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CITY OF CUPEWrINO
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BUILDING DIVISION PERMIT
kCONTRACT�RNFQRMATION
B UILOING ADDRESS:
ANTIQUE TERMITE & PEST
PE N 4070001
OWNER'S NAME:
PERMITI.SSUBDATE
E:
SANITARY O. C01 I4 0LNO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am litxnsed under provisions of Chapter 9 (commencing
P
with Section n)(xq of Division 3 of dm Basins it Professiorm Cad.and my license is
in full (arta and e(fett
TERMITE REPAIRS
Lieerem Class Lie.a
Data Contractor
ARCHITECT'S DECLARATION
ll E public r
nnd my plans duusad es ecords
1 udrsu
D 4: /4V� V
q
T)p—a'
Licensed Professional
DECLARATION
Oat
v K
I mn sUILDER
I huchy rheum that I oro. (mm Be, Contractor's n for the
o
c ty o
Cade: Any city or county
following aasoa (Semon ?1131.5, Business and Profcs : A
Burin
demobh, anygned structure
whim myuircs a permit m owdi
alter. nt
for such fi crepair
prim ha its issuance, also requioue the applicant for such permit m f le a signed aummem
ptiM Oa
Ft. Floor Area
Valuation
NommenccensW pursuant to the the COmrscuri Lbxnse loons
Sq.
Codur9
of Divioesnf
(commencing with Section 1(100) Of Division 3 of or
Professon.
al egeBusiness xempt AnynnaCd n
dust be u exempt IMrtfmm and the bei for she alleged exemption. Any violation of
3GIOM4029)M0
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the appi¢ant to a civil penalty of
not mart Nan fire hundred dollen IS500),
v
I, m owner of she pmpeny, or my employcu with wages u Wcir mic compensation,
Required Inspections
will do the work and flestmcture is not intended or offered forsale(Sce. 1044, Business
and Prefessamss Code: The Corer seams License taw dors at apply m an owner of
ns
q P
property who builds or improve Boman, and who doessuch work himself or through his
awn employees, provided Nat such improvements tie not intended oroRered for sale. IL
however, the building or improvement is sold within arc year of umplction, the owner
builder will have Be burden of proving Nat be did not build or improve for purpose of
Mile.).
I, as Owner of done propcny, am exclusively cofnNng with Burned convacmrs to
,
construct Be pmjed (Sec. toad. Business and Porecsions Code:) The Conuazmr's Li.
c me law does not apply to an owner of property who builds or improve themon, and
���
Catoh
who counsels for such projects with a convacmr(s) licensed pursuant to thena
Lium" taw.
❑ l am exempt under Sec. .B k PC for this wan
Aa®
JULU �n 2004
Owner Data
�y
WORKER'S COMPENSATION DECLARATION
I hereby &Ram under penalty of perjury one of the following declarations:
haw and will maintain a Certificate of Conxnlbself-insure for Worker's Compere
n, ss provided for by Sectiun 3100 of do labor Code, far the performance of the
k for which this permit is issued.
137)�ID
have and will meime. Worker's Compensation Insurance, az required by Section
of Oc Isbor Code, for the Performance of Ne work fm which this permit is issued.
Worker's Compensation lnsursnce canner and Policy number am:
ier. Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
'
(Tbiacmamn need not be completed if the permit is promote hundred dollars (SI(gB
or It..)
1 unify that in the Performance of the work for which this permit is issued. l shall not
employ any person in any manner an as to become subject o the Workus Compensation
Laws of CalBarma. Dan
Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the tabor Code, you moa
fonhwitb comply with such provisians or this Permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby alumOur there issed(S..consummatorren ding agency terthe perfunnam:c of
bre work for which Nis permit is issued (Sit. 7091, CO. CJ
Lenders Name
1<naers Aadw
j I certify But 1 have cud War application and state that the shout automation is
' Correa I agree to comply with all city and county on insnces and state laws mining to
building construction, and hereby authorize representatives of this city to enter upon Bic
i above-mentioned pmpeny for inspection purposes
(Wi) ague to save, indemnify and keep harmless We City of Cupertino against
j Iiebiliticajudgmcnts. cows and expenses which may in any way acetic against said City
in unsequenec of the goofing of this Permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
Signature of ApPliaHDam
HAZARDOUS ALS DISCLOSURE
S
Will Wee building stem of handle heaardous material
of (mum buildang e.
az defined by die Concis
nit Municipal Code. Chapter 9.12, and the Health and Safety
Chaps
cod. Schen uvz(a)?
