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03020048 CITY OF CUPERTINO BUILDING DIVISION PERMIT ^`o. e CTQTZTNP'U° MA7.' BUILDINGADDRESS: - PERMIT NO. HIEN Q. TRUONG OWNE S%up RP&BY Elk PERMIT ISS .� 3 ow SANITARY OL NO. ARCHITEC IENOINEER: BUILDING PERMIT INPO BLDG ELECT PLUMB MECH 3dF, hereLICENSED CONTRACTOR'S DECLARATION I by affirm that l am licensedddrum,uMer pmvhlau of Chapter 9(commeecing Job Description tj with Eeedn�],IX10) slon3of the Budnutgntl Profeulan Code.and mylicenseh n In Tull fptrs:dntl cffcei.ett ter. jniE on. lass Cala DEMO . Date ARCMITECI-StO DATION PERMIT ISSUED 03/20/2003 . (yStlptnanJ my PI..,lot be used cmcortla PERMIT PRINTED IN ERROR 02/12/2003 4� Llcewed Pmfesslonl OWNER-BUILDRR DECLARATION I 1 herehy affirm that I am eump,form,he Cantrsmors License Law for Oe 00 following mason.(Section 703 1.5,Buioas and PrefaWot,Code:Any city at county Se! which roquims a pmol,to construct alter,improve.dcmolkh,Or repair any stramum b` prior N its Issuance,also requires thesplican,for such permit to rile ulgned statement ggg that he is licensed pursuant lathe provisions or the Contractor's ttnaeLaw(Chapter 9 Sq.Ft.Floor Area Valuation (commmming wlN Semon 70011)or Divistlon3 of de Budnus and Pmfesrinns CuWe)or .let he Is exempt theorron and the bash for On,alleged exempdon.Any violation of Section than five eery applicantsfor(S5�R subfem the applicant to s civil pandty of APN Number C $gtwny 3Ype not mart than Eve bundrW dollars ❑I uowner ofthe P"Femy,m myemployees wiN wagesa Nelr sole rompen,ation, will do the work,and Ne swctuse u no,Intended woRemd(Doak(Sec.10N,Business in d Prormion Cade:Toa Convu,ara Liana law don oat apply m an owner or 316 0 2 0 6 5 . 0 0 Required Inspections prory who but lid idt M i reproves Hereon.end who dwa.-'— . awh work hi m self ar IlvougA du awn employers,provided Net such Improvements art no,intended muferM fortelt Ir. however,the building or lmporwmML is mid within one year of completion.the owner. NO ASSIGNED INSPECTIONS builder will have the buNen,of proving that he did not bulla at Improve for purpose of p'�q LE® uta). [31.as owner of de ors property,am exclusively contracting with licensed cmMm ,a construct the pmjed One.7114/,Business and Profusion Codep The Contractors U. came,Lw does not apply tO an owner of property who Wilda or Improves decrease,and, gt 1 f1 who contractsfor such porjocM with acon,nctadq licensed pursuant ro He Cmursctoes APflrl R 1 O 2O03 Licenm taw. ❑^unexc ptunder See Dau P�f; Qa,nn BUILDING WORKERS COMPENSATION DEOr4RPON I hereby afum under penalty of pedury can of the following declarations; , ve - nd will malnWn x CaNfi sm of Consent to self-Inuit redwMecesconpen- udon,as provided for by Sacdon 3700 of the Labor Cade.fru the performance of the work for which this permit h issued. ❑1 haw and will maintain Workers Compensation Insurance,as required by Section 7700 of He labor Code,for the peufamnanec of the work for which this permit is issued. My Worker,Campewdon Insurance=let and Policy number aro: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (fish—it-mend n01 hecompleud lith permit is foond hundred dollars 01 or last.) 1 certify that In No performame of the work for which this permit h Issued,I shall not employ any person in any manner an as in become anbjec„p the Workers'COmpenudon Laws of Callfomis.Dau Applicant NOTICE TO APPLICANT:If.after making this CeNream of Exemption,you should become mbJew m the Worker's Compensation prwialons of the Lehr Code,you mut 0 O fodhwith comply with such provision or this rermitahall be deemed rammed. rCONSTRUCTION LENDING AGENCY [r thereby strum Na,then is a consmcdon Lending agency for He raferommec of ai the work fru which this pemll is issued(SM 