12060057 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21740 OLIVE AVE CONTRACTOR:ANTIQUE TERMITE& PERMIT NO: 12060057
PEST
OWNER'S NAME: PERO SKLIJ 1913 STONE AVE DATE ISSUED:06/I1/2012
OWNER'S PHONE: 4089048269 SAN JOSE,CA 95125 PI IONE NO:(408)995-6700
❑ LICENSED CONTRACTOR'S DECLARATION7
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB
6�3 r
License Class Lie.ti G O J (g7-
/' MECH r RESIDENTIAL r COMMERCIAL
Contractor M Ic I_1� Mtn Date ail II
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APT CS-REMOVE AND REPLACE :SHOWER AND
(commencing with Section 7000)of Division 3 of the Business&Professions REPAIR SUBPLOOR.
Code and That my license is in full force and effect
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a cenilicate 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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$7185
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:35719084_00 Occupancy Type:
APPLICANT CERTIFICATION
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned properly for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Issued by: �G—!i
CITY OF CUPERTINO
N` �
, FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 21740 8:2174401ive Ave DATE: 06/11/2012 REVIEWED BY: Sean
Wiz.",. APN: BP#: "VALUATION: $7,185
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM
USE: PERMIT TYPE: _
WORK Remove and replace.(2).showers and repair subfloor in duplex.
SCOPE
•4
Mech. Plan Check I I Plumb. Plan Check I I Elea. Plan Cheek I I
Ach. I'eraiit Fee: Plumb. Penni!Ft'e: Els'. Permit Fee:
Other Mech. Insp. II��1 Other Plumh Imp. I Other Elco. loop.
Mee Mah.Imp. Fee: IILI'/mob. Insp. Fee: Elm Insp. rec:
NOTE: This estimate does no:includefees due to other Departments(Le Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc). These fees are based on the preliminary information available and are only an estimate Contact the Dept for addn 7 info.
FEE ITEMS free Resolution /1-053 Eli 7/I/I I) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 I 12 I s.f. Remodel, Bath(<=300 sf)
Suppl. PC Fee: Q Reg. 0 OT 0.0i hrs $0.00 $588.00 1REMRESBAT
A
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. FeeC) Reg. 0 OT 0,0 J hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Cnnsnyetion
A cin iuisnruive late: 0
Work Without Permit? . 0 Yes 0 No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Building or Structure 0
Travel Doctunentalin Fees: A
Strong Motion Fee: IBSEISMICR $0.72 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: , I $1.72 $588.00 TOTAL FEE:' $589.72
Revised: 06/05/2012
) 2_ our, ° c> Tsr7
���� /j CONSTRUCTION PERMIT APPLICATION B
% COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
/:,.,,. 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinq(dcupertino.orq
❑ NEW CONSTRUCTION ❑ ADDITIONAyI. �ILnt ALTERATION CFI ❑ REVISION I DEFERRED ORIGINAL.PERMITtl
/O Coe , .o i,YAQ� /I U�n 1110 t APN o 3C9 & /&J r l/
OWNER NAANAMEerO Stcj • PI o Toy-s-a(v 9 E-MAIL
S FREE F ADDRESS/'/ J CRY.S rArE.ZIP FAC
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CONTACT NAME UIS g 0 C124 13 0C12ur-enL PHONE P:SL\IL- /' / T I
r/r1,7(jr^9'— ({O(f— `Y G.��o3G'Z7 i n7p op
v\.7Tf �'L /E'iMl`f . C: \„
STREET ADDRESS CITY.STATE. ZIP
/, 17, $Tori€ / U42_ LLT v.c 7os-o c.4-91 /)-S {Ai
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❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME r(•1 I(/IPG/ a IL(Q-‘7� LICENSE NUMBER LICENSE.TYPE,„ BUS LICo c(
tttl(87I to6'Sd-$� -b,--'11_'-A / JN/ / J
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CO. PANY NAME FMAI} f FAN
px,.t-f-I cl,,e__ tCrn.�—LnC inti) cJ ay.+,4ud'2,-m. .cc.. 4oFr- S9C GS17
STREET ADDRESS CITY.STATE /IP PI IONI.
� P\--,-Q._NrP\--,-Q._ S •-•••:1/9 t 3 `+0 Y`-2 - P- c S-(4- G-A- q C-1�-� 4C,S-c 5.C6 3 CZ)
ARCIII DICE/ENGINEER NAME LICENSE NUMBER MUS LIC=
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY.STATE.ZIP PI IONE
DESCRIPTION OF WORK
--1--eat-- o LIR show-Z,e— / re p s ck u). r-vi — c f S a I-ud9,..