32(3)9
All roofs shall be inspected nor to an roofing material being Installed.
P P Y g
❑sees ❑Nm
g
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant arae equipment or devices whim
h nit aranua air contaminants u defined by Till Area Air Quality Management
all new materials for inspection.
uWm?
❑Yes ❑No
I have read Ne hmaNwr materials mquimmenls under Clup car 6.95 of the Cali for -
meHutto k Safety Cod. Seebmu 155(15,15533 and 35534.1 undersand that if the beilding
duce not currently have a warm, that it i my responsibility m nobly do o¢upaf Of the
mquiremcnts which must W met prior to issuance of a Certificate or Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or
amnorited agent Date
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CITY OF CUPERTINO
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CONTRACT®R INFORM
BUILDING DIVISION PERI
,O,N
1PI In
BUILDINCADDRESS:
ANTIQUE TERMITE & PEST
PE N 4070001
OWNER'S NAME:
MEILING C'HANC:
PERMITISSUEDATE
NE:
SANITARY O: CONTROL NO.
ARCHITECT'/ENGINEER:
ra�Li�Q�PERMIT
PO
PLOD MECH�
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
lob Descrip3n` 204
With Sacdon 7") of Division 3 ofdm Business and Pmfecsiuns Code.and my license is
in full forte and affect.
TERMITE REPAIRS
License Class Lie.k
g
Dam Contractor
BUILDING
ARCHITECTS DECLARATION
I undcmand my plans shall W used az public records
u
� /
f—�. q_/_
�T �� C� llC G //:_7 (✓„/�1-�/ J
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm Thal 1 am exempt from dm Contractor's License Law for the
follnwing rents.. (Section 7101.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, featured. m repair any structure
prior u5 its issuance, also requ res the applicant for such Permit to file a signed slaremem
the
Sq. Ft. Floor Area
Valuation
Nat be, is licensed pum anttn previsions none contractor, Licenm Law (Chapter 9
(commencing with Ssnion 70007 of Division 3 of the Basi rcesand Professions Code) or
Nat he is exempt therefrom and the basis for the alleged exemption. Any vic ladon of
3 6�er0 0
Occupancy Type
Station 7031.5 by any applicant for a permit subjects the applicanno a civil penalty of
not mode Nen five hundred dollars (150p.
❑ Las owner of she property, or my employees with wages as Nair sole compensation,
Required Inspections
will do the work, and the awcmre is not intended or alfcree for sale (Sm.706a, Business
pod Limitation Cade: The Committees License Law does aur apply to an owner of
propenywho builds or improves thcrcon, and who Lassitude work himself or through his
own employees, provided that such improvements art not intended or offered forests. if,
haw vel, Ne building or impressment is sold within one year of completion. the owner -
builder will have the burden of proving that he did not build or improve for purpose of
salt.).
❑ 1, as owner of Ne property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Cade:) The Contractor's LF
arae law does not apply m an owner of property who builds or improves thereon,and
who contracts for such projects with a con5ractor(s) licensed pursuant so de Cono m es
Lima. Law.
❑ 1 on exempt unticr Sec. . B & P C for Nis essann
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury enc of the following declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation. as provided for by Section 37W of the Labor Code, far Ne performance or the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
37M of NC Labor Code. for the pcdormarica of the work for which Nis permic is issued.
My Worker's COMPeesallmr Insurance carrier and Pal icy num her am:
Cartier, Policy No,
.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
QTis senium need nut be completed if the permit is formic hundred dollars (SIM)
leesi
1 « thfy Nnt in the performance of the work for which his permit is issued. l shall not
employ any Fenian in any manner se, as to become subject m the Workeri Compensation
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If, after making this Cemifcam of Exemption, you should
became subject to Nc Wolicfs Compensation previsions of the Labor Code. you most
comply with such pmviums of this permit shelf W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm had them is a construction lending agency Torr the perrarmance of
he work for which ibis permit is issued (Sec. 3097, Civ. C.)
Name
larder's Address
1 certify Nat 1 have read this application and sex¢ that the above infmeradear is
correct. 1 agree to complY with all city and county ordinances and sum laws relating w
Wilding construction. Load hereby authoro, rapmstroadvis of this city to enter upon Ne
anove-mentioned primary for inspummir Purpose.
