82208-D-1988 Permit, PEAM�*«�MaEA ISSUEDBY oa,e BUILDING PERMIT . FOR BUILDING INSPECTION CALL 299-2351
u � " v � �� `'2�l� �� BUILD NG INSPECTION OFFICE MINIMUM 24 HOURS NOTICE
70 W. HEDDING ST., SAN JOSE, CA 95110 TEL. 289-2351
LAND DEVELOPMENT ENGINEERING & SURVEVING p(y
JOB ADDRESS: C�EAREO FOR ISSURNCE BV OATE /D�I�—O 8
��9 �� P�n►ae�RG.ns r /'f V�.� COUNTV GEOLOGIST INSPECTION RECORD
STREE NUMBER
��IN�p/� ���� T�O/uC 0.EFREDFORISSWNCEBY �rIIE LFOUN�ATION /
NEAREST GRO55 STREEI
VR G FORMS UFEP GFOUNDwG � � O
C�k�ER T/N O � ❑ COMPLETE PRIOR TO OCCUPANCV,FOR SPECTION CALL 299-2871 �.Foams
Pos,aFF� E«�,.� ��P a i5<
�} ! L9/-zy2.8 ❑ Ro �MP ��E.AEoa� oa.E
POIIP NO CONCPEtE UNTIL iHE ABOVE HAS BEEN SIGNEO
OWNER W� �.0 �• DAvir � P„o„E O OWT.TPPR. CLERflEDBV OATE 3.HERTING �
CLEAFEO BV �ATE OUCTS
MAILING �Q P N� RG.¢ST �V�� � a COOLNGT
ADOflESS
Crtv `N � T/Nd ZiP �O I pj 5.GIRDERS INSULFTION
TRANSPO TATION AGENCV uHoear�oor+
. PHONE GLERRED;OF ISSIIf�JCE BY_�i� DATE /���7�6" 6.R�OOG�H PLBG.
ARCHITEUT �x��yti, ��f�
OR
ervcweea nooaess ua Ho. ❑ COMPLETE IOR TO OCCUPANCY,F R WSPECTION CALL 299-2591 0o r�o*coveA Fiooas urvrn Tre neove Nns eeerv swNeo
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❑ R0.IMP. CLEAREO 0V DATE ��BON�BEAMS POOL BON�ING
LIC.NO. CLA55 � ICONG.BLK.� -
MAILING PHONE �WY.NPFR. CLEAREO BV �ATE
� A�ORE55 � B.ROUGH PLBG.
COMGLETE
9 SEWER
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IDGFS
SANR.DIST.NO. SEP TK PE R NO. FOR INSPEQION CALL PRESSUFE
lOT //J 9 iRACT /O PLAN CHEC$$$NO ^ t � ZJB'GOBO 11 ROUGH POOF
� � -�C1JJ C /� � /I �' 1 �.G FRAME FWES 1ENR OFF
BLCCK BPN. ../ •`� y��—"" ' � � CLEPflEDFOFI550A EBY R'fDATE /D—��^�� 12AOOGHELEC
VPE OF IMPROVEMENT WIRING SERVICE BONDING.
