25909 AA,PLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
C11TY OF CUPERTINO nuh1BERICAL PERMIT NO,
9G-MECHANICAL.
BUILDING DIVISION APPLICATION/PERMIT BUILDING PROJECT IDENTIFICATION 25909
BUILDING ADDRESS: `�,//g SANITARY NO. APPLICATION SUBMITTAL DATE
2 oe..,Ta LOT It 24e� Iiat
P A PIIONE: CONT CI'Oft' NA LIC NO:
� NIC CONTROL p
RCHITECI' GIN[FR: LIC NO: ADDRES9t. ❑
CONTACT: PHONE: BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT FEE
_w BLDG PLUMB MECH
PERMIT ISSUANCE
LICENSED CONTRACT'OR'S DECLARATION APPLIANCES-RESIDENTIAL LOB DESCRIPTION
n9z I hereby affirm that l am licensed under provisions of Chapter 9(commencing with
Y100❑ Section 7000)of Division 3 of the Business and Profession&Code,and my license is in PANELS
t�d W full force and effect.
FZ License Class Lie.# UPT0200AMPS
rex<y Dam Convector 201-1000 AMPS
8s'�•1 , " /� �-",Y
Z�yZ ARCHITECTS DECLARATION OVERT AMPS SQ.FT.FLOOR AREA 1/SQ.FT,
O — I understand my plans shell be used as public records.
F rex F-� SIGNS ELECTRICAL
Licensed Professional
OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
EX: U 1 hereby affirm that I ten nem,'from Nmm
e Caalra 's License law far the
hLL13oo following reasao.(Section 703 1.5,Business and Professiana Code:Anycityorcounty 'TEMP.METER OR POLE MST.
L O which rec uire5 a jamm-In coraccom,ager,Improve,demolish,or repair.,am. Nis
fMtGY�r�a1 2 prior m its issuance,also requires the applicant for such pmantto rile a signed statement POWE0.DEVICES !
1)j C 0 that he is Iiecand pursuant an the provisions of the Cunpacies's License law(Chapter
9beammencing with Section 7000)of Division 3 oflhe Busimen and Professions Cade) SWIMMING POOL ELECTRIC VALUATIQI�-
{yyo
or that 703exempt thcrefromand the Permits subjects
tsthe exemption.Any violation of OUTLETS-SWITCHES- o�
1-2,Q or thatSectionhe is esbyanyapplicantfmn permit anhmngad exemption.Any l pevlty of )
S 0 not roman rivehundred dollars BS00). NEW RESIDPMIAL ELFCIR S PI'
I,esawnerofth<propeny,ormyemployees with wegesmtheirsolecampensation, Q STORIES TYPECONSTRUMION
a,3� w the work,and the structure isnotinanded moffcred forsale(SecJl)44,Basin
e&a
and fesslons Cade:The Commeam's License Law does not apply m m owner of
propereywhobuildaorimproves themonand who does such work himselford roughhi&
nemployces,provided that such improvements are ner intended oroffendl forsale.If, OCC.GROUP M.UNITS
however,the building or improvement is sold withinone ymeo(completion,the owner. T
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
TE
❑ I,acowner ofthe property,am exclusively contracting with liemsedconuautom to QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
construct the project(Sec.7044,Business and Professions Cade:)The Comments PERMIT ISSUANCE --
License Law does not apply toanowner ofpropenywho buildsaa improves thereon,and
who contracts forsuch projects with acomrumor(s)licensed pursuanOo the Conrsenrs ALTER FEB SUMMARY
License Law. (EA)
❑ I am exempt under Sec. ,HS,PC for this mason BACK FLOW PROTECT.DEVICE OUTSIDE
SANITARY YN_
Owner Dale Rl?CEIPTM
WORKMAN COMPENSATION DECLARATION hill DRAINS-FLOOR,ROOF,AREA,COND. SCHOOLTAX Y N
❑ I herebyaffum that l have acenificuteofronsain maelf-insure,...cenilicateofFIX'IVRFS-PER TRAPRECEIfTp
Wmken Compenmtionlnsumeeorucmifiedcopythereof(Sac.Jg00,Lab CJ which �— PARK FEL' Y_N
ars all employ«s under Permit. GAS-EA.SYSTEOUTLETS M-I INC.4 OURFCFIPF N
Policy M BUILDING DIVISION FF S
Company GAS-EA.SYSTEM-OVER 4 B1G PLANCHECK FEE1.16i
C1CeniOed copy is hereby famished.