(Wed agree to save, indemnify and keep harmless the City of Cupertino against
liabilities. judgmen, costs and calamitieswhich may in any way seems against said City
in of the ranning of this Permit.
cUNDERSTANDS
APPLICANT
AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
Signature of ApplicaData
HAZARDOUOU S MATE RIALS DISCLOSURE
HAZARDOUS
Will Nee future building or handle mamba(
Health
defined by the Cupertino Municipal Code. Chapter 9.13, and the Hcahh and Safety
Cupertino e. Chapter
C
Cada, Section 25532W)?
All roofs shall be inspected to an roofing material beim Installed.
❑res ON.
prior
P P Y b' g
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
Til haiaNnus air contaminants as defined by the Bay Arca Air Quality Management
all new materials for inspection.
❑Yes 0 N
I have mad the huramous materials requlrcmmn5 under Chapter 6,95 of the Califon
,
nia Health &SafntyCodc, Sections 35305, 25533 and 25534. I undcomed Nat if Nc Wilding
duo not currently have a mnart, that it is my msisom bitity to nobly the occupant of the
therimmem5Which ma5tbeMet prior toissuance ofaCersfcamofOccupmer'
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owmmoraamori.dagent
Date
WOOD DESTROYING PEST: ,'-IND ORGANISMS INSPECTION REPORT
Building No. Street, City, Zip
Date of Inspection
No. of Pages
177 CANDLELIGHT WAY, CUPERI INKI),
CA, 95014
06/29/04
4
NTIQUE TERMITE & PEST INC.
1913 Stone Avenue
San Jose, CA 95125
Ph: (408)995-6300 Fax: (408) 995-0517
y
W
Firm Registration No. PR 1187
Report ll0
32057B
Escrow No.
Ordered By:
Property (�Jvner/Party of Interest:
Report Sent To:
BAY REALTY
MELINI:
CI -TANG
10891 S. BLANEY AVENUE
1177 CAI
JDLELIGHT WAY
CUPERTINO CA 95014
CUPER,'i1,10
CA 95014
VERONICA YOUNG
857-4307 CELL 752-8282 OFF.
n
COMPLETE REPORT ❑ LIMITED REPORT [,i'
SUPPLEMENTAL`+HEFORI`�/j i' -REINSPECTION -REPORT El
General Description:
++ —
`Inspection Tag Posted:
T%i1S IS A SUPPLEMENTAL REPORT AND IS WRITTEN IN SUPPLEMENT
TO OUR
Al m
PREVIOUS REPORT.
Other T sttrye�}y
p�
f -1T % Iry'l�UPERIIN� O
_
An inspection has been made of the structures) :ix.:vn on the diagram in �eccordanof with the Altructyt6.P��t Control Act.
Detached porches, detached steps, detached dec:P,u
and any other struct III
e. rnOT�'[Sna Itlia'IidlegraFa e e not inspected.
Subterranean Termites ❑ Drywood Termites :-'
Fungus/Dryrot 129'" d her Findin{{11s ❑ Further Inspection ❑
If any of above boxes are checked, it indicates that there .o t
visible problems in accessible areas. Read the report for details on checked items.
•
This %9�f plane and ane M tm
kept on a job at aA III118'd ald 0 Is unit iwU I
to make any changes or dferebm an I ante
without written perm138to ppm ft Bu (ding
Department, City of Cupatfhro.
The stamping of This pian aW epscira gong
SHALL NOT be held to pemdi 07 tD b an
approval of the violation of any ---
any City Ordinance or State tats.
• cted By MICHAEL R. MEEK Lic:i :;:: No. OPR8038 Signatu
You are entitled to obtain copies of all reports and completion ne !::a on this property reported to the Structural I
To obtain copies contact : Structural Past Control Board, 1 n 10 P: n:. avenue, Suite 18, Sacramento, California 96o—oz—
N04E: Questions or problems concerning the above report :;how Directed to the manager of the company. Unresolved questions or problems with services
tl
performed may be directed to the Structural Pest Control uu:e1, :!, 16) 561-8708, (800) 737-8188 or www,pestboard.ca.gov. 43M-41 (Rev. 10/01)
2nd PAGE OF STANDARD IN" ;PGC! :i)id REPORT ON PROPERTY AT:
1177 CANDLELIGHT \ i\Y, CUPERTINO, CA, 95014 06/29/04 32057B
BUILDING NO. STREET, CITY, STAIE, ZIP INSPECTION DATE REPORT NO.