SUb-Foor- r- •rMM r /N 30/W k/17/Tf•
APT
lexitiI1NO USE/ ST
PROPOSED.UUSSSE/. CONSTRTTTYYPE v STORIES
3a7 ' V ,L USE TYPE O(JC. SOFT VALUATION(SI
EXISI0 NEW FLOOR DEMO TOTAL.
AREA AREA AREA NIS AREA
IL\TIIROO\I RII('IIENOnIER
REMODEL.ARRA L,2 qREMODEL AREA REMODEL AREA
PORCH AREA DECK AREA I TOTAL DECK,PORCII AREA GARAGE AREA' 0 DETACH
0 ATTACII
o DWELLING UNITS IS A SECOND UNIT ❑YES SECOND STORY ❑YTS
BEING ADDED' 0 N ADDITION' ONO JyS k 3
•
PRIA PPI.ICATION DYES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED ^ "
/ TOT ""' nN'
PLANNING APPLII 0 N PLANNING APPROVAL LETTER EICIILER IIOME1 0 NO . 4 et/ - /'
5
By my signature below.I cenify to each of the following: I am the property owner or authorized agent to ad on the property owner's behalf. I have read this
application and the information I have 1� �p(i�s�aacct. ave read the I)•scription of Work and verily it is accurate. I agree to comply with all applicable local
ordinances and slate laws relating¢ ykyR"��,ctrl :. repzi� �Cupertino w above-1 the abuYl ntifi d property ha inspection purposes
Signature of Applicant/Agent: `!Z/� Date: I _�__—
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP
_New SPU or Multifamily dwellings: Apply for demolition permit for OVER-TILE-COUNTER 0 BUILDING PLAN REVIEW
existing building(s)- Demolition permit is required prior to issuance of building
permit for new building. 0 EXPRESS 0 PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed I lazardous Materials Disclosure 0 STANDARD 0 PUBLIC WORKS
form if any I lazardous Materials are being used as part of this project.
0 LARGE 0 FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR 0 SANITARY SEWER DISTRICT
submittal of Building Permit application.
0 ENVIRONMENTAL HEALTH
BldgApp_20I/.dot revised 06/21/I1
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
CUPERJINO
Building Department
JOB ADDRESS: PERMIT #
zh1-10 aliop. Avenue 1 z06 OOS7
OWNER'S NAME: *WV y_• _ c L'hw�' PHONE # tog - cps - CS'oo
GENERAL CONTRACTOR Mi ct1 IUIP (� FAX # Lj0 g - S- OSI 7
I am not using any subcontractors: • 6/Il/I 2-
-
e. 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
& i11► z
Owner/Contractor.Signatare Date
•
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rog: Sub: Blk: Lot:
APN • 35719084 .00
DATE ISSUED • 06/11/2012
RECEIPT # • BS000017038
REFERENCE ID # . . : 12060057
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, INC
CONTRACTOR • MICHAEL R MEEK LIC # 24455
COMPANY • ANTIQUE TERMITE & PEST
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
• Cw..
WOOD DESTROYING' PESTS'AND ORGANISMS INSPECTION REPORT
I
I
BUILDING NO. STREET,CITY,STATE,ZIP Date of Inspection No_ofPages
21740 OLIVE AVENUE, CUPERTINO CA 95014 5/14/2012 12
ANTIQUE TERMITE; INC.
1913 Stone Avenue, San Jose, CA'95125 .e.-„TC.(�EIVE�
Ph: (408)995-6300 (408)995-0517 Fax - twv
JUN 11 2012
Firm Registration No. PR 1187 I Report No. 474313 I Escrow o.
Ordered By: •Property Owner/Party of Interest Report Sent To:
REAL PROPERTY INVESTMENTS - PERO SKILJ •
1872 HOMESTEAD ROAD 21740 OLIVE AVENUE
SANTA CLARA,CA 95050 • CUPERTINO,CA 95014
Attn: TOM ANTONOPOULOS
408-985-9666 408-985-9752
•
COMPLETE REPORT x❑ LIMITED REPORT ❑' 'SUPPLEMENTAL REPORT ❑ REINSPECTION REPORT ❑
General Description: Inspection Tag Posted:
ONE STORY MULTI FAIMLY UNIT WITH WOOD FRAME AND:WOOD SIDING AND GARAGE
STUCCO EXTERIOR
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 Termites-N Fungus/Dryrot ® Other Findings N Further Inspection
If any of above boxes are checked. it indicates that there'were visible problems in accessible areas. Read the report for details on checked items.
