12060064 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21744 OLIVE AVE CONTRACTOR:ANTIQUE TERMITE PERMIT NO: 12060064
& PEST
OWNER'S NAME: PEW SKILJ 1913 STONE AVE DATE ISSUED:06/12/2012
OWNER'S PHONE: 4089048269 SAN JOSE,CA 95125 PHONE NO:(408)995-6300
❑ LICENSED CONTRACTOR'S DECLARATION r r r
BUILDING PERMIT INFO: BLDG ELECT PI.UNIB
License Class Lie.q
MEGA RESIDENTIA I. COMMERCIAL.
Contractor Date
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: APT F-REPLACE SHOWER AND REPAIR SUIIFLOOR IN
BATIIROOM
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penally of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:S3593
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35719084.21744 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state That the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the GG''--
granting of this permit. Additionally,the applicant understands and will comply Issued by: prhl Date: (.D. 1 I-
with all non-point source regulations per the Cupertino Municipal Code.Section
9.18. C20C In1114--$t 2OLoOOS7
(-'( SI r c RE-ROOFS:
SigSignature�tU Gf -�-ta r'Gg Date All roofs shall be inspected prior to any material atcriul being installed. II'u roof is
installed without lirst obtaining an inspection,I agree to remove all new materials for
inspection.
0 OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of -
the following two reasons: AL1.ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,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&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to IIA"/-ARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code.Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
declarations: Ilealth&Safety Code,Section 25532(a)should I store ur handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation.as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality.Management District
performance of the work for which this permit is issued.' will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safety Code,Sections 25505.25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:
permit is issued. — -
I certify that in the performance of the work for which this permit is issued.I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If.alter making this certificate of exemption.I CONSTRUCTION LEN'DIN'G AGENCY
become subject to the Worker's Compensation provisions of the I.abor Code.I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec,3097.Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save ,\RCIIII'F:CTT'S DF:CLAR,VI'ION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs.and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records:
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
Community Development
10300 Tone Avenue
•
1 °• Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
CUPERJINO
Building Department
JOB ADDRESS: PERMIT
2- - t Oil isia,4ue v2 • Z O(v 6 S 7
, a
OWNER'S NAME: . . : Ppm) cc I PHONE # a, - qs - C''OC')
GENERAL CONTRACTOR4jPe-c FAX # 0 : • / - •S
Lam not,usingany subcontractors: U " GO/ l i II a
-.Signature Date
Please check applicable subcontractors and complete the following information:
® SUBCONTRACTOR BUSINESS NAME ; BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
•
Lathing
Masonry
Ornamental Sheet Metal -
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile •
•
Owner Contractor-S%iiature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 35719084 . 00 pPdO ON-)
DATE ISSUED • 06/11/2012 VYh 14-RECEIPT # • 85000017038
REFERENCE ID # . . . : 12060057 j 2010 DoS�
SITE ADDRESS • 21740 OLIVE AVE
SUBDIVISION
CITY • CUPERTINO
IMPACT AREA
OWNER • PERO SKLIJ
ADDRESS • 4150 WILLIAMS RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95117
RECEIVED FROM . ANTIQUE TERMITE, IN=
CONTRACTOR MICHAEL R MEEK LLC # 24455
COMPANY • ANTIQUE TERMITE & ?EST
ADDRESS 1913 STONE AVE
CITY/STATE/ZIP : SAN JOSE, CA 95125
TELEPHONE • (408) 995-6300
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
1BCBSC VALUATION 7, 185 .00 1 . 00 0 . 00 1 .00 0. 00
1BSEISMICR VALUATION 7, 185 . 00 0 . 72 0 . 00 0 . 72 0 . 00
1REMRESBAT SQ FEET 12 . 00 588 . 00 0. 00 588 . 00 0 . 00
TOTAL PERMIT : 589 . 72 0 . 00 589 . 72 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
CHECK 589 . 72 #12922
TOTAL RECEIPT : 589.72
I,o`rowo-q
\\ ' 1/ CONSTRUCTION PERMIT APPLICATION
%' COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
/,r,,,\ 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 l
CUPERTINO (408)777r3228 • FAX (408)777-3333 •buildinnacupertino.orq
0 NEW CONSTRJUCFI`ON 0 ADDITION ALTERATION/TI 0 REVISION/DEFERRED I �yORIGINAL I'EE�RMIT ii
-----.-" ;C/,•jl7/ IV/I\l/fJ' . 01 �1�V�l A-Q \PN$ .4 - / 111 / `-'ALV. 2/7 / el
OWNER NAME 7n< YO SPS I J ( o.1I Pllq�— 'Jo v....6„.„).6