• AREAS NOT INSPECTED: The -.nterior of hollow walls, areas beneath and behind
built in cabinets were n::;. inspected since inspection of these areas are
considered impractical. "e did not water test and do not certify against
leakage of any appliances; plumbing over finished ceilings, roof coverings
or decks. Such actions, e not performed, they are considered impractical
without specific wrl.'cCer:-mthorization. Floors which are carpeted makes
inspection of the floor:i_n;; in these areas impractical. Soffitted (enclosed
framing) areas of the sUi cture, makes inspection of interior framing
inaccessible for inspect!on. We make no guarantee against infestations,
leaks or adverse ccnditic,Is which may exist in such areas not inspected.
Attached and/or detached. I`ences were not inspected unless otherwise stated
in the body of this relxa:i:. Further inspection is recommended. Further
inspection of any inaccessible area and/or area not inspected would be
performed upon requ^st at- an additional change (with written authorization).
This property was not i.ra;)ected for the presence or absence of health
related molds or fu::g.i. Lsy California Law we are neither qualified,
authorized, nor liu -..sc_.',:o inspect for health related molds or fungi. If
you desire information-.!z;ut the presence or absence of health related
molds, you should conta(..L an industrial hygenist.
No furniture or appliance:;
were moved or removed, limiting this inspection
to the visible and acce.:;.ole
areas of the above structure shown on the
diagram. No statenei-its c;o:ir
be made regarding conditions in closed walls,
floors beneath cove:.-inq��,
areas below or behind appliances and built-in
• cabinet work, stall sho -.s
over finished ceilings, such structural segments
as porte cocheres, cic.+.;d
bay windows, buttresses and similar areas to
which there is no <:: c....,.;ithout
defacing or tearing out lumber, masonry or
finished work. Anti, ue :':-::.I(dte
& Pest Inc. does not inspect roofs. Should
interested parties esi. :-
further representation regarding roof, interested
parties should cont-ct ,,
11censed roof contractor. Antique Termite assumes
no responsibility for lean;<.r_,
not evident during the time of this inspections.
Our inspectors are not rc,,idpped
buildings will be i:spcc'c_,d
with extension la r-sterefore all
from the ground level
10' from the �;roLu�.:J1eve1
I�y�above
would be visuall
probing, etc) . Furt]:n j. i
:.,;)action of these inaccess e
not inspected is rc'oInr',.�fied
and will be performed upon request and at an
additional fee.
O
If requested by the ,et -r-.::- ordering this report, a reinspection of the
structure will be I;,-,Lcr :rid. This reinspection must be within four (4)
months of the date f tTL., inspection and there will be a reinspection fee
which will be due e._::1 p,t,;, :hle at the time of reinspection. Antique Tern -Lite &
Pest Inc. assumes r,-� liz'.:.'..1ity for repairs ccapleted by others. Guarantees
should be obtained ,-rem rsons or firm that performed actual repairs.
Owner's and/or ager:`:; ,,',' arrange repairs by other trades should satisty
themmeleves with p: .,;cr cTnits and licenses.
ANTI Q'ur: ERMITE & PEST INC. ---License No. PR 1187
3rd PAGE OF STANDARD iU:V REPORT ON PROPERTY AT:
r 1
L J
1177
BUILDING NO.
CANDLC'_'GI-IT vYAY, CUPERTINO,
STREET, C! Y, v?:•'S, ZIP
95014 06/29/04 32057B
INSPECTION DATE REPORT NO.
On work (labor) performct oy Antique Termite & Pest Inc. are for one (1)
year from the date of e,7,,-'pietion. Guarantees for local chemical
treatments are limited !o wood members treated only. Fumigations are
guaranteed for one .,car _com the date of completion. Plumbing repairs (parts
provided by this f:;u), 'i.noleun (vinyl materials), toilet resets or any
other measures for the ccI:trol of moisture (caulkings and grouts etc.) are
guaranteed for t!.irty (30) days. Antique Termite, Inc. assumes no
responsibility for .:ate!. :,.amage if the shower enclosure is not installed
innediately. The 9,: ran ::,_ on showers and tub units is void if the area is
used before 24 how:.:. If the shower fixtures do not fit the owner must
contact other tradesman . have new fixtures installed. If necessary for
floor installation, vani.t es are to be removed and replaced by others.
