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CITY OF CUPERTINO
T1
BUILDING DIVISION PEIRMT
CON-TRACTOR 77 NFhh �i a'
BUILI?186J ESCONGRESS PL
ULTRATECH
DIVISION, THE
PERMIT N ®2090193
DwVATA 4N VELV I N R AND CASSANDRk
787 N KING
RD
APPLICAT9x_)3yET6FY 2 0 0 2
PHONE:
4 0 8 92 9— 5 62 1
SANITARY NO. CONTROL NO.
ARCH ITEC (ENGINEER:
BUILDING PERMR INFO
•
BLDG ELECT PLUMB
MECH
LICENSED CONTRACTOR'S DECLARATION
T hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Description
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
TERMITE
RE PA I Rlob
in full force and effect.
REMOVE
EXTERIOR PLASTER TO
License Class Lic. #
Date Contractor
TREAT
TERMITE INFESTATION
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License law (Chapter 9
Sq. Ft. Floor Area
$ 1 ivAQtlon
(commencing with Section 7000) of pivision 3 of the Business and Professions Code) or
that he is exempt therefrom and the,hasis for the alleged exemption. Any violation of
C1CCU Occupancy
P Y
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
❑ 1, 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 sale (Sec. 7044, Business
and Professions Code: The Contractor's License law does not apply to an
equlred Inspections
owner of
102 —
PIERS
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 sale. If,
103 —
UFER
however, the building or improvement is sold within one year of completion, the owner-
104 —
RE BAR
builder will have the burden of proving that he did not build or improve for purpose of
sale.
105 —
ANCHOR BOLTS
1, as owner of the property, am exclusively contracting with licensed contractors to
106 —
SEWER & WATER
e struct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li-
cense law does not apply to an owner of property who builds or improves thereon, and,
202 —
UNDERFLOOR PLUMBING
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
203 _
UNDERFLOOR MECHANICAL
License law.
❑ lam eympt under Sec. B & P C for this reason
204 —
UNDERFLOOR FRAME
Da,/ y � �p
-
205 —
301 —
UNDERFLOOR INSULATION
ROUGH PLUMBING
WORKER'SCOMPENSATIONDECLARO"
I hereby aftrtn under penalty of perjury one of the following declarations:
302 —
TUB & OR SHOWER
❑ I have and will maintain a Certificate of Consent toself-insure for Worker's Compen-
sation. as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
304 —
ROUGH ELECTRICAL
❑ I have and will maintain Workers compensation Insurance, as required by Section
3 0 5 —
FRAME
3700 of the labor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
306 —
HOLDOWNS
Carrier: Policy No.;
307 —
INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
308 —
SHEETROCK
(Thissection need not becompleted if the permit is forone hundred dollars (S HX))
309 —
EXTERIOR LATH
(it less.)
310 —
INTERIOR LATH
I certify that in ehc perfo ncc of the work for which this permit is issued, I shall not
311 —
SCRATCH COAT
cm to an rso, i anner so o me su c t to the Workers' Com nation
Laws of Cali nia. D ` + �' A== `�
App lic lfV. t _�
313 —
501
ROOF NA I L
FINAL ELECTRICAL ENERGY
N. E TO APPLICANT: If, after making this Certificate of Exemption, you should
be subject to the Worker's Compensation provisions of the labor Code, you must
_
502
FINAL PLUMBING ENERGY
forthwith comply with such provisions or this permit shall be deemed revoked.
503 —
FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
504 —
FINAL BUILDING ENERGY
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
505 —
506 —
FINAL ELECTRICAL
GAS TEST
Lender's Address
I certify that I have read this application and state that the above information is
507 —
FINAL PLUMBING
correct. 1 agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize representatives of this city to cuter upon the
5
FINAL MECHANICAL
above - mentioned property for inspection purposes.
O 9
FIN DE
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
5
N G
in consequence of the granting of this permit.
APP CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by51
WORKS Date
S EREGULATI NS.
Re -roofs
Type of Roof
�r_ O
�J
nature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code. Section 25532(a)?
❑ Yes �No
All roofs shall be inspected
prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes [4Nu
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code. Section 25505, 25533 and 25534.1 understand that if the building
does not currently have a tenant, that it is my responsibility to notify the occupant of the
egmm is which must be met prior to issuprice cia Cenifica c par r•
Signature of Applicant Date
�-
All roof coverings to be Class "B" or better
Owner Or authorized agent part
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R,
CITY OF CUPFKrINO
CONTRA INF�O,RMATION,
"BUILDING DIVISION PERMIT
-TOR
u1Lp®gAC1FyFsCONGRESS PL
ULTRATECH
DIVISION, THE
PERM] 'rN ®2090193
ATA30N VELVIN R AND CASSAND
787 N KING
RD
APPI-RATONI' // 77 "Y61r 2002
PHONE:
408 929 -5621
SANITARY NO. CONTROL NO,
ARCHD7ECr /ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
LICENSED CONTRACTOR'S DECLARATION
1 frothy affirm that I am licensed under provisions of Chapter 9 (commencing
TERMITE
REPAI Rlob Description
with Seetion 70 (n of Division 3.f the Business ail Professions Cock, and my license is
N mil route and Ellett.