3097,Civ.C.) W�Q Lenders Name z lender's Address U O 1 certify that 1 have read this application and sum Hat Ne Above Infwmadon is D.U COMOCL I apes,to comply with all city and county ondinances and sum laws nhting to 0 building construction.and hereby auNorire mPresenuuves Of this city to enter upon the W ahove-meMuned pmpery for Inspection Purposes (We)agree in taw.Indemnify and keep harmless the City of Cupertino against sew h liabilities.judgments,costs udeapemnewisch may in any way armee against said Chy U 7 in consequence of the granting of this permit r7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOIXT Issued by: Date SOURCE REGULATIONS. *,KZ_, Re-roofs . Y arum of AppUesnVCom DO pass HAZARDOUS MATERIALS Darmor an Type of Roof WIII y t applicant,o(mum building e.Chapter nom w handle Health a material u defined io the 32(a)? O Municipal Code.CTsmr 9.13,and He NcalH antl Safety Code,Section 33532(x)1 E]Ycs All roofs shall be inspected prior to any roofing material being installed. WIIIthe applicant w future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove uvi=11unr coaminant,u def ed by tie Bay Area Air Quality Management all new materials for inspection. m7 ❑Yes u 1 have mad He huudau,mamdals requirement,under Chapter 6.95 of the Califor. nit Hued@SatclyCodc,Smimu25505.25533,M125534.1utdcmand timllde Wilding does not currently have s naso,that It u my reaponibuity 0 Must' the awunnt ca om requimme uwhi mUB be mel prior u Bsouwc Of•Ccwr.ca of cut cy. Signature of Applicant Date Ownerun ore sen, Sp All roof coverings to be Class"B"or better •. • CITY OF CUPERTINO 1� 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp: Rng : Sub: Blk: Lot : APN . . . . . . . . : 31602065 . 00 DATE ISSUED. . . . . . . : 02/13/2003 RECEIPT # . . . . . . . . . : 21104 REFERENCE ID # . . . : 03020048 SITE ADDRESS . . . . . : 10628 RANDY LA SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER HIEN Q. TRUONG ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2055 RECEIVED FROM . . . . : HIEN TRUONG CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : HIEN Q. TRUONG ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2055 TELEPHONE . . . . . . . . : • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ------ ---- ---------- BPERMFEE VALUATION 4 , 000 . 00 97 . 00 0 . 00 97 . 00 0 . 00 BPLANCHK PERMIT FEE 97 . 00 82 .45 0 . 00 82 . 45 0 . 00 BSEISMICRE VALUATION 4 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ---------- ---------- ---------- ----- - ---- TOTAL PERMIT 179 . 95 0 . 00 179 . 95 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 179 . 95 VISA TOTAL RECEIPT 179 . 95 • Pacific Gas and 10900 North Blaney Avenue Electric Cupertino, CA 95014 Company 1 City of Cupertino D 10300 Torre Ave. D Cupertino, Ca 95014 INAR 2 0 2003 To Whom It May Concern: y— Subject: Removal of Gas and/or Electric Facilities The gas and electric facilities have been removed and/orab doned at Ioban 1k Ara Dy L+J , cuPGlT-nNo on 3 / 1Dq . If you have any further questions, please contact me at (408) 725-2024. Sincerely, • Service Planning SCITY OF CUPERTINO* DEMO O� ° z �" 4-1 CUPERTINO PERMIT APPLICATION FORM APN # Date: Building Address: 0 7 2 S Liv ^, o c �5- Owner' Name:Phone#: n x/'60 Contractor: License#: Contact: Phone#: Applicant/Contractor: A/n e,r pSq.Ft Permit Info: Elect Plumb Mech ription: al: f S(d t•,i Commercial: oor Area: Architect/Engineer: -Valuation- Type of Construction: Occupancy Grou • Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILIDNG BSEISMICOM Seismic Commercial BUILIDNG BSEISMICRE Seismic Residential BUILIDNG BPLANCHK Plan Check Fee BUILIDNG BUSLIC Business License BUILIDNG f y FEB 13 2 03 I V ' i i W I o Daae Y6trca -_� I Q Y • 7 3� /6'6"t lioe p�/In fah snow T."ie2 !Oec.