❑ Certified copy is bled wilt the city inspection divivion. GREASFJINDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEF.
COMPENSATION INSURANCE
(This section need not becomplead if s,permit is for one hundred Indiana(1100) SEWER-SANITARY-STORM EA.200FT. ENERGYME
orlms.)
I certify Nat in the performance offle work for which this Permit is issued,l shall WATER HEA'lTR WNENT/ELECfIt
not employ any person in any manner an as m become subject te the Workers' PAID
z Cm,msatianl.xwsof CAifomia. Data M/B
WATER SYSTEFATING Date Receipt#
Applicant
zO NOTICE TO APPLICANT:If.after amusing this Certificates of Exemption,you should NEWRESIDENTIALPLMB. SQ.FT. TOTAL:
f/J become subject to the Worker's Comp mentimt provisions of the Labor Code,you must
a ; forthwith comply with such provisions w this permit Nall be deemed invoked. BUILDING FEE to
P, CONSTRUCTION LENDING AGENCY SEISMIC ME
7 2 I hereby affirm dust hem is a construction lending agency for the perfomance of ELECTRIC ME
O the work for which this permit is issued(Sec.3097,Civ.CJ
rndaa Name
LL. F Lender's Add.. QTY. MECHANICAL PERMIT FEE PLUMBING FEE
V I certify that I have read this application and sus that the above information is
correct.l Agra to comply with all city and county ordiruneca and state law&relating to PERMIT ISSUANCE MECHANICAL FEE
F" building conswctioa,and hembyunsoriurtpresentatives afthiacity memerupon the
V Zabove-nmentioned property for inspection purposes. ALTER OR ADD TO MECH. CONSTRUCf10N TAX
(We)agree to save,indemnify and kap humleas the City of Cartesian
against
liabilities.Judgments.costa and.peau,which may in myweyaccyse=ga. s=d Cit AIR HANDLING UNIT(TO 10A00 CFM)
in conseque, f ng of is Permit,
AIR HANDLING UNIT(OVER 1B."CFM)
mgntum of ApplicanVConm Data XHAUSTHOOD(W/ UD
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,00)BTU) Data Receipt
te
Will the applicant or future building occupant sm or handle hazardous material
as HEATING UNIT(OVER 100,0100 BTT]) TOTAL:
defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)?
❑Yes 11 No VENTILATION FAN(SINGLE MID)
ISSUANCE DATE
Will thea licant or future buildin as tusee BOILER-COMP DHP OR 100]X10 BTU)
pp g poo yuirtmem ordevices whichemit
hazardous she conmminants ss derined by the Bay Arca Air Quality Management BOILER-COMP(OVER 100,001)BTU) q
❑Yea C3 No NEW RESIDENTIAL MECH. SQ.FT.
I have read the hazardous materials re,broaems..or,Chapter 6.95 of the /'1)Q ]0
if the uil Health occur Cwc,Sections 25505,t it is and 25534. limy to notify
that V .( ���
if the building does not currently have a tenant,that it is my responsibility m notify the /.