Kitchens and laur,!.y ..:-eas also must have appliances removed before
installation. An ac i_:tio,!c 1 fee of $ 75.00 per appliance and or furniture
will be charged for "•.nl.':q.e Termite to remove and/or reinstall. We do not do
painting,texturinc:, L;tai!:.ng or wallpapering.
Notice: Reports on `Lis sr:cucture prepared by various registered companies
should list the sc f:i.r;ci::ngs (i.e. termite infestations, termite damage,
fungus damage, etc. ver, recommendation to correct these findings may
vary from company I conj..I!iy. You have a right to seek a second opinion from
another company.
THIS IS A SEPARAT!'D !t Pr "'_' WHICH IS DEFINED AS SECTION I,
• SECTION II AND UN"IN TIER INSPECTIONS CCNDITIONS EVIDENT ON THE DATE
OF INSPECTION.
r7
SECTION I: Contains itai-, where there is evidence of active infestations,
infections, or co _i.ois which have resulted in or from infestation or
infection.
SECTION II: Are c: _ti;u:; deemed likely to lead to infestation or infection,
but where there is o v.1 <, i ble evidence of such found.
UNKNOWN FURTHER IN. CC1C:!: Recommendations to inspect areas which during
the original inspecl.Acn, .tid not allow the inspector access to complete the
inspection and can: -t: L, :afined as Section 1 or Section 2.
WHILE PERFORMING T'.':'Ifi':!i_S OR ANY CONSTRUCTION REPAIRS, ANTIQUE TERNUTE
INC. WILL NOT BE I:,. O??::: C'>LE OR LIABLE FOR ANY DAMAGE TO EIE I'RTCAL OR
PLUMBING WHICH MA`:' IN WALLS ORB � _
A' .Q;J ERMITE & PEST INC. --- License No. PR 1187
4th
PAGE OF STANDARD"'
IEC::••.N REPORT ON PROPERTY AT:
1177 CANDL1=lD3HT
Vn Y, CUPERTINO, CA, 95014 06/29/04 320578
BUILDING NO. STREET, C.";,
Sli.li ZIP INSPECTION DATE REPORT NO.
•
TILE OR LINOLEUMP'.
" ' "C17 . i S:
Bids which are gi,
. in ::port for replacement of ceramic tile or linoleum
are based on using st c,: _.laird grade material. . Ceramic tile bids are based
on standard-square
:" til-<=s at a cost of $2.78 per square foot for shower
walls or tub shower
waa.:s. Ceramic floor tile bids are based on 8x8
tiles at $2.75 pe.
-jua,c foot. Tile selections can be made at: Dal-Tile,
2549 Zanker Road,
.n Jc":- (408) 441-6988 OR Florida Tile, 1560 Montague
Expressway, San Ja
(40?J1.432-8114. Linoleum bids are based on using
standard grade '
eL:n; at $.99 per square foot. Linoleum selections
can be made at: Ar.
c)ny DiLeriors, 401 E Hedding Street, San Jose (408)
292-3737 or standar'.
gr..dc selections can be viewed at: website:
A14floors.ccm Til(
�d/,-: linoleum selections must be made at least 5 days
prior to schedule.
�p:i _:. Any upgrades, must be paid by client at the time
of selection. If
.•O ::_':.ection is made prior to repairs,
standard/neutral cc-or
61e or sheet vinyl will be installed.
MID POLICY SrATEti':olds, sometimes called mildew, are not wood
destroying organi.,. )1�,= .ch 3 licensees do not have a duty under the
Structural Pest C, col '..x and related regulations to classify molds as
harmful to human_t'h :?: not harmful to human health. This does not
modify the Structm 1. Pe:: ;. Control Act or related regulations.
THIS IS A SUPPLEIT:'.. AL '.':;PORT IN CONJUNCTION WITH OUR ORIGINAL REPORT
• #32057A DATED 06/C 200, •'•ND SHOULD BE MADE A PART THEREOF. NOTE: IT SHOULD
BE REALIZED THAT ; I GIVLa, ON THIS REPORT IS IN ADDITION TO BID GIVEN ON OUR
ORIGINAL INSPECPI:
SUBSTRUCTURE::
Item 1J: FINDING: During L' ;s:s of repairs to item , CI
ge was found
to the plates, jc- e::; additional T&G subfl �U{ (�RECON%KQ =ION: cub and replace the damag st�aw jg new
white steel tub E :ew :rI-Xanic tile set in mortar. Install a new chrome
obscure glass enc -:n:e. NOTE: Our bid includes the cost of a local
building/plumbing. _ l::.. NOTE: There is a anti -scald valve already
installed.