�� „2 ,�2 — �o6al rp h'•�„ ©�/ rev ZANE- 01/21/03 10:52 FAX 636 256 4340 CITIMORTGAGE PRESIDENT 001 ............ FIM .............. IF: , SM CO. S*M" dfi mortgage" P.O. Box 790001 Saint Louis, MO 63179-000I January 21, 2003 rtk'I CITY OF CUPERTINO FEB 1 3 2003 ATTENTION: STJSANMACGOWAN 10300 TOFRE AVENUE CUPERTINO, CA 95014-3255 RE; MORTGAGOR(S)NAW.: HIEN Q TRUONG NGHI CHAU PROPERTY ADDRESS: 10628 RANDY LAINE CUPERTINO, CA 95014-2055 Dear Ms NfacGowan: CitiMortgage,Inc. has received your request for information on the demolition of the above referenced • property. Please be advised the above referenced mortgage loan was paid in full January 17, 2003. Therefore, CitiMortgage,Inc. no longer has any interest in the above property. If I may further assist you,please contact me directly at 1-(800)-695-0384, extension 6-5513. When you call or write, please refer to loan number 2000215211. Thank you. --�incerely, Judy Travis Customer Service Representative Enclosure(s) Cc:Fax 1-(408)-777-3333 Hien Q. Truong Nghi Chau • *Call;are randomly monitored and mcorded to enure quality Service. Ch!Mompg.. tae.d.a bus4m,a Cia.rp Movpp i.MT and NM. Antember of cittgroupT SU- *93 Rev. 07102 01/07/03 14:06 FAX 636 256 4340 CITIMORTGAGE PRESIDENT 001 '\MM cmtomcr Scrvicc a J mortgage P.O. Box 790001 Saini Lows, MO 63179-0001 January 7, 2003 CITY OF CUPERTINO ATTENTION: SUSAN MACGOWAN 10300 TORREAVENUF CUPERTMO, CA 95014-3255 PF: MORTGAGOR(S)NAME: MEN Q TRUONG NG141 CHAU PROPERTY ADDRFSS: 10625 RANDY LANE CUPFRTINO, CA 95014-2055 Dear Ms MacGowan: CitiMortgage, Inc. has received your request for information on the demolition of the above referenced property. Under the Security Agreement, the mortgagor(s) are obligated to maintain the property and ioveagreed not to destroy or substantially change the property. Their failure to keep these promises and agreements gives the Lender the right to require irrunediate payment in full CitiMortgage, Inc. does not consent to the demolition of the property. We reserve the right to exercise all _fights under the Security Agreement at anytime. If the mortgagor(s)elect to pay the loan in full, we will -elcasc the Lien. The mortgagor(s)may call and request a Payoff Statement mailed to them. If I may further assist you,please contact me directly at 1-(800)-695-0384, extension 6-5513. When you ,--all or write, please refer to loan number 2000215211. Thank you. Sin erely, /Customer Travist Customer Service Representative .Znclosure(s) FEB 13 2003 Cc: Fax 1-(408)-777-3333 Hien Q. Truong Nghi Chau • "Calls an randomly nionimcd and recorded to enRlTt CILUbly service. SU- 193 Rev.07102 Ci6Mor"c,Lw.do=business u 1.MT NM. Amemberofatqrouo�j _ FROM :MRPo< CU11HO �Ff�rX NICD. :411W16816!91101426 t- c7 2OP3 35:37K] ?S MC Crodlnp• 541•Oemotttlo^ �I lel ,o, Lie. No.No.641663 2491 Ototl-va VJay • San Jose.OA.O M-o Kqk 9o. "r oa ewrmo. (40M 846.0945 Mobile(SW 234.1900 ' ......_....- ........ _...._.... .... % OAT. =ampla"ad ciRcauon aMc^a[-vil star PDT T a (�fl We femiAh you with the following proposal for your cons+dorahua ON Pollows FEB �_3- 2D03._. . - .._._.._. _._.._... ----------- bemolt<,bfz u['....,'rct]me at „ -.-_....t, t. .,.0628.....10,anc�a ......, �1¢u-f--=o:f...a-U- 4-6p-L.1-anC -CO2CM2. �. __......__.._..-.._.... . —....._...__.. ...__._..._....._._..... 5.U.e Wilul...6Q...,( t..e�,eRn.,.Q. ....cx zz-deb'xcA _._... -l:-a r._-tjre- o'a r...o�'- 94000 00 ._.._.......__. ... - ._...... ..... ... .--------- . . ... ..-.............. _...__. .... ....__._......_... ........__..._.__. Ll A--. 4 i£cma. .nat...ui.aZA.Le, rbundat.Lott..,b.cc.h�cJ !';n.