aseepant of the requirements which must be met prior to issuance of a Certificate of Cyr f
Occupancy,
Owner or indimixed agent poem TOTAL: ISSUE
DBY: ,ry
OFFICE
WOOD DESTROYING PESTS AND ORGANISMS INSPECTION REPORT
This is an inspection report only - nota Notice of Completion
ADDRESS OF PROPERTY INSPECTED
STREV CITY LIF WY.p E 1IN R OF
21739 Terrace Drive Cupertino 95014 43 A/23/96 S
MAX'S TERMITE .CONTROL Affix atop here on Board caps anly
1385 STOCKBRIDGE DRIVE A LICENSED PEST CONTROL :
SAN JOSE,CALIF. 95130 OPERATOR IS AN EXPERT IN
.408—.985-BO61 HISI HER FIELD. AW OUESTIONS
RELATIVE TO THIS REPORT SHOULD
408-989-5889 PAGER# BE REFERRED TO HIMMER.
REGISTRATION B PR 1369 REPORT M S1ANP r 3211176T ESCROW A
ORDERED BYt Bon MOe,RE-MAX Realty,19200 Stevens Creek Blvd,Suite 210,Cupertino,CA,95014
REPORT SENT Tor above nyder
PROPERTY OWNERr Richard S Margaret Wolpert,21739 Terrace r1ve,Cuper no, a i t. 9t)W4
PARTY IN INTEREST. em
ORIGINAL REPORT LIMITED REPORT D 'SUPPLEMENTAL REPORT [3• REINSMC1101P REPORT 0• rta Data
1 N F g D F D D H F C B g
Frame,one storyfamilydwelling With N D U U R U T A A A E X H
GENERAL DEBC_RIPTIpNt . 9 _ A T R g T N .H M R U L C O
C T T W O e P T L L e W
-stut,Llo, exterior. TWO sta11 attached garage eP° N e R R o U R O H T te, s
on
Hood shake rof. s R D p o D H, o I L
®
A
Q I PAY- 0 .R 0 D O AR E e n
lNGPECTION TAG POSTWt _ In subarea E E P N M p L, R O e e D g
D 8 I e M C L e I
OTHER INSPECTION TAGS. - T e E Nr+ RS
H I R g T g H T V I U
A O M B A e R
e N I C 6 h
T T
E
e g
SUffink)rTLiRE oW
All X
O S Concrete 2 II Or more above arade
VENTILATION Adeauate u 6r-more above arade
ABUTMENTS Planter box See' below 2L
,ATTICSFACES
.6411ACIES Two stall ^attacbeaaccessihip See below
OF _p
INTERIOR
OTHER-MERIOR
DUI TRAMAND EXPLANATION OF FINDINGS (This repon is limited to Structure or structures shown on di rant)
qA �
iia
_ -
coy EC,
jilt
I
tIA IgD ►D; �� °��� 097996
��
1 �NSp
n
l�G I I ClTyOF r/01V q
' 1 CUPFAT/N p rMFNT
ti4 I
�A
FRONT —` -
Inspeetod-by RICHARD: FRABONI Ucense'No. ' OA 8121 a Signature10
—
R. QueaHone or profile m Io ftj the chow ropotf should pe directed to the mpropsr of tNa oomDgny Unreeof�ap qui na or rddome with
aaMoeeplmlrltomisd may bsoddiraaaatad torI a Snuaturel-Pear Control Board 4412131097.7a79.(4161.507.9110,m(87�p1 626• 28.
ypaymaln of e'�t2 00 ae�areh fee to f T�'ha 6truoturaral Pni'�Qgnlotrol 'aoa'ida,t442 HeweaA!0S
n1.,81e9.t8 B o rCiN}omie B9I& H Loan
SECOND PAGE OF STANDARD INSPECTION REPORT OF THE PROPERTY LOCATED AT:
Address of
Property 21739 Terrace Drive Cupertino 95014
Inspected
Bldg. No. Street City Zip
April 23 .1996
Stamp No. Date of Inspection Co. Report No.
(If any)
The interior was furnished and occupied at time of our inspection. The
following areas were not inspected because they are not accessible:
Areas under furnishings,storage,built-ins,appliances,rugs and\or
carpets (if any) ,the interiors of hollow walls,floors and roof overhang
soffits and the inaccessible attics or portions thereof. Any plumbing
leaks evident at time of our inspection are noted on this report. This
company cannot be held liable for any hidden leaks or leaks that happen
. after the date of our Original Inspection. We do not inspect roof
covering as we do not feel qualified to make such inspections.