****** This _t Se.:cion 1 Item ******
E
ERP1ITE & PEST INC. --- License No. PR 1187
ANTIQUE TERMITE & PEST INC.
1913 Stone Avenue
San Jose, CA 95125
-Ph: (408) 995-6300 Fax: (408) 995-0517
• WORK AL HORIZATION CONTRACT
Address of Property: 1177 CANDLELIGHT \11.,,Y, CUPERTINO, CA, 95014
Inspection Date: 06/29/2004
Report u: 32057B
Title Co. & Escrow p:
SECTION 1
1j: $ 3750.00
Authorize the Following
ion 1 Items to be Performed.
S}3(I ITION 2
We A,:.arize the Following
Secli.. i Items to be Performed.
Page 1 of 2
FURTHER INSPECTION
We Authorize the Following
Items for Further Inspection.
Proposed Cost Section 1: S 3750.00 Proj oc,A Cost Section 2: Proposed Cost Fur.lnsp.:
Total fJl Sections:
MOLD DISCLAIMER
There may be health related issues associated ,til the structural repairs
reflected in the inspection report referenced e:; this Work Authorization
Contract. These health issues include but are rv; limited to the possible llo
release of mold spores during the course of ropa;r . We are not qualified to U
and do not render any opinion concerning such h•:,;i th issues or any special
precautions. Any questions concerning healtL issues or any special _t?t
precautions to be taken prior to or during the co_ se of such repairs should
be directed to a Certified Industrial Hygienist ;,.fore any such repairs are
undertaken.
I have read this work authorization contract end U0,.1 inpection report it refers to.
SIGNED WORK AUTHORIZATION CONTRACT MUST BE RECEIVEL• I:FORE WORK WILL BE SCHEDULED.
I have read and understand the terms of this work o _. orization contract and hereby agree to all terms thereof.
APPROVED AND READ BY: 1) !> ACCEPTED FOR: DATE
P,IELING CHANG, ANTIQUE TERMITE & PEST INC.
ANTIQUE TERMITE & PEST INC. Page 2 of 2
1913 Stone Avenue
San Jose, CA 95125
Ph: (408) 995-6300 Fax: (408) 995-0517 x,
WOPA AE; ?'HORIZATION CONTRACT
Address of Property: 1177 CANDI—FUGHT \Nr],Y, CUPERTINO, CA, 95014
Inspection Date: 06/29/2004
Report u: 32057B
Title Co. & Escrow k:
ANTIQUE TERMITE & PEST INC. AGREES:
1: To guarantee all repairs completed by this compon/ for one year from date of notice of completion, except for plumbing, grouting
cauLking, and re -setting of toilets, which will be :;,:aranteed for (30) days. We assume no responsibiLity for work performed by
others.
2: To be bound to perform this work for the price y.,,tod in our cost breakdown for a period not to exceed (30) days.
3: To use reasonable care in the perform: of our .:ork but to assume no responsibility for damage to any hidden pipes, wiring, or
other facilities or to any shrubs, plant, other te.
OWNER OR OWNER'S AGENT AGREES:
1: To pay for services rendered upon notice of completion of work.
Properties which are in escrow to be be paid at close of escrow, not to exceed 60 days from date of notice of completion.
Properties not in escrow or those with no b.ryer fu, same, require 1/3 deposit prior to work and the balance will be due within
10 days of notice of completion.
2: To pay for service charges 1.52 per month or porion of any month beyond the (30) days after completion of work by our company.
3: Owner grants to Antique Termite, Inc. a security ifiterest in the above described real property to secure payment of the sum for
work and inspection fee completed.
4: In case of non payment by owner,reasom•hle otter, :.ty fees & any costs of collection to be paid by owner,whether suit filed or not
BOTH PARTIES AGREE:
1: If additional damage is discovered by Antique Te,rA to & Pest Inc.in the performance of the work,Antique Termite agrees to notify
owner or agent of the amount of the damage and the o:::ount of the additional work necessary to be performed at an additional cost as
per supplemental report. ShouLd local buil :-iy depir anent require additional work to be performed, additional work would be
performed at owner's expense. Same would ,at Lin_,:., in a supplemental report.