REMOVE
EXTERIOR PLASTER TO
Lincose Class Lic.a
Date Cmumem,
TREAT
TERMITE INFESTATION
ARCHITECT'S DECLARATION
E DECLARATION
1 understand my plans shall hic use) as
/ O
License) Pnrfeemonal
OWNER -BUILDER DECLARATION
-
I hereby affirm that 1 from the Comas Law for the
Any
following reaso (Scotian 11immo Business and
1. , Business Code: Any tiny or county
Co : c
which irds. ..r, d nods
nr rcpmg any
is e a re ametrthe
V
its
pdann is issuance, pursuant to fos the applicant the Con Permit lice s signet statement
e, also applicant h Permit t statement
that pursuant mtht provisions onne cnmracmrsndPrse Law (Choptefv
Sq. FL Floor Area
$19A16Ittion
(commescingwiit
(commencing with Section of 3 oft heegedexeandon.Ayvi Code) (it
that
and)
he Kazis for
that tio is exempt therefrom and exemption. Any violation of
be cts LEE,
omthnfbywry or apnmitsubjmutheapplicantmacivilpenaltyof
Occupancy Type
not reddantfar
ram mom than five hundred dollars (ESm).
P Y YP
❑ I. as owner of NC property. or my employees with wages as their one compensation,
will do me work, and the structure is not intended or offered for sale (Sec. 7(1,14, Business
and Professions Cade: The Contractors License Law does not apply to an owner of
10 2 -
PIERS Cgmred Inspections
property who builds or Empower Nescon. and who does such work himself or through his
own employees. provided that such imprommcn¢ arc not intended oroBered formle. If.
103 -
UFER
however, the building or improvement is sold within one year of completion. the owner
104 -
REBAR
builder will have the burden of paving Nat he did not (wild or improve for purpose Of
'°le
105 —
ANCHOR BOLTS
—Al. as mvnr of the property, am exclusively contracting with licensed contractors to
106 -
SEWER & WATER
tami the project (Sec G(W . Business and Professions Code:? The Contractor's Li.
ense law does not apply to an owner of property who builds or improves human. ad.
202 -
UNDERFLOOR PLUMBING
contracts such pmjccuwiNaconhaanr (s) licensed pursuant to NC Conracor's
License
203 —
UNDERFLOOR MECHANICAL
1 am c)cmpt under Sec. B & P C for this moon
204 —
UNDERFLOOR FRAME
205 —
UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARA
301 —
ROUGH PLUMBING
I hereby affirm under Penalty of perjury one of due following declarations:
3O2 -
TUB & OR .SHOWER
❑ 1 have and will Dust main a Certificate Consent of Conseno met binsum for Worker's Com Nn-
asti(in, az provided for by Section 37q) of the tabor Ct de. for the perfmmance of the
303 —
ROUGH MECHANICAL
work for which Nis permd is issued.
304 —
ROUGH ELECTRICAL
1 have and will maintain Worker's Compensation Insurance, as required by Scctinn
3 0 5 -
FRAME
3700 of the labor Cole, for the performance of due work for which this permit is issued.
My Worker's Compensation lnsumntt cafder and Policy number am:
306 -
HOLDOWNS
Curie, Policy No'
307 —
INSULATION
CERTIFI COMPPESATION INSURANCE
308 308 -
SHEETROCK
('ITivsection need not becompleted iflfr Northisforo^e hundreJdollarsoRk)
309 —
EXTERIOR LATH
or less.)