�. , f.'io�a/i"ga�edL�g.., , . ....... .... . . ... ... .... .... . ( m'G:Yssafu9C 1]el ehry m Glrnlrl ruGerlul.xuJ luLvl '- i4m1%ld!e lit aceeniuncc with ifCx:peci(ie]Gnrie;nr t:'1e avm oG —i Fn.rn_��tau.ncnd_..arar..n:�{ — - olatalsta�{09f1:AB _�. Pavuble as fouoae: ---- 0 eimn ��C_O.n n .Vi munnu:'m duurunvredW i.:.e o�ecakA.Pll u.r,C,rr.MrnlmdwJ ie a.wr:nm�ik.n.�::nu ___- _- — NpV•+:cke.el.uiarC yr.-Z�:.4^.�W:e[aUon or de.n.mmf:cuwtn�':c ar•6lislio::u i:eelvinn Atrthovc2 >7tr cu4L•x�:P Fr tMWIA 4At�ureR.engin aitl:r1.anu wW DeWitt i(1 CFGS tiWJ,i o>'Cr 51Qrl8fUff. ,_ wYl 1GV1r tl:t:tTlllili[��.\11.rKTR.I�e:na r^r L:l.^_.[3!(MITT`•lnk<t.PrC1�V alv�f rlNk)'r!x')rt:nl <'ra anmmi bwrnrtu cfry lih:'.!nroIDfnn Imhnrnrresvm lne.lm:ve.Ourund: l4 duY ltpll' 4(YI"LTIUSp POtiy II+&V be wi[bJr.Pm: rnamn ry!v�rMmrn'.fom;<naa:uarlmure::nt by us llnot,at'cc{ila:vd(hi n_ .d";, '`ACCEPTANCE OF PROPOSAL---7![r.pr;ces,spzcificanons and mndl-ion?arc ssi7+:lHcl ury and:u'e�eretr'arxepted.ern[:,rq Nub-�I+�ztW m tln — nie work.'v aTmixilivl.1'ayTrt•nl will be xnao as oullned atmvc, • I`si;natorp _ Clalc.__ Slgnat::x Date City of Cupertino • • Public Works Department 10300 Torre Ave. Cupertino CA 95014 • (408).777-3354 Debris Bins Debrisfrom aproject in Cupertino can be collected and disposed of in either- 1. a Los Altos Garbage Co. bin(call 725-4020 to order), OR 2. a bin owned by the project's general contractor or demolition contractor, OR 3. a private truck with a bed, but no bin The Los Altos.Garbage Company is the only debris bin service provider franchised to do business in Cupertino. Bins from other leasing companies may not be used in Cupertino. Please check all that.appry:• .: EB - Y - ❑ I will use a Los Altos Garbage Company bih D ❑ I will use a bin owned by the general contractor or the de . ❑ I will use a private truck, and not dropa bin. ' FEB. 03 . . . Recyclable materials collecti®n Recyclable materials may be collected in private debris bins or containers leased from ANY company, as long as the materials are both-- 1. oth:1, separated by type of material into separate containers,AND 2, are not contaminated by garbage. Separated recyclable materials are materials that are separated into individual containers, • each containing just one type of recyclable material. Typical examples of recyclable materials include: metal,wood, concrete, steel-reinforced concrete, asphalt;tree trimmings, white goods,toilets, rocks'and clean fill dirt. Separated recyclables must ultimately be recycled or otherwise reused, and not disposed of in a landfill. Contractor should be prepared to provide the name and phone number of any recycling companies being used on the project. A list of some local recycling companies that can accept separated recyclable materials is available in the literature display rack in the downstairs Planning/Building Department lobby. Si ature: - Date., /I • Name (printed) "ph,: lX N C� Tbb formtom=In intoPMied'sWftPUmaIleroruma=Wonof**pmisa. COGS FIDE DEPARTMENT - --, i� T, F SANTA CLAM COUNTY D' �' : ' ° i • 14700 Winchester Bw., Los Getos, CA 95032-1818 (408)378-4010 (phone) • (408) 378-9342 (fax) April 1, 1999 By City of Cupertino . Mr. Joe Antonucci, Building Official 10300 Torre Avenue Cupertino, CA 95014 Subject: Building Demolition Request Dear Mr. Antonucci: The Santa Clara C-ounty.Fire Departinent is continually looking for buildings that are being demolished to use for fire training exefcises such as search and rescue, 4 ventilation, and forcible entry-exercises. These training exercises have.proven to be a valuable tool in teaching and •reinforcing our employees' knowledge of firefighting. If an owner wants to donate property that is scheduled for demolition, the following procedure is followed: • The owner contacts the fire department with the address of the property. • • The fire department