2: The above additional work to be perfcin.. l ,;ill n:t be done without written authorization from owner or owner's agent.
ICE TO PROPERTY OWNERS: (Under California Contr:>.:iors License Law)
ides under the Mechanic's Lien Law o rant r.:c'.or, subcontractor, laborer, supplier or other person who hetes to improve your
erty but is not paid for his work or : ;pties i.,.s a right to enforce a cLaim against your property. This means that, after a
court hearing your property could be sold I the cou:r officer and the proceeds of the sate used to satisfy the indebtedness. This
can happen even if you paid your own conn,:tor in I%A t,ff the subcontractor,laborer or supplier remains. unpaid. To preserve their
right to file a claim or Lien against your rcpert/,.:vrtain cLaimants such as sub -contractors or material suppliers are required to
provide you with a document entitled ^ Pr '::ninary rcrice'-. Its purpose is to notify you of persons who may have the right to
fite a lien against your property if they .:e not i;, .d.
NOTICE OF COMPLETION: document is not r wed u.;it all funds due to ANTIQUE TERMITE & PEST INC as outlined above are
in escrow and supplied with full authorir-..:'olt for r:tcase by all concerned parties. If there is not the total amount and /or
there is not authorization for full rel• ^ 'uy "...'a parties, completion/clearance is to be returned to ANTIQUE TERMITE
immediately. To use this completion/,teat : if thy; above stipulations are not met is to assume direct legal responsibility for
the entire amound due to Antique Termi:( lnc.
CHEMICAL SENSITIVITY OR ALLERGIES: (I. ecc:.,.,.nt) Does any person to your knowledge living or working at this address have
any chemical sensivities or allergies th,.. moque I,.rmite should be aware of prior to work? If yes, they should contact their
physician concerning occupancy during nr `ter is r, chemical treatment, if specified herein, prior to signing below.
1#09N Cap V
ERMITE & PEST INC. --- License No. PR 1187
r
L
CITY OF
CUPERTINO
•CITY OF CUPERTINO • I
PERMIT APPLICATION FORM °
APN # 3 / q OS_X
Fee Description
Fee Group
Date: 2 ` / a G
Building Address:
MECHANICAL
BBOILERI
Mailing
Address (if different from building address):
7 7
Boiler> 100K to 500K Btu
MECHANICAL
BBOILER3
Boiler> 500K to 1M Btu
Owner's Na e:
n
Boiler> 1M to 1.75 M Btu
MECHANICAL
Phone #:
e- I
MECHANICAL
BCONSTAX
Construction Tax
BUILDING
Contractor:
BUILDING
BCONSTAXBQ
License #:
r
e� �1 t
Hotel and Motel
BUILDING
G 5z, BE,
Contact: I
Phone:
BELEC1000
Elec 600V <= 1000A
Cupertino Business License#:
BELEC1001
E Fax:
S—
051
SS
Building Permit Into:
BENERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
Bldg
Elect ❑
Plumb ❑
Mech ❑
Job Description,
Residential L5'
Commercial ❑
Sq -Ft. Floor Area:
$/Sq.Ft.:
O
5a 4-/-
Cost of Project-
jr J r
Occupancy Gro r
Type of Constructs
�G
t
rpp#,
Please check this 0ject is a
�lL,nI
5-
b4
second -story addition: ❑
roject Size: Standard
❑ Large ❑
Major
❑
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBOILERI
Boiler <= 100,000 Btu
MECHANICAL
BBOILER2
Boiler> 100K to 500K Btu
MECHANICAL
BBOILER3
Boiler> 500K to 1M Btu