DIAGRAM 1101 TO SCALE
IP CE COPY'
11A
1F 1E
I 11A 11B
COMMUNITY DEVELOPMENT DEPART AENTID iC
BUILDING DIVISION-CUPERTINO 16 24
•
APPROVED 1H
This set of plans and specifications MU T be Iiept at the 11111J
job site during construction.-It Is .i.14. .L,l tomato nay 1.1K
changes or alterations on same:dr deviate - 110 11M
therefrom,without approval from the Building-Qfflctal. , 11E 1OB
The stamping of this plan and specifications SI-�ALLNOT-•j. Toa
be held to permit or to be an apr royal of tie violationj.
- 1B
of any provisionsroof any City Oru .pco nr State Law. 10A
C>cl 11F
J��, / .F/TitTG� /` ' 11G
BY 11rv111111J
DATE 6 •// _.✓gf • -- 11F 11K
PERMIT NO. ./alb 0657 11Hhop>
)0I
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 Ip the Structural Pest Control Board dunng the preceeding two years.To obtain copies contact structural Pest
Contra Board.2005 Evergreen Street.Suite 1500.Sacramento.California 95815:
NOTE:Questions or problems concerning the above repon 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 at(916)561"8708.or(800)737-8188 or www.peslboard.ca.gov. .;1 43M-41(Rev-10/01)
I.
2nd
PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
21740 OLIVE AVENUE, CUPERTINO CA 95014 5/14/2012 47430
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
_✓
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3rd •
PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
21740 OLIVE AVENUE, CUPERTINO CA 95014 5/14/2012 47430
BUILDING NO. STREET.CITY.STATE.ZIP INSPECTION DATE REPORT NO,
WHILE PERFORMING TREATMENTS,OR ANY CONSTRUCTION REPAIRS, ANTIQUE TERMITE INC.WILL NOT BE
RESPONSIBLE OR'LIABLE 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 IT IS FOUND THAT LOCAL BUILDING CODES REQUIRE ADDITIONAL REPAIRS TO BE
PERFORMED, THESE ADDITIONAIJREPAIRS 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.canibe 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/or linoleum selections must be made at least 5 days prior to scheduled repairs. Any
upgrades, must be paid by client at thei time of selection. If NO selection is made prior to repairs,
standard/neutral color' tile. or.sheet vinyl will be installed.
MOLD POLICY STATEMENT: Molds, 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 infestationtor 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 inspection and cannot be defined as Section 1 or Section 2.
SUB STRUCTURE AREA:
ITEM 1A NOTE: A portion of the dwelling is constructed over a concrete slab with finished walls on the
interior and exterior-which:limits our , inspection to the accessible areas. No representation can
be made in regards •to' the absencor presence of infestations or infections in these
inaccessible areas:
Information Item NOTE
ITEM 1B NOTE: The dwelling isconstructed over a concrete slab with finished walls on the interior and
exterior which limits our inspection to the accessible areas. No representation can be made in
regards to the absence or presence of infestations or infections in these inaccessible areas.
Information. ,Item.• , NOTE
ANTIQUE.TERMITE, INC. -- License No. PR 1187
' 4th ;..
PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
21740 OLIVE AVENUE;CUPERTINO CA 95014 5/14/2012 47430,
BUILDING NO. STREET.CITY,STATE ZIP
INSPECTION DATE REPORT NO,
SUB STRUCTURE AREA:
ITEM 1C FINDING: Earth contact 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. $ 200.00
This is a Section 2 Item
ITEM 1D FINDING: Fungus damage was noted ito the subflooring under the hall bathroom tub shower and
floor at the unit indicated on.the diagram.
RECOMMENDATION: 'Remove the three wall shower surround, tub, toilet, and tile floor. Remove
and replace the-damaged subflooring with new material. Install a new anti-scald valve, a new
standard grade tub,.new standard grade tile set on cement board, and new standard grade floor
tile set on cement board: Reset,the toilet on a new wax ring. $ 3975.00
This is a Section 1 Item
•
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.
TILE OR LINOLEUM SELECTIONS: Bids which are given in report for replacement of ceramic tile or linoleum
are based on using standard gradematerial. 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 baseck 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/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 color,tile-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 recent changes 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 charge for 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.