checks the location to see if the building meets their needs and verifies.that the property is owned by the requesting individual. • The fire .department signs a hold harmless agreement with the owner. (The' fire department assumes liability for their employees while at the site.) The fire department will notify all the surrounding neighbors that a fire training exercise wilt be conducted. This program has been.very successful with our agency. By using an available resource in the community, the community benefits as well as the fire department: We would appreciate your assistance in asking your building department to notify builders of our request and give them a copy of this letter. Thank you. Sincerely, Kenneth L. Waldvogel Deputy Chief/Training Division KLW:jh EM0LMMi1tEQV6T.L71t.JH"W1 . . - A Callfornla Flre protection Distriet serving Santa Clara County and the communities of Campbell, Cupertino,Los Altos,Los Alta Hills,Los Gatos,Monte Serena,Morgan Hill, and Saratoga 0 0 ASBESTEST, INC. • 1550 Dell Avenue,Suite G Campbell,CA 95008-6912 (408)374-3362 Fax(408)374-7269 CLAN'S ELECTRICAL January 27, 2003 3021 LINBURN CT. SAN JOSE, CA 95148 Job No. A-26521-03 ATTENTION: HIEN CLANG TROUNG PROJECT: 10628 RANDY LANE CUPERTINO ASBESTOS IDENTIFICATION BY POLARIZED LIGHT MICROSCOPY Non-Fibrous Fibrous Asbestos Other Fibrous Materials or Sample Identification Minerals. % Materials. % Minerals. % 1 KITCHEN/FAMILY ROOM NONE DETECTED NONE SAND, BINDER, FLOOR TILE 100% 2 SHEETROCK/JOINT NONE DETECTED ORGANIC FIBERS, BINDER, 97% COMPOUND COMPOSITE 3% • 3 STUCCO NONE DETECTED NONE SAND, BINDER, 100% 4 HOUSE ROOFING NONE DETECTED ORGANIC FIBERS, MISC. PARTICLES, 35% BINDER, 65% 5 CARPORT ROOFING NONE DETECTED ORGANIC FIBERS MISC. PARTICLES, TOP LAYER 35% BINDER, 65% 6 CARPORT ROOFING NONE DETECTED ORGANIC FIBERS, BINDER, 10% BOTTOM LAYER 90% This test report relates only to the items tested. The materials were examined by polarized light microscopy according to Environmental Protection Agency methods. Reported asbestos percentages were estimated based on comparison to test samples provided by the EPA. Samples will be stored for six months and then properly disposed unless prior arrangements have been made. Respectfully submitted, ASBESTE T, INCORPORATED Robert M. Kumagai FEB 13 2003 D Microscopist CAC 92-0841 B • kE(; )RDI'�G REQUESTED BY: T I t I es I / pages - S'•'.aRT TITLE OF CALIFORNIA, OC IA, INC. 1 6225098 DOCUMENT : IIIIIIIIIIIIIIIIIIIIIIFees 10 66 RQ. TRUONG PAIG 62 es IO: IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII AMTe625 7d HIEN 3021 Linburn Court San Jose, CA 95148 RDE a 009 ERENDA DAv15 a/22/2062 SANTA RECORDER 22 ,i,l _ Recorded at the rac;"est ORDER N0. _35336570 of j;ewar; Title ci Cali ornia ESCkC)Vv NO. 35336570 — SPACE A13pVE'f HIS LINE FOR RE'CORDER'S USE GRANT DEED 'The undeniened grantor(s) declare(s): A.P.N.: 316-02-065 Documentary transfer tax is S 625 . 90 City tux S 0 . 00 I rix) computed on full value of property conveyed, or 1 computed on full value less value of liens or encumbrances remaining at time of sole. ) Unincorporated area: (XX) City of CUPERTINO , and POR VALUABLE CONSIDERATION, receipt of which is hereby acknowledged. MILDRED D . SPENCER A WIDOW hcrehvVRANTSto HIEN Q . TRUONG NGHI CHAU HUSBAND AND WIFE AS JOINT TENANTS - the liilluwing described real prupcny m the City of CUPERTINO County of Santa Clara . State of California SEE ATTACHED EXHIBIT "A" D D FEB 13 2003 By — DA'rE: April 12 , 2002 i STA'rE OF CALIFORNIA } MILDRED D . SP CER } ss. COUNTY Ori �- Un /5�.:'1 before me pe.,' rally appy��yre} 1 re �1�Lf'CY^6 ty perso8ally known to me (or proved to'nneit the basis of sauslac- `�o-:a�• tory evidence) to be the person(s), whose name(s)'is/are