C, I 1:-MLAll. J
STREET ADDRESSi4[5b 7�IA 1�1Iq\t&LmT. .e(/1 CITY.Ys TATE.ZIP I r\e
CONTACT NAME LU/S R oc.Q4I V�7 PI IONI'. _ E-MAIL / 7-
(� �/�".L?!�' 0`9-' �Urf— �7 ".S Co 71.3 C-17-7-) . nU OD Qr�7tf Wit' /t'r„el I`e . ('. \„
STREET ADDRESS CITY,STATE, ZIP F,X
i rf17, Sl"v„e_ A-uQ - „Stint 7c c-12_ Cel— i< --.S aocf ;SS GS/ 2
❑OWNER 0 OWNER-BUILDER ❑ OWNER AGENT "4ONTRACTOR ❑CONTRACTOR AGENT 0 ARCHITECT ❑ENGINEER ❑ DEVELOPER 0 I[NAN'I
CONTRACTOR NAAIE Al I( AGG' /Z. fiC2,11/4_ LICENSE NEMER . LICENSE TYEE IVIS I.ICM y c
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PRI 1e7trlo6S.);8sI, / .Q Otf /
CO.+II'ANY W\KIE E:MAI FAX
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SI REFI ADDRESS, CITY.STATE.ZIP 1S- PI IONE
let3 `s-or`-e. AN- a
Scs-� a-A-- 4S)�-- 4os-i-C63ce,
ARCIIITET/ENGINEER NAME LICENSE NUMBER BUS TIC•
COMPANY NAME E-MAIL FA.X
STREET ADDRESS my.STATE.ZIP PHONE
DESCRIPIIONOF WORKT1
f-e0-T-- o Ut show-Q,— / re, p I c. .ma.... — 0 -C— SQ �t,c-
�lJt-D-e\Our rte.eU\t 1 //v go,---,ii -
11 APIF
EXIST LNG USE PROPOSED USE CONSTR TYPE $STORIES
-51C/7 -51C-7. _\ /) USE ITTOCC SU FL VALUATION'1 Si
EXIST G NI:0-FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
-
RATIIROOMKIIIEN OTHER '
REMODEL.AREA L?554 REMODELI(' AREA REMODEL.AREA
PORCH AREA DECK AREAI TOTAL DECKIPORCII AREA GARAGE AREA ❑DETACH
❑Al TACH
$OWIiLIING UNITS. IS A SECOND UNIT DYES SECOND STORY OYES -- G
BEING ADDED? ONO ADDITION? ONO ' 13
PRE-APPLICATION OYES IF YES.PROVIDE COPY OF IS TIE BLDG AN ❑YES ;RECEIVED Tot••• ”""^TInN
PLANNING APPL• 0 NO PLANNING APPROVAL LETTER EICHILER HOME? 0 N
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the preipeny owner's behalf I have read this
application and the information I haved is rreci ave read the D scription of Work and verify it is accurate? I agree to comply with all applicable local
ordinances and state laws relating true( aut rep at ICupenino to enter the abuve-irntif d property for inspection purposes
Signature of Applicant/Agent: Dale (O-/i t�/ /----
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP
_New SPU or Multifamily dwellings: Apply for demolition permit for / OVER-TRE-COUNTER 0 BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. 0 EXPRESS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD 0 PUBLIC WORKS
form if any I hazardous Materials are being used as pan or this project.
❑ LARGE ❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
. I 0 ENVIRONMENTAL HEALTH
Jgdk;I pp.?011.dor revised 062 t i l l
. 1 WOOD•
DESTROYING PESTS AND`ORGANISMS INSPECTION REPORT
BUILDING NO. STREET.CITY.STATE.ZIP q Dale of Inspection No.of Pages
•
21744 OLIVE AVENUE CUPERTINO CA 95014 5/15/2012 9
ANTIQUE TERMITE; INC:; gVE}D
1913 Stone Avenue, San Jose;•CA 95125 BEIC
Ph: (408)995-6300 (408)99570517 Fax SUN 1 ZOV2
•
Firm Registration No. PR 1187_:. .; Report No. "47451 Escrow No.
Ordered By: • Property Owner/Party of Interest Report Sent To:
REAL PROPERTY INVESTMENTS PERO SKILJ
1872 HOMESTEAD ROAD 21744 OLIVE•AVENUE
•
SANTA CLARA,CA 95050 CUPERTINO,CA 95014
Attn: TOM ANTONOPOULOS
408-985-9666 408-985-9752 •
•
•
COMPLETE REPORT E LIMITED REPORT ❑ - SUPPLEMENTAL REPORT ❑ REINSPECTION REPORT ❑
General Description; Inspection Tag Posted:
ONE STORY SINGLE FAMILY DWELLING WITH,WOOD-FRAME AND WOOD SIDING
EXTERIOR -
7 Other Tags Posted:
An inspection has been made to the'structure(s) shown on the diagram in accordance with the Structural Pest Control Act. Detached porches, detached
steps,detached decks and any other structures not on the.diagram were not inspected.
Subterranean Termites IN Drywood.Terrnites 1 • Fungus/Dryrot ® Other Findings IN Further Inspection
If any of above boxes are checked, it.indicates•tliat.there were visible problems in accessible areas. Read the report for details on checked items.
•
DIAGRAM IIOT TO SCALE,
•
st!iFFICE Copy
17A 11A 118 11C • . ..
COMMUNITY DEVELOPMENT DEPARTMENT 1F 1B
BUILDING DIVISION-CUPERTINO' qv1E IA 10A 1c 18
APPROVED 1C 1C
This set of plans and specifications•MUST be kept at the ID
jcb site during construction. It Is unlawful to make any
changes or alterations on same,or to deviate
therefrom,without approl7ahfrorrithe•Buildi tg Official.
The stamping of this plant and specificatlonsSRBLL NOT
be held to permit or to'be ari approval of the violation
of any provisions of any''Citityy Ordihanbe or State Law. 6A
BY 1Efl/v' . 6A
DATE 6 ' /// 47- - 6A 68
PERMIT NO. /c7e) C7.' '
•
Inspected by LUIS E. RODRIGUEZ State License No.FR38503 Signature
You are entitled to obtain copies of all reports and completion notices on this properly reported to the Structural Pest Control Board during the preceeding Iwo years.To obtain copies contact:Structural Pest
Control Board.2005 Evergreen Street.Suite 1500.Sacramento:California 95815.