Interested parties are advised to consult a licensed roofer for roof
inspection wheather .or not recommendations and/or notations concerning
the roof are made elsewhere in this report.
" NOTICES The Structural Pest Control Board encour s enmpetitive
business practices amongsegitergd companies Reports on this s£ructure
gxepared by various registered companies should list the same findings
(i.e. telt infestations termite damage, ungus damage. atr Y
However recommendations to correct these findings may very grog company
to .c0mnany, Therefore, you may wish to seek a second o isnnion since
there may be alternative methods of torr ting the pindj„Dgs 1=icted on
this report that may be less costly."
NOTE: IF A RE-INSPECTION OF THIS PROPERTY .IS REQUESTED BY THE PERSON
ORDERING THE ORIGINAL INSPECTION REPORT WITHIN FOUR (4) MONTHS,THIS
COMPANY WILL MAKE THIS RE-INSPECTION REPORT,AND MAY MAKE SAID RE-
INSPECTION FOR A CHARGE NOT TO EXCEED: $ 125.00 PER TRIP.
THIS IS A SEPARATED REPORT WHICH IS DEFINED AS SECTION I/SECTION II
CONDITIONS EVIDENT ON THE DATE OF OUR 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 CONDITION DEEMED LIKELY TO LEAD TO INFESTATION OR
INFECTION BUT: WHERE NO VISIBLE EVIDENCE OF SUCH WAS FOUND. FURTHER
INSPECTION ITEMS ARE DEFINED AS RECOMMENDATIONS TO INSPECT AREAS)
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.
SUBSTRUCTURE AREA
1A. We noted active infestations of subterranean termites on subarea
soil surface, subterranean termite tubes were noted along sewer
pipe at front of house.
RR9COMMENDATION Treat infested soil areas with chemicals for control of
subterranean termites in compliance with instructions on the labels.
Remove all evidence in subarea. Chemical to be used Dursban.
«« THIS IS A SECTION I ITEM »»
1B. Evidence of active subterranean termites and damage was
noted in subarea adjacent to front porch area, subterranean
termites are entering into subarea from dirt fill beneath planter
box area. Damage was noted to approximately 10 feet of 4x6
rim joist.
RECOMMENDATION See item 6A for recommendations.
«« THIS IS A SECTION I ITEM >>
.STALL SHOWER - TUB SHOWER
2A. Water damage was noted to_ sheetrock behind tile at front of bathtub
in hall bathroom.
RECDMMENDATION Remove tile at front of bathtub, cut out and replace
damage sheetrock. Tape and texture, re-install tiles removed and grout.
We do no painting. NOTE: If damage extends into any areas other then
indicated on or findings,there will be additional costs to make repairs.
<<<< THIS IS A SECTION 'I ITEM »»
CONTINUED ON PAGE THREE:
THIRD PAGE OF STANDARD INSPECTION REPORT ON THE PROPERTY LOCATED AV :
Address of
Property 21739 Terrace Drive Cupertino 95014
Inspected
B1dg.No. Street City Zip
• April x, 1996
Stamp No. Date of Inspection Co.Report No.
(if any)
CONTINUED FROM PAGE TWO:
STALL SHOWER
2B. We performed a standard water tested stall shower in master
bathroom and found it to be leaking. Shower pan is defective.
water and fungus damage was noted to subflooring in front of
stall shower.
RECOMMENDATION Remove shower door, strip all tiles frow walls,dam and
floor of stall shower. Remove defective shower pan. Cut out and replace
damaged subflooring. Install a new 3 ply hot-mopped shower pan and
sub-drain. Install new water-proof sheetrock and .new ceramic tiles of
a standard grade ($2.35 per ft. ) set on a mortar base on' walls,dam and
floor of stall shower. Install a new safety glass shower door.