sub- scribed to the within instrument and acknowledged to nne that he/she/they executed the stone in his/her/their authorized r ^ capacilvOcs), and that by his/her/their signature(s) on the instru- ' t the person(s) or the'entity upon behalf of which the per- s) acted. executed the instrument. WITNESS my I and and official sea Signature �� '� �'i / (This area for official notarial seal) . ntnu.'rnx s'rA'nt�\it:N rs .As Duaecn:o Aaox-I: NTRWt 5M e�o mortgage Customer Service P.O. Box 790001 Saint Louis, MO 63179-0001 January 21, 2003 CITY OF CUPERTINO ATTENTION: SUSAN MACGOWAN 10300 TORRE AVENUE — ,------CUPERTINO, CA 95014-3255 _ RE: MORTGAGOR(S)NAME: hIIEN Q TRUONG NGHI CI-IAU PROPERTY ADDRESS: 10628 RANDY LANE CUPERTINO, CA 95014-2055 Dear Ms MacGowan: ' I CitiMortgage, Inc. has received your request for information on the demolition of the above referenced property. Please be advised the above referenced mortgage loan was paid in full January 17,2003. Therefore, CitiMortgage,Inc.no longer has any interest in the above property. If I may further assist you,please contact me directly at 1-(800)-695-0384, extension 6-5513. When you call or write,please refer to loan number 2000215211. Thank you. incerely, Judy Z"is Customer Service Representative i Enclosure(s) Cc: Fax 1-(408)-777-3333 I-Iien Q.Truong U L lU ll Ll Nghi Chau By--- -Calls y --•Calls are randomly monitored and recorded to cnsum quality service. SU- 193 Rev. 07102 CdMongage,me don bo.lncm v Citicorp MonMg in MT and NM. _ _ AmeMberof caigroup? SANTA CLARA COUNTY • *1AA 408-4010 VECTOR CONTROL DISTRICT 1-800-675-1155 976 Lenzen Ave. �;.. G 4 _ -:.x Technician's # San Jose, CA 95126 �y `y-e www.sccvector.org chnician onno� RODENT HOME & YARD IN--/SPECTION FORM SR# 21MY7 Address: /rt/-2 (l /i/L City: Owner O Tenant O Previous Visit: ATTRACTANTS FOUND: O Pet food/birdseed O Fruit O Nuts O Citrus O Uncovered garbage cans O Insects(snail & slugs) O Vegetable garden O Harborage O Other ENTRY &ACCESS POINTS TO BUILDLINGS NEEDING REPAIR: O Vent screens, attic&foundation O Holes in roof O Pet doors O Open doors&windows O Chimney O Fences O Trees O Patio cover O Crawl space opening O Unfinished construction O Pipes, cables&wiring entering walls& foundation O Under/around garage doors(s) O Over-lapping roof lines O Other� ///L- /ifiJ P, ANIMAL DAMAGE TO: O Lawns O Gardens O Flower beds O Roof O Vent screens O Fo dations O Sidewalks O Heating ducts O Insulation O Wiring O Plumbing O Other 4119 P, • THE FOLLOWING IS NEEDED FOR YOUR PROPERTY TO MINIMIZE OR ELIMINATE RODENT PROBLEMS O Weather stripping around garage and house doors O Remove any trash accumulation O Keep sheds tightly closed O Seal where pipes/wires enter building _ O Keep crawl space covers in good condition and secured O Spark arrester needed onrent O Seal all openings where roof-lines overlap O Replace and/or reinforce screensO Harvest all ripe fruits, citrus and nuts from trees and off ground O Ivy or other plants thinneErBemio3 003 O Keep all garbage cans covered and secured O Keep all doors and windo jByLosecl after sunset O Keep all pet doors closed and secured O Take all pet food and containers inside by sunset O Cut back all trees, bushes and shrubs approx. 24-36 inches from roof O Store all firewood approx. 18"above the ground and 12"away from any structure Comments:�,N40/ lLtZk�i�n22f.z15 SS PROPERTY OWNER/TENAT PLEASE NOTE:After all entrances are sealed shut, any rodents left inside the structure �hould be trapped with a snap trap. Traps should be baited with oatmeal,walnut meat, or peanut butter CAUTION: Do not use Any rat poisons inside structures THE AS VE CONDITIONS HAVE BEEN FULLY EXPLAINED TO ME � 9 SIGNATURE(OwC� ant): ZLC � DATE: / ®5653 nFV W02 "