NOTE:Questions or problems concerning the above report should be directed to the manager of the company.Unresolved questions or problems with services performed may be directed to the Structural
Pest Control board al(916)561-6706.or(800)737-8185 br www,peslboard w,gov. 4311-41(Rev.10101)
J ,
2nd
PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
21744 OLIVE AVENUE, CUPERTINO CA 95014 5/15/2012 47451
BUILDING NO. STREET.CITY.STATE.ZIP INSPECTION DATE REPORT NO.
AREAS NOT INSPECTED:The interior of hollow walls, areas beneath and behind built in cabinets were not inspected since
inspection of these areas are considered impractical. We did not water test and do not certify against leakage of any
appliances, plumbing over finished ceilings, roof coverings or decks. Such actions, were not performed, they are
considered impractical without specific written authorization. Floors which are carpeted makes inspection of the flooring in
these areas impractical. Soffitted (enclosed framing) areas of the structure, makes inspection of interior framing
inaccessible for inspection. We make no guarantee against infestations, leaks or adverse conditions which may exist in
such areas not inspected. Attached and/or detached fences were not inspected unless otherwise stated in the body of this
report. Further inspection is recommended. Further inspection of any inaccessible area and/or area not inspected would be
performed upon request at an additional charge (with written authorization). This property was not inspected for the
presence or absence of health related molds or fungi. By California Law we are neither qualified, authorized, nor licensed
to inspect for health related molds or fungi. If you desire information about the presence or absence of health related
molds, you should contact an industrial hygienist.
No furniture or appliances were moved or removed, limiting this inspection to the visible and accessible areas of the
above structure shown on the diagram. No statements can be made regarding conditions in closed walls, floors
beneath coverings, areas below or behind appliances and built-in cabinet work, stall showers over finished ceilings,
such structural segments as porte cocheres, enclosed bay windows, buttresses and similar areas to which there is no
access without defacing or tearing out lumber, masonry or finished work. Antique Termite Inc. does not inspect roofs.
Should interested parties desire further representation regarding roof, interested parties should contact a licensed roof
contractor. Antique Termite assumes no responsibility for leaks not evident during the time of this inspections. Our
inspectors are not equipped with extension ladders, therefore all buildings will be inspected from the ground level only. All
wood members above 10 from the ground level would be visually inspected only (no probing, etc). Further inspection of
these inaccessible area(s) or area(s) not inspected is recommended and will be performed upon request and at an
additional fee.
REINSPECTIONS: If requested by the person ordering this report, a reinspection of the structure will be performed.
This company will reinspect repairs done by others within four (4) months of the date of the original inspection. A
charge, if any, can be no greater that the original inspection fee for each reinspection. The reinspection must be done
within ten (10) working days of request. The reinspection is a visual inspection and if inspection of concealed areas
is desired, inspection of work in progress will be necessary. Any guarantees must be received from parties
performing repairs, Antique Termite & Pest Inc. does not guarantee work performed by others. Reinspection fee is
payable at the time of inspection.
GUARANTEES: On work (labor) performed by Antique Termite Inc. are for one (1) year from the date of completion.
Guarantees for local chemical treatments are limited to wood members treated only. Fumigations are guaranteed for
one year from the date of completion. Plumbing repairs (parts provided by this firm), linoleum (vinyl materials), toilet
resets or any other measures for the control of moisture (caulkings and grouts etc.) are guaranteed for thirty (30)
days. Antique Termite, Inc. assumes no responsibility for water damage if the shower enclosure is not installed
immediately. The guarantee on showers and tub units is void if the area is used before 24 hours. If the shower fixtures
do not fit the owner must contact other tradesman to have new fixtures installed. If necessary for floor installation,
vanities are to be removed and replaced by others. Kitchens and laundry areas also must have appliances
removed before installation. An additional fee of $ 75.00 per appliance and or furniture will be charged for Antique
Termite to remove and/or reinstall. We do not do painting,texturing, staining or wallpapering.
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, recommendation to correct these findings may vary from
company to company. You have a right to seek a second opinion from another company.
ANTIQUE TERMITE, INC. --License No. PR 1187
•
•
•
3rd .
PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
21744 OLIVE AVENUE; CUPERTINO CA 95014 5/15/2012 47451
BUILDING NO, STREET.CITY.STATE.ZIP INSPECTION DATE REPORT NO,
WHILE PERFORMINGTREATMENTS OR ANY CONSTRUCTION REPAIRS, ANTIQUE TERMITE INC. WILL NOT BE
RESPONSIBLE ORLIABLE•FOR ANY DAMAGE TO ELECTRICAL OR PLUMBING WHICH MAY BE CONCEALED IN
WALLS OR BELOW SLABS. BUILDING PERMITS REGARDING REPAIRS WHICH A BUILDING PERMIT IS
REQUIRED, IF ITIS'FOUND-THAT LOCAL BUILDING CODES REQUIRE ADDITIONAL REPAIRS TO BE
PERFORMED, THESE ADDITIONALREPAIRS WOULD BE AT THE OWNERS EXPENSE AND SAME WOULD BE
OUTLINED A SUPPLEMENTAL;REPORT.
TILE OR LINOLEUM SELECTIONS: Bids which are given in report for replacement of ceramic tile or linoleum
are based on using standard grade material. Ceramic tile bids are based on standard-square 4 tiles at a cost
of $2.78 per square foot for.shower walls or tub shower walls. Ceramic floor tile bids are based on 8x8 tiles at
$2.75 per square foot.'Tile selections can be made at Dal Tile 2549 Zanker Road San Jose CA 95131
408-435-1566. Linoleum bids are based on using standard grade linoleum at $.99 per square foot.