«« THIS IS A SECTION I ITEM »»
ABUTMENTS
6A. Subterranean termites are entering into subarea .from dirt fill
beneath planter box adjacent to front porch area. Damage was noted
to 4x6 rim joist in subarea adjacent to planter box.
ECOMMENDATION Dig out soil in planter box as necessary, remove back
'Wbricks in planter box adjacent to wall, open stucco to expose damaged
rim joist. Cut out and replace damaged rim joist. Treat area as
necessary with chemical for control of subterranean in compliance with
instructions on the label. Install metal flashing over exposed, wooden
members to a point 6 inches below top foundation and to a point above
bricks . Re-install brick removed adjacent to wall and re-stucco.
We do no painting. .If damage extends into any areas other then
indicated on or findings,there will be additional costs to make repairs.
<<<< THIS IS A SECTION I ITEM »»
GARAGE
BA. Plywood trim along base of garage door in delaminated, garage door
is also in need of repairs.
RECOMMENDATION Call in a licensed garage doorman to make necessary
repairs and/or replacements to garage door.
<<<< THIS IS A SECTION II ITEM »»
DECKS PATIOS
9A. No physical or visual inspection was possible beneath wood deck at
rear of house, no visable evidence of infection or infestation was
noted and no outward indications of damage was noted from top side
of deck. We make no guarantees and assume no responsibility for
inaccessible areas.
ILRECOMMENDATXON We make no recommendations. Point of information.
«« INFORMATIONAL ITEM ONLY »»
OTHER INTERIOR
10A. water damage was noted to underlayment beneath linoleum in front
of bathtub 3nhall .bathroom.,,,;
R�1r7P MOAfiION 'Fake a toilet,' take u 611 undezla" '«
pp ymernt and :linoleum.- �.from bathroom bathroom floor. Install new underlayment and new linoleum of a
standard grade ($ 7.50 per yd) on bathroom floor. Re-set toilet on a new
ax-seal.
«« THIS IS A SECTION I ITEM »»
CONTINUED ON PAGE FOUR:
FOURTH PAGE OF STANDARD INSPECTION REPORT OF THE PROPERTY LOCATED AT:
Address of
Property 21739 Terrace Drive Cupertino 95014
�spected
Bldg. No. Street City Zip
April 23.1996
Stamp No. Date of inspection Co. Report No.
(If any)
CONTINUED FROM PAGE THREE:
OTHER INTERIOR
10B. Water damage was noted to underlayment beneath linoleum in front
of stall shower in :master bathroom.
RECOMMENDATION Take up toilet, take up all underlayment and linoleum
from bathroom floor. Install new underlayment and new linoleum of a
standard grade ($ 7.50 per yd) on bathroom floor. Re-set toilet on a new
wax-seal.
<<<< THIS IS A SECTION I ITEM »»
10C. Water and fungus damage was noted. to underlayment beneath linoleum
around toilet in 1/2 bath room, water and fungus damage was also
noted to underlayment and possibly to subflooring beneath linoleum
in front of dishwasher in kitchen.
RECOMMENDATION Take up toilet in 1/2 bathroom, remove dishwasher in
kitchen, remove washer and dryer in laundry room. Take up all
underlayment and linoleum from floor in kitchen, laundry room„ and 1/2
Es
hroom. Cut out and replace any damage subflooring adjacent' to
hwasher. Install new underlayment and new linoleum, of a standard
e on floor in laundry room,kitchen and 1/2 bathroom.. Re-set toilet
on a new wax-seal. Re-install dishwasher. Re-install washer and dryer.
«« THIS IS A SECTION I ITEM »»
10D.. Water damage was noted to cabinet false bottoms beneath kitchen
sink.
RECOMMENDATION Cut out and replace .water damaged false bottom beneath
kitchen sink and install a piece of linoleum over fai`sebottom.