ANTIQUE TERMITE, INC. --License No. PR 1187
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' 5th r
PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
21740 OLIVE'AVENUE;CUPERTINO CA 95014 5/14/2012 47430
BUILDING NO, STREET.CITY,STATE.ZIP INSPECTION DATE REPORT Na
SUB STRUCTURE AREA:
ITEM 1E FINDING: Evidence of infestation by drywood termites was noted at the subarea. These
infestations appear to extend into inaccessible areas. (THIS BID INCLUDES 27140 AND 21740
A&B).
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.structtire 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-isia 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 once fumigation is ordered.
This is a Section 1 Item $3009.00
NOTE: If fumigationis.prepaid in full prior to fumigation date, discounted cost for
fumigation would be $2651.002(THIS BID INCLUDES 27140 AND 21740 A&B).
IF ALL 4 BULIDINGS ARE FUMIGATED AT THE SAME TIME. THE PRICES ARE AS FOLLOWS:
$3583.00 OR A PREPAYOF$3093.00.
PREP WORK ISREQUIRED-FOWTHE FUMIGATION. PLEASE CONTACT ALDO @SMART PREP
(408)768-9401.
ITEM 1F FINDING: Evidence'of infestation.by drywood termites was noted in item lE (fecal pellets).
RECOMMENDATION: In'compliance•with the Structural Pest Control Board, remove or mask
over all accessible drywood termiteevidence (pellets) upon completion of treatments.
This is a Section 1 'Item • $ 150.00
ITEM 1G FINDING: Subterranean termite damage was noted at the subflooring and rim joist in the area
indicated on the diagram.
RECOMMENDATION: Remove and replace the visible, structurally damaged wood members. Brace
and/or reinforce the structurally weakened wood members. Note These repairs are outlined to be
performed from the sub area. •.If.this method of repair becomes impractical or if any additional
findings are made,-a supplemental report will be filed with additional findings, recommendations
and bids for completion.-'
This is a•Section 1 Item $ 310.00
ANTIQUEXERMITE, INC. --License No. PR 1187
6th
PAGE OF STANDARD:INSPECTION REPORT ON PROPERTY AT:
21740 OLIVE AVENUE, CUPERTINO CA 95014 5/14/2012 47430
BUILDING NO, STREET.CITY.STATE,ZIP INSPECTION DATE REPORT NO.
SUB STRUCTURE AREA:
ITEM 1H 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 (shelter tubes).upon completion. Proposed chemical Termidor SC-active ingred:
Fipronil. NOTE: Our guarantee for this treatment is limited to the treated area(s) only.
This is a Section 1 Item $ 310.00
ITEM 11 FINDING: Portions of the substructure are inaccessible for inspection due to insulated subflooring.
RECOMMENDATION: Further inspection is recommended. If others remove the insulation and upon
request, we would return to the property, perform further inspection and issue a supplemental
report on any findings.
Unknown Further Inspection Recommended $ 150.00
STALL SHOWER:
ITEM 2A NOTE: The hall bathroom showerwas water tested at the time of this inspection. No leaks were
detected at this time.
Information Item NOTE
GARAGES:
ITEM 8A FINDING: Portiohs of the garage framing are inaccessible for inspection due to storage and/or free
standing cabinets. Interested parties should be aware that Antique Termite, Inc. assumes no
responsibility for any inaccessible areas.
RECOMMENDATION: Further inspection is recommended. The owner/occupant is advised to move
the storage and/or freestanding cabinets. At that time, upon request we would return, perform
further inspectionand issue a supplemental report on any findings.
Unknown Further Inspection Recommended $ 150.00
OTHER-INTERIORS:
ITEM 10A 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
ITEM 1013 FINDING: The unit #A 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
ANTIQUE TERMITE, INC. --License No. PR 1187
' 7th
PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
21740 OLIVE AVENUE, CUPERTINO CA 95014 5/14/2012 47430
BUILDING NO. STREET,CITY.STATE.ZIP INSPECTION DATE REPORT NO.
OTHER-EXTERIORS:
ITEM 11A FINDING: Stucco cracks were noted at various areas of the structure.
RECOMMENDATION: Owner to seal and maintain the stucco cracks in the areas indicated on the
diagram. OTHERS
This is a Section 2 Item
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 FINDING: Earth to wood contact was noted at the siding in the areas indicated on the diagram.
RECOMMENDATION: Contact other trades to lower the soil.
This is a Section 2 Item OTHERS
ITEM 11D 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 11E FINDING: Fungus damage was noted to the sheathing in the area indicated on the diagram.
RECOMMENDATION: Cut out the damaged section and do not replace.