Linoleum selections can, be made at S&G Carpet 4952 Almaden Expressway, San Jose, CA 95118 (408)
414-1188 Tile and/of-linoleum selections must be made at least 5 days prior to scheduled repairs. Any
upgrades, must.be paid by client at the time of selection. If NO selection is made prior to repairs,
standard/neutr'al 'color tile or sheet vinyl will be installed.
MOLD POLICY STATEMENT:41olds, sometimes called mildew, are not wood destroying organisms. Branch 3 licensees
do not have a duty under the Structural Pest Control Act and related regulations to classify molds as harmful to human
health or not harmful to human health. This does not modify the Structural Pest Control Act or relate d regulations.
SECONDARY RECOMMENDATION (SUB STANDARD): Anytime a secondary recommendation (local treatment) is
recommended, we must state who requested this secondary recommendation. Secondary recommendations are
considered sub standard recommendations and guarantees are limited to treated areas only as stated in report.
THIS ISA SEPARATED REPORT WHICH IS DEFINED AS SECTION I, SECTION II AND UNKNOWN FURTHER
INSPECTIONS CONDITIONS''EVIDENT ON'THE DATE OF INSPECTION.
SECTION I: Contains items•where there is evidence of active infestations, infections, or conditions which have resulted in
or from infestation or infection.
SECTION II:Are conditions deemed likely to lead to infestation or infection, but where there is no visible evidence of such
found.
UNKNOWN FURTHER INSPECTION: Recommendations to inspect areas which during the original inspection, did not allow
the inspector access to.complete the;inspectiomand cannot be defined as Section 1 or Section 2.
SUB STRUCTURE AREA:
ITEM 1A FINDING: Fungus damage was noted to the plywood subflooring under the tub shower.
RECOMMENDATION: Remove the three wall shower surround and tub. Remove and replace the
damaged subflooring with new material. Install a new standard grade tub, a new anti-scald valve,
and new standard grade wall tile set on cement board.
This is a Section 1 Item $ 3210.00
If it is found that during the course of repairs, damage and/ or infestation is found to extend into previously
inaccessible areas, a supplemental reportwill be issued outlining findings and costs for any additional
repairs or treatments. Antique-Termite Inc. does not do any texturing, painting or wall papering.
•
ANTIQUE TERMITE, INC. --License No. PR 1187
•
. • 4th ' ,''..
PAGE OF STANDARDIINSPECTION:REPORT ON PROPERTY AT:
21744 OLIVE AVENUE, CUPERTINO CA 95014 5/15/2012 47451
BUILDING NO. STREET.CITY.STATE.ZIP INSPECTION DATE REPORT NO.
SUB STRUCTURE AREA: •
TILE OR LINOLEUM SELECTIONS:.Bids which are given in report for replacement of ceramic tile or linoleum
are based on using standard grade material. Ceramic tile bids are based on standard-square 4 tiles at a cost
of $2.78 per square foot for shower walls or tub shower walls. Ceramic floor tile bids are based on 8x8 tiles at
$2.75 per square foot. Tile selections can be made at Dal Tile 2549 Zanker Road San Jose CA 95131
408-435-1566. Linoleum bids are based on using standard grade linoleum at $.99 per square foot.
Linoleum selections can be'.made' at S&GCarpet 4952 Almaden Expressway, San Jose, CA 95118 (408)
414-1188 Tile and/or linoleum selections must be made at least 5 days prior to scheduled repairs. Any
upgrades, must be paid by client at the time of selection. If NO selection is made prior to repairs,
standard/neutral:colortile..or sheet vinyl will be installed.
NOTE: A building 'permit will be obtained to perform repairs. Should local building
department require additional'documentation or additional repairs be performed in order to comply
with local building codes; same'would be outlined in a supplemental report along with additional
cost for same.
Addendum to Contract: Due to"recentchanges in the law, we are required to give you the following notice. Our
inspection report. contains a recommendation for lethal gas fumigation. This company subcontracts lethal gas
fumigation to : Cost Less Fumigation Inc. (408) 918-9100 or Driskell Fumigation (408) 920-6353 .
Notice: The chargefor service that this'company subcontracts to another registered company may include the
company's charges for arranging and-administering such services that are in addition to the direct costs associated with-
paying the subcontractor. You may accept Antique Termite Inc's bid or you may contract directly with another
registered company. Antique Termite Inc. will not be responsible for any act or omission in the performance of work that
you directly contract with another to perform. By signing the attached contract, you authorize Antique Termite Inc. to
subcontract this fumigation to a registered fumigation company.
ITEM 16 FINDING: Evidence of infestation by drywood termites was noted at the subarea. These
infestations appear to extend Into.inaccessible areas.
RECOMMENDATION: Seal up;and fumigate the entire structure with a lethal gas
(VIKANE/SULFURYL FLUORIDE AND CHLOROPICRIN) for the control of drywood termites in all
areas of the structure. Remove the seals for reoccupancy. NOTE Antique Termite is not liable for
any damage which may occur to roof or plant life during fumigation. Fumigation cannot begin
during inclement weather. In the case of rain or strong winds the job may be postponed to a
later date. Additional information will be shown on the Occupants Fumigation Notice which must
be signed and returned to'the fumigation department before the fumigation date. Structure must
be vacated for two nights (one.night to fumigate,one night to allow for proper ventilation.) All
preparation work to get structure ready for fumigation is owner/occupants responsibility. Should
owner desire a fumigation prep company to do the necessary prep-work, they should contact
Fumigation Department-there is a cost for this service, which will be in addition to price for
fumigation.