MECHANICAL
BBOILER4
Boiler> 1M to 1.75 M Btu
MECHANICAL
BBOILER5
Boiler > 1.75M Btu
MECHANICAL
BCONSTAX
Construction Tax
BUILDING
BCONSTAX
Ind/Off/Comm/Quasi
BUILDING
BCONSTAXBQ
Con. Tax for BQ Zone
BUILDING
BCONSTAXH
Hotel and Motel
BUILDING
BCONSTAXR
Constax— Resi/Mobile
BUILDING
BELEC1000
Elec 600V <= 1000A
ELECTRICAL
BELEC1001
Flee 600V > 1000A
ELECTRICAL
BELE 200
Elec Svcs 600V <= 200A
ELECTRICAL
BENERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
49
6�
1 of
CITY OF
CUPERTINO
OCITY OF CUPERTINOO
PERMIT APPLICATION FORM
Quantity Fee ID
Fee Description
Fee Group
BMISCELL
Miscellaneous Fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
BNUCOMME
New Comm Electric
ELECTRICAL
BNUCOMMM
New Comm Mechanical
MECHANICAL
BNUCOMMP
New Comm Plumb
PLUMBING
BOVERTIME
Inspection Overtime
BUILDING
BPBACKFLOW
Atmospheric Vacuum
PLUMBING
BPCESSPOOL
Cesspool
PLUMBING
BPERMFEE
Bldg Permit Fees
BUILDING
BPFIXTURE
Pblg Fixture
PLUMBING
BPGAS
Gas Piping System Fee
PLUMBING
BPINTERCEP
Ind Waste Interceptor
PLUMBING
BPLANCHK
Plan Check Fee
BUILDING
BPLANCKADD
Plan Check Add Multi
BUILDING
BPLANCKREP
Plan Check Repeat Fee
BUILDING
BPREPIPE
Re i e Of Fixtures
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSPRINK
Lawn S rinkler/Backflo
PLUMBING
BPSTORM
Storm/Rain Water
PLUMBING
BPTRAP
Kitchen Trap
PLUMBING
BPVENT
Alt of Drain & Vent
PLUMBING
BPWATER
Install/Alter Water Pie
PLUMBING
BPWHEATER
Water Heater/Vent
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BREINSPECT
Reinspection Fee
BUILDING
BREMACOVER
A/C Unit > 10,000 clip
MECHANICAL
BREMAIRHAN
A/C Units <= 10,000 cfm
MECHANICAL
BREMAPPLI
Appliance Install
MECHANICAL
BREMBUSWAY
Remodel Busways
ELECTRICAL
BREMFIXT
Lighting Fixtures
ELECTRICAL
BREMFURN
Relocation of Furnace
MECHANICAL
BREMFURNOV
Relo Furnace > l OK btu
MECHANICAL
BREMHEAT
Heater Installation
MECHANICAL
BREMINHOOD
Installation of Hood
MECHANICAL
BREMMISC
Misc Apparatus
ELECTRICAL
BREMNRAPP
Rem Non -Res Appliance
ELECTRICAL
BREMPOLE
Pole/Platform Fixture
ELECTRICAL
BREMPOWER
Power Device/Apparatus
ELECTRICAL
BREMRECEPT
Rc tl, Switch & Outlets
ELECTRICAL
BREMRELOCA
Relocation of Hood
MECHANICAL
BREMREPALT
Repair/Alter Heating
MECHANICAL
BREMRESAPP
Remodel Res Appliance
ELECTRICAL
C.
2of3
CITY OF
CUPERTINO
CITY OF CUPERTINO*
PERMIT APPLICATION FORM
Quantity Fee ID
Fee Description
Fee Group
BREMSIGNAD
Rmdl Signs Add Branch
ELECTRICAL
BREMSIGNS
Remodel Signs, Marquee
ELECTRICAL
BREMTHEATR
Theatrical Lighting Fix
ELECTRICAL
BREMVENFAN
Vent Fan Single Duct
MECHANICAL
BREMVENSYS
Ventilation Systems
MECHANICAL
BSCBLVD
Scb Specific Plan
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSPECIAL
Special Inspection
BUILDING
BSWIM
Swimming Pool
BUILDING
BTEMP
Temporary Power
ELECTRICAL
BTEMPPERM
Temporary Bldg Permit
BUILDING '
BTEMPSVCS
Temp Dist Svcs
ELECTRICAL
BUSLIC
Business License
BUILDING
ELECTRIC
Electrical sq foot
ELECTRICAL
EPERMITFEE
Elec Permit Issuance
ELECTRICAL
MPERMFEE
Mechanicals . foot
MECHANICAL
MPERMITFEE
Mech Permit Issuance
MECHANICAL
PPERMITFEE
Plumbing Permit Issue
PLUMBING
PPLBG
Plumbing Fee sq foot
PLUMBING
ZADDCHG
Address Chane
BUILDING
3 of 3