall in closet adjacent tub for further inspection
and file a supplemental report.
•***** Unknown Further Inspection Recommended ****+*
SHOWERS/FLOORS:
Item 4: Indications of water damage were found to underlayment beneath vinyl floor
covering in master bath adjacent shower. Fungus activity was found to
sub-flooring beneath this location. This condition appears to be the result
of condition noted in Item #2 and leakage through glass shower door.
RECOMMEND: Remove existing floor covering and underlayment throughout -
. replace minor damaged sub-flooring (if any) - install new underlayment and
standard grade vinyl throughout this bathroom and reset toilet.
NOTE: We assume no responsibility for possible concealed plumbing problems
which may not be evident until toilet is removed. Also, our repairs do rot
include internal toilet mechanisms. Price quoted for this item is based on
standard grade vinyl. Existing material may have cost more, however, we have
no means to determine replacement value at this time.
****** This is a Section 1 Iter ******
FOUNDATIONS:
Item 5: Faulty grade level was found to exist (garden soil is even with or above top
of foundation) .
RECOMMEND: Lower soil in this area using care to maintain proper drainage
• away from the wall to eliminate this condition.
****** This is a Section 2 Item ******
ATTIC:
Item 6s We inspected the attic as possible and found no evidence of adverse
conditions (unless noted elsewhere in this report) , however, insulation
material, debris from past roof repairs and/or limited clearance make this
attic somewhat inaccessible. We assume no responsibility for inaccessible
areas,
********* Informational Iter *********
' GARAGE:
Item 7: Interior of garage was inspected as possible, however, we consider this
garage approximately 80% inaccessible due to storage of personal items.
While no outward evidence of adverse conditions was found we assume no
responsibility for inaccessible areas.
********* Informational Item *********
J & M TERMITE CONTROL, Inc. --- License No. OA7990
f��
dth PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
;• 7990 Woodlark Way Cupertino
BLDG. NO., STREET CITY
02832SR 01/15/1991 5367A
STAMP NO. DATE OF INSPECTION CO. REPORT NO.
r
Item 8: Excessive moisture was noted to garage floor in area of water treater. It
appears this may be the result of leakage at corroded pipes noted in this
area and/or washing machine drain leakage.
RECOMMEND: Owners are advised to engage a plumbing firm concerning necessary
repairs.
This is a Section 2 Iter ******
OTHER:
Item 9: We noted rain gutters clogged with debris. This condition may cause water
i damage and/or fungus damage to wooden members.
RDCCMMEND: Owners are advised to clean gutters to eliminate this condition.
****** This is a Section 2 Iter ******
SECTION II: THE FOLEOWING ARE CONDITIONS USUALLY DEEMED LIKELY TO LEAD TO
# INFESTATIONS OR INFECTIONS BUT WHERE NONE ARE EVIDENT AT THIS TIME: ITEM(S)
r # 5,8 and 9.
• IF CERTIFICATION IS REQUESTED REPAIRS MUST BE AUTHORIZED WITHIN (120) DAYS
OF THIS INSPECTION AND THE FOLLOWING ITEMS) MUST BE COMPLETED: Items)
#1,2 and 4.
FURTHER INSPECTION(S) : Iters #3.
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J & M TERMITE CONTROL, Inc. --- License No. OA7990