NOTE: Our bid does not include any prep work. All instructions must be thoroughly read and
performed. Failure to complete!fumigation prep or failure to return signed papers prior to
fumigation date will result in cancellation and/or rescheduling. Specific preparation instructions
will be issued oncefumigaition:is ordered.
This is a Section 1 Item $ 1331.00
NOTE: If fumigation is prepaid in full prior to fumigation date, discounted cost for
fumigation.would be.$1177.00.
• ' ANTIQUE TERMITE, INC. --License No. PR 1187
3 •
5th ' •
PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
21744 OLIVE AVENUE, CUPERTINO CA 95014 5/15/2012 47451
BUILDING NO. STREET.CITY.STATE.ZIP INSPECTION DATE REPORT NO.
SUB STRUCTURE AREA:
NOTE: If fumigation.is{prepaid in full prior to fumigation date, discounted cost for
fumigation would be $1177.00.
Prep is required for the property. Please contact ALDO @SMART PREP AT (408)
768-9401.
ITEM 1C FINDING: Evidence of infestation by drywood termites was noted in item 1B (fecal pellets).
RECOMMENDATION: In compliance with the Structural Pest Control Board, remove or mask
over all accessible drywood termite evidence (pellets) upon completion of treatments.
This is a Section'1 Item $ 175.00
ITEM 1D FINDING: Earth'dontact was noted at the cellulose debris (wood scraps, cardboard, ect.) in the
crawl space.
•
RECOMMENDATION: Remove and dispose of all cellulose debris of a rakeable size or larger.
This is a Section 2 Item $ 195.00
ITEM 1E FINDING: Fungus damage, drywood termite damage, and subterranean termite damage were
noted to the rim joist and sheathing in the area indicated on the diagram.
RECOMMENDATION: Remove the siding from the exterior. Remove and replace the damaged rim
joist and sheathing with new material. Replace the siding where removed. Contact other trades to
paint.
This is a Section .1 Item $ 795.00
•
If it is found that during'the course of repairs, damage and/ or infestation is found to extend into previously
inaccessible areas,.a•supplemental-report will be issued outlining findings and costs for any additional
repairs or treatments. Antique Termite Inc. does not do any texturing, painting or wall papering.
ITEM 1F FINDING: Evidence of infestation by.Subterranean Termites was noted at the substructure at the
approximate location. indicated on the diagram. The infestation appears to originate at the
exterior soil.
RECOMMENDATION: Dig.a trench at the exterior soil adjacent to the visibly infested area. Treat
with a registered•.termiticide and backfill the trench. Scrape down all accessible evidence of
infestation (sheltectubesp.upon completion. Proposed chemical Termidor SC-active ingred:
Fipronil. NOTE: Ourtguarantee for this treatment is limited to the treated area(s) only.
This is a Section 1 Item • $ 310.00
ABUTMENTS: •
ITEM 6A FINDING: There are hollow abutments and/or columns at the approximate location(s) indicated on
the diagram. The framing inside this area(s) is inaccessible for inspection.
RECOMMENDATION:, Further inspection recommended. If so desired, upon request we would open
the inaccessible areas and—perform further inspection. Any additional findings would be listed on
a supplemental report: Note: Our bid (if given) is for opening the inaccessible area(s) only, any
repairs or closing the areas opened would be an additional charge.
Unknown Further Inspection Recommended BID ON REQ
ANTIQUE TERMITE, INC. -- License No. PR 1187
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.c^ _
6th ,
PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
•
21744 OLIVE AVENUE, CUPERTINO CA 95014 5/15/2012 47451
BUILDING NO. STREET,CITY.STATE.ZIP INSPECTION DATE REPORT NO.
ABUTMENTS:
ITEM 6B FINDING: Fungus damage;was•noted to the 2x4 plate at the column.
•
RECOMMENDATION: Cut out the damaged section and replace with new material. Contact other
trades to paint.
This is a Section 1 Item $ 175.00
If it is found that during the course of repairs, damage and/ or infestation is found to extend into previously
inaccessible areas, a supplemental report will be issued outlining findings and costs for any additional
repairs or treatments. Antique Termite Inc. does not do any texturing, painting or wall papering.
OTHER-INTERIORS:
ITEM 10A FINDING:The hall bathroom toilet is loose.
RECOMMENDATION: Reset the existing toilet on a new wax seal. Note If any additional findings
are made, a supplemental report will be issued outlining any additional findings and
recommendations.
This is a Section 2 Item $ 175.00
ITEM 10B FINDING: The hall bathroom shower head was noted to be above the window. This condition may
allow moisture intrusion into the wall.
RECOMMENDATION: Owner should keep these areas well sealed and install plastic curtains.
This is a Section 2 Item OTHERS
OTHER-EXTERIORS:
ITEM 11A FINDING: Fungus damage was noted to the rafter tails at area indicated on the diagram.
RECOMMENDATION: Remove and replace the damaged rafter tails. Note: Should damage extend
further or into inaccessible areas, a supplemental report will be issued outlining findings and
additional repair costs. Roof coverings may have to be removed in order to facilitate repairs.
Owner to paint.
This is a Section 1 Item $ 195.00
ITEM 11B FINDING: Deteriorated paint was noted at the exterior.
RECOMMENDATION: Engage the services of a licensed painting contractor for repairs.
This is a Section 2 Item OTHERS
ITEM 11C NOTE: The detached structures were not inspected.
Information Item NOTE
If it is found that during the course of repairs, damage and/ or infestation is found to extend into previously
inaccessible areas, a supplemental report will be issued outlining findings and costs for any additional
repairs or treatments. Antique Termite Inc. does not do any texturing, painting or wall papering.