310 -
INTERIOR LATH
1 cenify mat in the pe ,to f h work for which phis permit is issued. 1 shall not
311 —
SCRATCH COAT
cmpcoy any perwn i Intros n c e'uo NC WOrkeri Compcnsmion
awrorcayur .D �n �s� I
Afewsoafpt `6nia.0 .w L
313 —
501 —
ROOF NAIL
FINAL ELECTRICAL ENERGY
NpS'IOp TO APPLICANT: If, after along this Cenili'atc of Exemption. you should
i
fr subject to the Worker's Compensation
provisions of the labor Come. you must
forthwith comply with such provisions (it this Permit shall End deemed revokeJ,
502 —
FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
503 —
FINAL MECHANICAL ENERGY
I hereby affirm that theft is a construction lending agency l it the performance of
504 —
FINAL BUILDING ENERGY
the work for which this profit is issued (Ste, 3(11 Civ. C.) Name
Le nder's
505 -
506 —
FINAL ELECTRICAL
GAS TEST
Lender's Address
I eerily that I have read this application and sate that the above inhumation is
507 -
FINAL PLUMBING
correct. 1 agree to comply with all city and county ordinances and slam laws relating to
building construction, and hereby mmonm representatives of Nis city m enter Moro the
5
FINAL MECHANICAL
above - mentioned properly for inspection purposes.
0 9
FIN
(We) agree Io me., indemnify and keep harmless the City of Cupertino against
DE
liabillues,judgmena. cuss and exIames which may in any way scene against said City
5
N G
to comma mace of the granting of this permit.
APP CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT
Issued by51
WORKS Date Par' j
S E Rr:GULATl NS. 71
RC -roofs
O
from nfnpplicamicammetor Date
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant Of future Wilding oeeupant store or handle hammous material
tined by the Cupenin^ Municipal Code. Chapter 9.12, and the Ilealth and Safely
C. Section 25532(a)?
❑Yes kh.
All roofs shall be inspected prior to any roofing material being installed.
Will She applicant future building occupant use a Or which
PP o P equipment
If a roof is installed without first obtaining n inspection, I agree to remove
g P g
wit ice' US air ttmaminanu az JcfincJ by the Bay Area Air Quality Managcmcm
d Quality Marta
District?
all new materials for inspection.
❑ Yes
I have mad tfr hanimous marenals requirements under Chapter 6.95 of the Califor-
nia Ilcalth At Smmy Codd, Scone, 255115, 25533 and 25534.1 unJCrsand Nan if file building
does ommmcy have a avant, that it is my om,mohllhy In nnufy tbe dwtupant of the
y which mum �Mmctpri to ism he w',aN�,..L]rl,�,'an
Signature of Applicant Date
/�mlJty
/jy/�
i�YJA ��L /i/�
All roof coverings to be Class "B" or better
m
auman,image ^t Dar
P WOOD DESTROYING PESTS AND ORGANISMS INSPECTION REPORT
This is an inspection report only - not a Notice of Completion.
0 ADDRESS OF PROPERTY INSPECTED
t
BUILDING NO. STREET CITY ZIP COUNTY DATE 6F NUMBER OF
CODE INSPECTION PAGES
10105 CCINGRESS PL. CUPERTINO 95014 43 08/29/02 3
Affix stamp here on Board copy only
The ULTRATECH Division A LICENSED PEST CONTROL
954 OPERATOR IS AN EXPERT IN
PO Box 18
Pan Jose 95 95158 HIS FIELD. ANY QUESTIONS
Jose, RELATIVE TO THIS REPORT
408 536 -0550 Fax 408 536 -0565 SHOULD BE REFERRED TO HIM.
REGISTRATION# PR 4194 REPORT# 025703 JV I STAMP# ESCROWk
Ordered by: Ms. Sandy Watson, 10105 Congress P1., Cupertino, CA 95014
Report Sent to:
Property Owner: MS. Sandy Watson,
Party in Interest:
ORIGINAL REPORT I2 LIMITED REPORT ❑ SUPPLEMENTAL REPORTI3 �' REINSPECTION REPORT ❑ * STA L
MPtt GATE
General Description: TWO Story, Single family residence
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With a Wood shake roof.
Inspection Tags Posted: Subarea
--
OtherinspectionTags: FUmi _9 11 O1 Ultratech 8 /15102
Chem -Tech, 7/26102, 11%99, Sj01
1. SUBSTRUCTURE AREA See lA
2. STALL SHOWER
J
3. FOUNDATIONS
4. PORCHES ...STEPS
5. VENTILATION
6. AVUTMENT5
7. ATTIC SPACES
8. GARAGES
9. DECKS ... PATIOS
10. OTHER ... INTERIOR
11. OTHER ... EXTERIOR See 11A & 11B
DIAGRAM AND EXPLANATION OF FINDINGS (This report Is Ilmlted to structure or structures shown on diagram)
:1
Lti L_
FRONT
Inspected by JOhri M. Van HooSerUcenseNo. OPR7757 Signature T.
You are entitled to obtain copies of all reports and completion notices on this property filed with the pr eceding iwo years upon payment
of a $2.00 search fee to: The Structural Pest Control Board, 1418 Howe Avenue, Suite 18, Sacramento, California 95825 -3204.