i BUIL� FEMOO A�0 TO REGNR MOVE GONVERT �EMOLISH p�EARED FOR OGCOPANCY BV P.S.OFTE 00 NOT INSULNTE UNTIL ABOVE HAS BEEN SIGNE�
50 FT ' ^f No.o� No.al
' sizE .�i— Z ^ �j�S FAMi��EsQ(v� s*or+ies wQ FIRE MARSHAL
PEPMR N�MBER USE OF ' . FOR INSPECTION CRLL
13JNSULATION µ�q�� CEILING
s*aucruae - 2993805
�� �ey � � �� `�� , �(�. iasHEEr �
U � �l CLEARED FOF ISSUNNCE BV DPTE /D—/"7 O AOCN
� 155TUCC0 WIRE
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PLANNING FiHa�ir�.w�esi
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SET FRONT SI�E FEAR ZONE 11GA5
� BACKS � I APPLINNCES
FEET Q
� VARIANCE OR OEV.REO.LOMG. 18 ELECTRICAL
13PEC.FEO. FlNAL Ifl.tures�
( AflCH.SRE FOR INSPEQION GPLL �9.BUI�DING
APPROVAL BY: .299_2454 co�.ia�E1E
, " /0����p p NO UTIIITIES WI�L 6E C�EAflEO UNTIL"BNLOING COMPLETE nA5 9EErv SIGNEO
Coumy Fila� CLEAREO FOR 65UANGE BY DATE
' soo s�nie Maa y �� c�enaeo roa occuvaucv ev onre , � , PERMIT EXPIRATION
NOiE TOTAL FEES E%GIU�E APPUGABLE ELELTFICAL.PLUMBING SEPTIC TANK FEE VAWATION TOTRL FEES ' �
� nr�oMECNnHicn�aEamrtFeEs. �Z � Z� G.". � s" PERMIT EXPIRES IF WORK
COMPLETE BACK OF FIRST PAGE piqE ,� `�,� . � . IS NOT STARTED WITHIN 180
aea�es io,�ew�a:o,,oi�s����s���iees oa�a m�s�ee maoe m ine n,om�mr��ai cvo.issunrvce Fee n/yo MAASNai � � n DAVS OF PERMIT ISSUANCE
lmgmconlo�mancewi��a�qlkableaeclionls�o11M5an�aClaraLounryONinanre �Q t ol�f-� P�aNCNecK � r y ',�y. OR 180 DAYS FROM LAST
CMe �
� Foarn a� ioias � �O °Ef""'� p �ry ;;Q �,y SIGNED INSPECTIUN.
` � � I O G G 4,�j �
3�/� �J a � G
THIS PERMIT SHALL EXPIRE BY LIMITATION AND BECOME NULL AND VOID IF WORK IS NOT COMMENCED WITHIN 180 DAYS. ` �
"REFUND: WHERE NO PORTION OF THE WORK OR CONSTRUCTION COVERED BY THIS PERMIT HAS BEEN COMMENCED BEFORE THE EXPIRATION DATE HEREOF, REQUESTS FOR
REFUNDS MUST BE MADE IN WRITtNG TO THE DIRECTOR OF THE BUIIDING INSPECTION OFFICE ON OR BEFORE ONE HUNDRED-EIGHTY (180) DAYS FROM THE DATE OF ISSUANCE
OF THIS PERMIT." < .`` ', .;` ;
GRADE LINES AS SHOWN ON DRAWING ACCOMPANYING THIS APPLICATION ARE ASSUMED TO BE CORRECT. IF ACTUAL GRADE LINES ARE NOT THE SAME AS SHOWN, REVISED ,
DRAWINGS SHOWING CORRECT GRADE LINES, CUTS AND FILLS, TOGETHER WITH COMPLETE DETAILS OF RETAINING WALLS AND WALL FOOTINGS REdUIRED, MUST BE RESUBMITTED -�
TO THIS OFFICE FOR APPROVAL.
WORKERS' COMPENSATION DECLARATION � � �
LICENSED CONTRACTORS DECLARATION
. : , . . • • '
I hereby affirm that I have a certificate of consent to self-insure, or a certificate of
I hereby affirm that I am licensed under provisions of Chapter 9 (Commencing with Worker's Compensation insurance, or a certified copy, thereof (Sec. 3800, Lab. C.). _ , . ,
Section 7000) of Division 3 of the Business and Professions Code, and my license is � ` . �"Polic�No: Company
in full force and effect. O Certified copyis'hereby furnished. '
License Class Lic. Number O Certified copy is filed with the county building inspection department or county
Date Contractor department.
OWNER-BUILDER DECLARATION Date Applicant
I hereby affirm that I am exempt from the Contractor's License Law for the following CERTIFICATE OF EXEMPTION FROM WORKERS'
reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires COMPENSATION INSURANCE
a permit to construct,alter,improve,demolish, or repair any structure,prior to its issuance, (This section need not be, completed,if theipermit is�for�one hundred dollars ($100)• , _
also requires the applicant for such permit to file a signed statement that he is licensed . . oc less:) ' � 1 I ', `�� .
pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with' � ' I certify�that in the performance of the work for which this permit is issued, I shall
. Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt not employ any person in any manner so as to become subject to the Worker's Compen- /
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by sation Laws of California. � ! . � � � � ,
any applicant for a permit subjects the applicant to a civil penalty of not more than 4.t`y �� -7,,���w .p �� �
five hundred dollars ($500).): Date Applicant /"/ d4
� I, as owner of the property,or my employees with wages as their sole compensation, NOTICE TO APPLICANT: If, after making this Certificafe'of Exemption;you should become • ' '
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Busi- subject to the Worker's Compensation provisions of the Labor Code, you must forthwith �
ness and Professions Code: The Contractor's License Law does not apply to an owner comply with such provisions or this permit shall�be�deemed�revoked. 1 � � , ' , . � .
of property who builds or improves thereon, and who does such work himself or through ' � • � • �.
his own employees, provided that such improvements are not intended or offered for CONSTRUCTION LENDING AGENCY.,,> �� � � �•-,,� ' � ,
sale. If, however, the building or improvement is sold within one year of completion, the ' �- I hereby affirm that there is a�constru ion ending agency for the performance of the
owner-builder will have the burden of proving that he did not build or improve for the work for which this permit is issued (S. . 0 7, Civ. C.).
purpose of saleJ. . — — JI
O I, as owner of the property, am exclusively contracting with licensed contractors Lender's Name �
to=constluot=the'project`(Sec:704'4-Business—and-Professions Code:'The Contractor's - - - I
License Law does not apply to an owner of property who builds or improves thereon,.�.; ,• Lender's-Address ,
and who contracts for such projects with contractor(s) licensed pursuant to the Contrac- � � �
tor's License Law.). I certify that I have read this applicati and state that the above information is correct. '. �
I� I am exempt under Sec. 703�, s , g, & p,C. for this reason w<<-L I agree to comply with all city and county ordinances and state laws relating to building
DO 4JORK M�lSta'C.F . construction,�andihereby authorize representatives of this coun[y to enter upon the
� p , �ab,oAvementioned�prop�eprty fo�r(1'n)spection purposes. .
Date / ' yi��� Owner �N�e�.nu�,e_, � x°. ��6�ts6. • ` ' � �"/ ' pl'•' !X �A.wi�.v 9�uI" f/�
- n a2...1:�t+�-
: . � ) 1 ; . �ure of Applicant�or Agent Date
, '
�
. .. . . . Y �. . F . � . . . . . _ .
�j
INSULATION CERTIFICATE
870 Savaker Ave.,San Jose,CA 95126
(408) 9983373
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONfORMANCE WITH
CURFENT ENERGY REGULATIONS, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE
OF CALIFORNIA, IN THE BUILDING LOCATED AT:
LOT x TRACT x
� STREET 18860 Pendergast Ave. ��Ty Cupertino
6XTERIOR WAILS:
MANUFACTURER THICKNESS/TYPE 3i,� VALUE 11 ,
� CEILINGS: Ui1f8CEd
BATTS;
R-
� MANUFACTURER THICKNESSlTVPE 6 �� VAWE 19
BLOWN IN; MINIMUM Unfaced R.
� MANUFACTURER THICKNESS VALUE
� S�UARE FOOTAGE COVERED NUMBER OF BAGS USED
F LOORS;
R-
MANUFACTURER THICKNESS/TYPE VALUE
SLAB ON GFADE: R-
NANUFACTURER THICKNESS/TVPE VALUE
,�WIDTH OFINSULATION INCHES
��FOUNDATION WALLS:
R-
� MANUFACTURER THICKNESS/TVPE VALUE
GENERALCONTRACTOR County Building 24aterials
CALIfORN1A CONTRACTOF75 LICENSE s
DATE
.� SIGNATURE TITLE
� INSULATION CONTRACTOR:AII AITI@fIC8f1 Insulation
�' CALIFORNIA�CONTRACTORS�LICENSENO.S4OO7Z DATE S�ZL�91
J
= , %��, _ �� ��, � Office Pianager
�SIGNATUFiE U � TITLE
1988-82208-00 BPermit 12/1/1988Issued
Inspection Data Sheet -
18860 Pendergast Ave., Cupertino, CA 95014Location
Cross Street
Contractor
Owner Davis M.L/ Self
Owner Phone
Residential Addition & Remodel 235/502'Job Desc
2Zone
Code Comments Date Insp Disposition
Geology Land Develop Planning Roads / Airports Environ Health Fire Marshal
Request
Called Date Insp Phone Code 1 2 3 4 5
Fees
Note
ST02 Approved5/18/89FOUNDATION FORM/REBAR
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