«« THIS IS A SECTION I ITEM »»
OTHER - EXTERIOR
11A. Fungus and dryrot damage was noted to numerous sections of roof
sheathing. on overhangs around house and damage was also noted to
rafter adjacent to front porch.
RECOMMENDATION Take up roof as necessary to facilitate removal of damage
roof sheathing. Cut out and replace damaged sections of ,roof. sheathing.
Make necessary repairs and replacements to damage rafter it front of
house. We do no painting. Homeowner will be having a new roof
installed.
«« THIS IS A SECTION I ITEM »»
11B. Paint on exterior wood work in some areas around house is peeling
off and missing in some areas.
SERE VENUAON Painting on exterior wood work around house should .be
aiTIntained by homeowers.
«<< THIS IS A SECTION II ITEM »»
11C. Wood shakes on roof are deteriorating,curled and splitting in
numerous areas.
RECDMHENDATION Call in a licensed roofer to inspect roof and issue a
report, on. condition of..sameand make necZe Itessary repairs and\or
replacement of "roof to ensure a water tight .sealo
«« THIS 'IS A SECTION II ITEM »»
CONTINUED ON PAGE FIVE:
FIFTH PAGE OF STANDARD INSPECTION REPORT :OF THE PROPERTY. LOCATED AT:
*Address of
Property 21739 Terrace Drive Cupertino 95014
Inspected
Bldg. No. Street City zip
April 23 ,1996
Stamp No. Date of Inspection Co. Report No.
(If any)
OCCUPANTS CHEMICAL NOTICE
MAX'S TERMITE CONTROL will use pesticide chemicals specified below for
the control of wood destroying pests or organismsin the: locations
identified in the Structural Pest Control report as indicated above.
The pests to be controlled:
_.X Subterranean Termites Fungus or Dryrot
_Beetles Drywood Termite Other
The Pesticide proposed to be used and the active ingredient.
X DURSBAN TC: Active ingredients: Chloropyrifos
DURSBAN PT270:' Active ingredients: Chloropyrifos
COPPER GREEN: Active ingredients: Copper Naphthenate
VIKANE: Active ingredients: Sulfuryl Flouride
_ OTHER: SAFROTIN: Active ingredients: Propetamphos
$tate Law requires that you be given the following .information:
UTION-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 an& the..United States
Environmental Protection Agency. Registration is granted .when the State
finds that based on existing scientificevidence 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 degree of
exposure,so exposure should be minimized. "
" If within 24 hours following application you experience symptoms
similar to common seasonal illiness comparable to the' flu,contact. your
physician or poison control center and your pest control operator
immediately. (This statement shall be modified to include any other
symptoms of over exposure which are not typical of influenza."
For further information,contact any of the following.:
Max's Termite Control. . . . . . . . . . . . . . . . . . (408) 985-8061
County Health Department. . . . . . . . . . . . . . . . . (408) 299-5955
County Agriculture' Commissioner. . . . . . . . . . (408) 299-2171
Poison Control Center. . . . . . . . . . . . . . . (408) 299-5112
Structural Pest Control Board
1430 Howe Avenue,Sacramento,CA,95825. . . . . (916) 263-2544
rsons with respiratory or allergic conditions,or others who may be
ncerned about their health relative to this chemical treatment,
should contact their physician concerning occupancy during and after
chemical treatment prior to signing this NOTICE.
NO CHEMICAL APPLICATION WILL BE PERFORMED UNTIL SUCH TIME THAT THIS
�'WYix ACCEPT"`RE__EA� HAVING READ THE- INSTRUCTIONS., I ,THE UNDERSIGNED,
S, RETUlN
PON.�IBIf.:ITY "F�OR` ALI:'Z`HE °AFOREMENTIONED` -�. •.-�:,,: , ;.: :....... . ,::;. .:.
NER/OCCIJPANT DATE OWNER/OCCUPANT ' DATE
MAX'S TERMITE CONTROL - PR 1.369