ANTIQUE TERMITE, INC. --License No. PR 1187
• Y..r :•
) . ..
• 7th
PAGE OF'STANDARD'INSPECTION:REPORT ON PROPERTY AT:
•
21744 OLIVE AVENUE;CUPERTINO CA 95014 5/15/2012 47451
BUILDING NO. STREETICITY.STATE,ZIP INSPECTION DATE REPORT NO.
All repairs completed by others -must be .reinspected by Antique Termite before certification will be issued. The
reinspection will only CERTIFY the absence of infestation of infection in the visible and accessible areas. Antique Termite
does not guarantee work completed by others, nor does this firm make any statements concerning workmanship of
those repairs. Workmanship,is only determinable by those paying for or receiving those services. A reinspection of
specific items on the report .or of any other condition pertaining to this structure can be done at an additional cost of
$150.00 per trip. This.reinspection must be performed within four(4) months of the Original Inspection Report.
REINSPECTION•FEE''OF.$150..00.Is:PAYABLE.AT THE TIME OF INSPECTION.
Antique Termite, Int. does not guarantee. work-performed by others. Such guarantees should be obtained from those
performing the repairs.7 Antique Termite, Inc. only certifies the absence of infestation or infection in the visible and
accessible areas. If it is.fbund that others.have concealed or hidden infestations or infections during the course of their
repairs, it will be the responsibility of interested parties to pursue the responsible party. Antique Termite, Inc. does not
inspect for or comment on•workrnan like manor on repairs done by others. Interested parties must satisfy themselves
with the proper permits and licenses andto the quality or appearance of work which is not completed by our company.
CHEMICAL NOTE:•'Section_8538: (a).:•!-!State-law requires that you be given the following information:
CAUTION--PESTICIDESARE.TOXIC CHEMICALS. Structural Pest Control Companies are registered and
regulated by the Stru'cturahPestControl 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'degree 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 physiclamor poison control center (800-876-4766) and your pest control
operator immediately'." (This•:statement shall be modified to include any other symptoms of overexposure
which are not typical of Influenza.).
For further information, contact the following:
Antique Termite Inca(408),995-6300, for health questions--County Health Dept (408) 918-3400, for
application questions--Cnty'Agriculture Commisioner(408) 918-4600, and for regulatory Information--
Structural Pest Control,Board•(916) 561-8700 located at 2005 Evergreen Street Ste #1500,Sacramento,CA
95825. The following list:of chemicalsmay be used by Antique Termite Inc. In the treatment of the above
mentioned property •
Chemical: r 'planufacturer: Active Ingredients:
Bora-Care Nisus•Corp. Disodium Octaborate Tetrahydrate
Zythor '.Ensystex Sulfuryl Flouride
Dragnet SFR FMC-Corporation • Permethrin
Tim-Bor • US Borax &Chemical.Corp. Disodium Octaborate Corp.
Tetrahydrate Sodium Borate"
Premise Foam Bayer.Corporation Imidacloprid
Termidor SC BASF Fipronil:Pyrazole
Power Plant Blizzard System D-Limonene
Cy-Kick Whitmire Micro-Gen Cyfluthrin
Vikane DowAgroSciences Sulfuryl Flouride
,:ANTIQUE;TERMITE, INC.L License No. PR 1187
' 8th
PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
21744 OLIVE AVENUE, CUPERTINO CA 95014 5/15/2012 47451
BUILDING NO. STREET,CITY.STATE.ZIP
INSPECTION DATE REPORT NO.
FUMIGATION NOTICE
Structural fumigants are colorless, odorless, and do not affectpaiints, finishes, or fabrics. Dishes and
utensils can be used without washing. By Federal law and as indicated by the label, the following
items must be removed before fumigation with any fumigant. Persons, plants, pets, baby.mattresses
enveloped with plastic covers. All food and medicines not sealed in glass or metal containers. This
includes food in refrigerator and freezers. It is to the responsibility of the occupant to have these items
removed_
Soil should be soaked with water at least 12" from the foundation outward. This can be done the
evening before and may help to protect plants. Vines and shrubs connected to the structure must be
freed by the owner with ample space provided to get fumigation tarps behind same. All antennae and
roof ornaments must be removed byowner or occupant. All automatic timing, devices (sprinklers,
lights, etc.) must be disconnected dring fumigation. Solar systems must be turned off and drained.
Should the owner desire a fumigation prep company to perform the necessary prep-work, please
contact our office and we can give you the name and phone number of a company which can perform
the necessary prep work for a fee. Il is the responsibility of the owner to takecare of all necessary
prep work. 1t prep work is not done when fumigation crew arrives, the job will be canceled for that
day.
Our crews must fumigate several structures in various locations each day. Therefore, the time that any
fumigation is scheduled for must be approximate only. Most fumigations are scheduled for sealing
some'lime duringthe first day and opened the next da after,proper exposure to the fumigant. The
time for ventilaion varies and in most cases the building will not be certified for re-occupancy until
late afternoon the day after it is opened. The structure must be vacated for approximately 72 hours.
The tarps will be put up the date scheduled, removed the following date, aired out, and then declared
safe to re-enter the date after the tarps have been removed. A sign will be posted on the front door as
to when structure is safe to re-enter. We do not wish to inconvenience you by having you wait for the
arrival of fumigation crew. When you decide on a date make arrangements about thekeys and leave
with the assurance that your building will be properly fumigated.