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 (800) 737 -8188 or (916) 263 -2533.
ADDRESS OF i
PROPERTY
INSPECTED 10105 CONGRESS PL. CUPERTINO
BUILDING NO. STREET CITY
08/29/02 025703 JV
STAMP NO. DATE OF INSPECTION CO. REPORT NO,
SCOPE OF INSPECTION. IMPORTANT INFORMATION
This is a report of an inspection for wood destroying pests and
organisms of an occupied, furnished structure. This inspection was of
only the visible and accessible areas of the structure. This
inspection and report does not reveal building code compliance or
non-compliance. For information about code compliance, a company that
makes structural home inspections should be engaged. We have not
inspected areas under furnishings, appliances, storage or floor
coverings nor did we inspect inside finished walls or ceilings.
Inspection of these areas is not practical. If inspection of any of
these areas is requested, we would perform that inspection for an
additional charge. We did not inspect electrical, heating or
mechanical systems nor did we inspect the plumbing systems except as
may be specifically noted below. Inspection of these systems is
beyond the scope of this inspection report. THE EXTERIOR SURFACE OF
THE ROOF WAS NOT INSPECTED. IF YOU WANT THE WATER TIGHTNESS OF THE
ROOF DETERMINED, YOU SHOULD CONTACT A ROOFING CONTRACTOR WHO IS
LICENSED BY THE CONTRACTORS' STATE LICENSE BOARD. The attic was not
inspected due to a lack of clearance space. We inspected the upstairs
stall shower but did not water test it as there were no stains
underneath to indicate leakage. We were only able to inspect the
second story eave areas visually from the ground. The area under the
water heater pedestal was not inspected.
"NOTICE: REPORTS ON THIS STRUCTURE PREPARED BY VARIOUS REGISTERED
COMPANIES SHOULD LIST THE SAME FINDINGS (I.E. TERMITE INFESTATIONS,
TERMITE DAMAGE, FUNGUS DAMAGE, ETC.). HOWEVER, RECOMMENDATIONS TO
CORRECT THESE FINDINGS MAY VARY FROM COMPANY TO COMPANY. YOU HAVE A
RIGHT TO SEEK A SECOND OPINION FROM ANOTHER COMPANY."
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 THREE
YEARS FROM 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.
(1) SUBSTRUCTURE AREA
1A. FINDING: The subarea soil is damp to wet on the upper left
rear side. It appears that water is coming in
through the ventilator screens.
RECOMMENDATION: The owner should divert the water away from these
vents to keep as much water as.possible from going
under the structure,
NOTE: There is a sump plp:�,-ins�t,1l40;in t 4 ie subarea. we
do not know if it iso - 2 it ona 1. 1V The T condensate
--he
from the air conditi into a tub below
g
At?:!
,e
I
the air conditioner. the tub is full.
It should be emptied.
_(11) OTHER... EXTERIOR
11A. FINDING: There are drywood termite pellets on the front porch
comming from inside the wall.
RECOMMENDATION: Due to the nature of these infestations, it will be
necessary to seal the entire structure and fumigate
it with Vikane (Sulfuryl Flouride). We will use tear
gas (Chloropicrin) as a warning agent. The entire
structure must be vacant for at least 48 hours for
this process. We will use all due caution in out
operation, however, we assume no liability for any
damage to the roof coverings, solar panels, TV
antennas or plantings adjacent to the structure. The
occupants must sign the Occupants Fumigation Notice
and comply with all of the instructions.
Page 2 of 3
ADDRESS OF
PROPERTY
INSPECTED 10105 CONGRESS PL. CUPERTINO
BUILDING NO. STREET CITY
08/29/02
STAMP NO. DATE OF INSPECTION CO. REPORT NO.
112. FINDING: There are drywood termite pellets on the front porch
indicating an infestation inside the wall.
RECOMMENDATION: Crack off the stucco in this area, expose the wood
members and treat this infestation with Cy -Kick
(Cyfluthrin) and Tim -Bor (Disodium octaborate
tetrahydrate). Close the wall and restucco to match
as closely as possible. Repaint to match as closely
as possible.
NOTE: We will perform either item 11A or 11B at no cost to
the owner. The owners should indicate their choice
to us. In any event, we would extend the guarantee
on the property for an additional year. After
the fumigation or treatment, pellets should be
swept off at the porch.
NOTE: In our opinion, item 11B would require a local
building permit.
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 Pesticide Regulation 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 (800) 876 -4766 and your pest
control company immediately.
"For further information, contact any of the following: Your Pest
Control Company (408) 536 -0550; 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 (800)
737 -8188 located at 1422 Howe Avenue, Sacramento, Ca 95825
Page 3 of 3
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