The GAS service must be shut off prior to fumigation. The fumigation company will contact PG&E
to schedule to have service turned off. It is the owner's responsibility to contact PG&E to cone back
out to the property to turn the gas service back on and relight pilot lights. Homeowner should contact
PG&E at feast 4 days in advance to schedule them to come back out. PG&E will not turn service back
on unless they are shown,the re-entry notice which the fumigation companyghas posted at the.
PG&E orstheyn will leaveitheproperty and,reschedulle to come back out to tile nstrrucctuowremonce notice
notice is macre available to them. Electricity will remain on.
The utmost care will be taken during fumigation's to avoid any possible roof or plant damage.
However, in the case of brittlettpwood shingles or tiles there is always the possibility of some
damagee mayhbe unavoidable. Plants that are too be
tothedstructure touallow proper sandbagging of
the tarps may be damaged. We can assume NO responsibility for damage resulting from these
conditions
This building will be fumigated with poisonousases. All persons and animals MUST vacate the
premises when the fumigation crew arrives. Under NO circumstances can anyone enter the structure
until the fumigation companyis notice is posted giving the time and date for safe re-entry. Fumigation
cannot commence without a signed notice "Occupants Fumigation Notice in fumigators.possession
which will be sent opt once fumigation date has been scheduled and will have an additional notes as
to the prep work which must be done prior to the fumigation date by OCCUPANyf
Should you have any questions regarding fumigation, please contact our office at (408) 995-6300 or
fumigation company.
ANTIQUE TERMITE, INC. --License No. PR 1187
• • • .. .. 1.
9th - -
PAGE OF.STANDARD.INSPECTION REPORT ON PROPERTY AT:
21744 OLIVE AVENUE, CUPERTINO CA 95014 5/15/2012 47451
BUILDING NO. STREET.CITY.STATE.ZIP INSPECTION DATE REPORT NO.
FACT SHEET FOR VIKANE* (Sulfuryl Fluoride)
In the interest of Dow Elanco's commitment to product stewardship,this fact sheet is intended to provide basic
information and how it is used: If you'have additional questions about Vikane or the procedures described,call
the Dow Elanco Customer information Services at 1-800-352-6776.
WHY BUILDINGS ARE FUMIGATED
Insects that feed or'tunnelintothe-wood can seriously damage houses, apartments, and other
dwellings or structures: Each year termites or other wood destroying insects damage approximately 2
million homes. Depending on the extent or location of the infestation, fumigation is the only total
control method proven to ellmMn festa to� �f rod des nginsects.
'BUILDINGSMIGA
Because Vikane is a gas;-prior to fumigation the structure Is completely sealed. I his serves to contain Vikane in
the building so it can penetrate wood thoroughly and eliminate the pests. Depending on the construction of the
building,the doors and windows may be sealed with tape and a plastic sheet,or the structure may be covered
with a tarp. The building.willlremainusealed for 4 to 72 hours depending on the specifics of the job. Warning
signs are posted around the-building-notifying people to keep out.
After the tarp is removed;,a professional fumigator will aerate the structure by opening the doors and windows.
Fans may also be used to clear outthe building. Once the building has been thoroughly aerated,the fumigator is
required to measure;the level of any fumigant remaining in the living space to ensure it is below the established
safe re-entry concentration.:Your building should not be cleared for re-occupancy until it is safe to enter. The
fumigator will post a-notice onyourbuilding indicating the day and time for re-entry. Structures can be occupied
only when the concentration is 5 parts-per million or less(this represents a margin of safety—laboratory animals
have been exposed to 100-partsper million for 2 weeks with no adverse effects). Because Vikane is a true gas
and not a vapor,aeration is rapid"'Recent studies demonstrated that in most structures levels are less than 1
part per million within'6'hours of-clearing and have no detectable levels of Vikane with 24 hours after the start of
aeration.
Sulfuryl Fluoride isa colorless;,odorless gas, so a warning agent is added to the building,which causes watery
eyes and a scratchy throat. If-you experience these symptoms in a structure that has been recently fumigated,
you should leave immediately.and;call the pest control company to have your building re-tested.
SULFURYL FLUORIDE (POTENTIAL HEALTH RISK FROM OVEREXPOSURE)
Sulfuryl Fluoride is a-gas and can potentially enter your body through Inhalation. Because it is a gas,it does not
stay on dry surfaces;therefore;there is no exposure from touching treated surfaces.
Nervous system and respiratory irritation:
Over exposure to high levels of Sulfuryl Fluoride can result in nose and throat irritation and nausea. At high
concentrations (such'as those used during the fumigation), can cause excess fluid in the lungs,sleepiness,
pneumonia,and convulsions. These symptoms would be expected to appear within 8 hours after such exposure.
In the unlikely event that you.experience these symptoms in a building that has been recently fumigated, you
should leave immediately. Consult your physician and call the pest control company to have your building
re-tested.
Additional studies:
Sulfuryl Fluoride has not been shown-to cause birth defects In pregnant animals,exposed under experimental
conditions. In addition,,current studies have demonstrated there are no mutagenic or genotixic effects caused by
exposure to Sulfuryl Fluoide.
SSafety'Precautions and Homeowner Preparation
-Discuss the treatment program In-advance,with,your pest control company so you fully understand what will be
done and what you need to do.
-Carefully follow the instructions'iyou are given about what items you are to remove from your building.
-If you are Interested or concernedryou should-ask your pest control company to show the records of how your
building was aerated before-It was cleared for re-entry.
•
-Call DowElanco Customer Information'Servlce at 1-800-352-6776 if you need additional information or have
questions concerning the product.
•
• - -ANTIQUE TERMITE, INC. --License No. PR 1187
ANTIQUE TERMITE;-:INC. - Page: 1 of 2
1913 Stone Avenue, San Jose, CA 95125
Ph: (408)995-6300 (408)995-0517 Fax
„WORK AUTHORIZATION CONTRACT
Address of Property: 21744 OLIVE AVENUE, CUPERTINO CA 95014
Inspection Date: 5/15/2012
Report It: 47451
Title Co. E. Escrow #: Escrow #
SECTION 1 SECTION 2 FURTHER INSPECTION
1A $ 3210.00 •10 $ 195.00 6A BID ON REQ
18 $ 1331.00 10A $ 175.00
1C $ 175.00 10B OTHERS
1E $ 795.00 118 OTHERS
1F $ 310.00
68 $ 175.00
11A $ 195.00
•
We Authorized the Following We Authorized the Following We Authorized the Following
Section 1 Items to be Performed. Section 2 Items to be Performed. Items for Further Inspection.
v� sfioe 'sc. A
Proposed Cost Section 1: • Proposed Cost Section 2: Proposed Cost Fur.lnsp.:
•
•
• MOLD DISCLAIMER
There may be health related issues associated with the structural repairs reflected in the inspection report referenced by this
Work Authorization
Contract. These health issues include but are not limited to the possible release of mold spores during the course of repairs.We are
not qualified to
and do not render any opinionconcerning such:health'issues or any special precautions. Any questions concerning health
issues or any special
precautions to be taken prior to or during the course of f such repairs should be directed to a Certified Industrial Hygienist before any
such repairs are
undertaken.
TIME &MATERIAL
For items which are bid at time and.material--cost is based on$105.00 per man per hour + cost of materials + 10% unless otherwise
stated in report.
I have read this work authorization contract and WDO inpection report it refers to.
SIGNED WORK AUTHORIZATION CONTRACT MUST BE RECEIVED BEFORE WORK WILL BE SCHEDULED.
I have readand understand the terms;of this work authorization contract and hereby agree to all terms thereof.
APPROVED AND READ BY: •4 ` ' • DATE ACCEPTED FOR: DATE •
ANTIQUE TERMITE, INC.
.
ANTIQUE TERMITE; INC. Page: 2ot2
1913 Stone Avenue, San Jose;.CA 95125,r
Ph: (408)995-6300 (408)995-0517 Fait: •
•
4 Ci
WORK-AUTHORIZATION CONTRACT
Address of Property: 21744 OLIVE AVENUE, CUPERTINO CA 95014
Inspection Date: 5/15/2012
Report I: 47453.
Title Co. & Escrow Si: Escrow # '
•
ANTIQUE TERMITE INC.AGREES:
1: To guarantee all repairs completed by this company for one year from date of notice of completion, except for plumbing, grouting,
caulking, and re-setting of toilets,which will,be guaranteed for(30)days.We assume no responsibility for work performed by
others.
2: To be bound to perform this work for'the.price'quotedin our cost breakdown for a period not to exceed(30)days.
3: To use reasonable care in the performance of.our work but to assume no responsibility for damage to any hidden pipes,wiring,or
other facilities or to any shrubs, plants or other life.
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 buyer for 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 1.5% per month of portion of any month beyond the(30)days after completion of work by our company.
3: Owner grants to Antique Termite, Inc.:asecurity interest 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,reasonable attorney fees 8 any costs of collection to be paid by owner,whether suit filed or not.
5: Credit card payments: We accerit.Visa & Mastercard. A 2%service charge will be added onto all credit card payments.
BOTH PARTIES AGREE:
1: If additional damage is discovered by Antique Termite Inc.in the performance of the work,Antique Termite agrees to notify
owner or agent of the amount of the damage and the amount of the additional work necessary to be performed at an additional cost as
per supplemental report. Should local building department require additional work to be performed, additional work would be
performed at owners expense:Same would be outlined in a supplemental report.
2:The above additional work-to be performed will notbe done without written authorization from owner or owners agent.
NOTICE TO PROPERTY OWNERS: (Under California Contractors License Law)
Provides under the Mechanic's Lien Law any contractor;subcontractor, laborer, supplier or other person who helps to improve your
property but is not paid for his work-or supplies has a right to enforce a claim against your property. This means that, after a
court hearing your property could be sold by the court officer and the proceeds of the sale used to satisfy the indebtedness. This
can happen even if you paid-your own contractor in full,if the subcontractor,laborer or supplier remains unpaid. To preserve their
right to file a claim or lien against your,property,certain claimants such as sub-contractors or material suppliers are required to
provide you with a document entitled "Preliminary Notice". Its purpose is to notify you of persons who may have the right to
file a lien against your property.if they are not paid.
NOTICE OF COMPLETION: document is natio be used until all funds due to ANTIQUE TERMITE INC as outlined above are
in escrow and supplied with fullauthorization for release by all concerned parties. If there is not the total amount and/or
there is not authorization for full release by both parties, completion/certification is to be returned to ANTIQUE TERMITE
immediately. To use this completion/certification if the above stipulations are not met is to assume direct legal responsibility for
the entire amount due to Antique Termite Inc.
CHEMICAL SENSITIVITY OR ALLERGIES:-(Note to occupant)Does any person to your knowledge living or working at this address have
any chemical sensitivities or allergies that Antique Termite should be aware of prior to work? If yes, they should contact their
physician concerning occupancy during and after any chemical treatment,if specified herein, prior to signing below.
>ANTIQUETERMITE, INC. -- License No. PR 1187