This is a Section 1 Item $ 310.00
ITEM 11E FINDING: Fungus damage was noted to the siding in the area indicated on the diagram.
RECOMMENDATION: Cut out the damaged section and Z-Bar in new material. Contact other trades
to paint.
This is a Section 1 Item $475.00
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 11G FINDING: The earth to wood contact noted in item 11C has caused fungus damage to the siding.
RECOMMENDATION: We will lower the soil in this area while performing the repairs outlined in
item 11F.
This is a Section 1 Item INCL. W/ 1F
ANTIQUE TERMITE,INC. --License No. PR 1187
•
•
• 8th
PAGE OF STANDARD INSPECTION'REPORT ON PROPERTY AT:
21740 OLIVE AVENUE, CUPERTINO CA 95014 5/14/2012 47430
BUILDING NO. STREET,CITY.STATE,ZIP INSPECTION DATE REPORT NO,
OTHER-EXTERIORS:
ITEM 11H FINDING: Rot damage was noted to,the facia boards.
RECOMMENDATION: Remove and replace the damaged facia boards. If damage extends
further or into iriacessible areas, a supplemental report will be issued as to the findings and
additional repair costs. Owner to paint.
This is a Section 1 Item $ 210.00
ITEM 11I FINDING: Fungus damage and drywood termite damage were noted at the roof eaves at the
approximate location(s) indicated on the diagram.
RECOMMENDATION: Remove the roof covering where necessary. Remove the visibly damaged
wood members and check for concealed damage/adverse conditions. If no additional findings are
made, install new materials where removed. Note Our bid includes painting the new materials
with one coat of white primer paint only. Note If any additional findings are made, a
supplemental report will be filed with additional bids for repair. Note: Our repairs will be made
with commonly available building materials. The size and pattern matches will be
approximated based On current lumber. sizes. An exact. match of the existing materials on
structures over 30 years old is not guaranteed. Note The owner should contract with a licensed
roofer to replace the rooficovering (where removed) upon completion of this repair.
This is a Section 1 Item $ 875.00
ITEM 11J FINDING: Roof coverings will,be removed or disturbed in conjunction with repairs for wood
destroying organism damage as outlined in item 111.
RECOMMENDATION: Upon completion of wood repairs as outlined above, owner to contact a
licensed roofing contractor to.inspect and repairand/or reinstall roof coverings in repaired area and
guarantee the water tight condition of roof coverings. Note: Interested parties should be aware
that Antique Termite, Inc: will not be responsible for any roof leaks and assumes no liability
against future damage°which may occur in the event that roof coverings are not re-installed in this
area. Note: If gutters'need to be removed in order to facilitate repairs, owner to have other trades
reinstall, repair or install new gutters-upon completion of wood repairs
This is a Section 1 Item OTHERS
ITEM 11K FINDING: Drywood termite 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 inaccessiblel'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 • $ 695.00
ITEM 11L FINDING: Fungus damage was noted to the barge rafters at area indicated on diagram.
RECOMMENDATION: Remove fungus damaged section and replace with new wood.
This is a Section 1 Item $ 210.00
•
'ANTIQUE-TERMITE,INC. -- License No. PR 1187
fl
9th •
PAGE OF STANDARD.INSPECTION;REPORT.ON PROPERTY AT:
21740 OLIVE AVENUE, CUPERTINO CA 95014 5/14/2012 47430
BUILDING NO. STREET,CITY.STATE,ZIP INSPECTION DATE REPORT NO.
OTHER-EXTERIORS:
ITEM 11M FINDING: Evidence of.drywood termites was noted at the exterior.
RECOMMENDATION: See recommendation in item #1E above regarding fumigation of entire
structure.
This is a Section 1 Item SEE 1E
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.
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.PAYABLEAT THE TIME OF INSPECTION.
Antique Termite, Inc. does not guarantee work performed by others. Such guarantees should be obtained from those
performing the repairs. Antique-Termite, Inc. only certifies the absence of infestation or infection in the visible and
accessible areas. If itis found 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 workman like manor on repairs done by others. Interested parties must satisfy themselves
with the proper permits and licenses and to 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--PESTICIDES,ARE.TOXIC.CHEMICALS. Structural Pest Control Companies are registered and
regulated by the :Structural.Pest•Co,trot 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.whenthe 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-physician or 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.)
ANTIQUE TERMITE, INC. --License No. PR 1187
•
•
10th
PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
21740 OLIVE AVENUE, CUPERTINO CA 95014 5/14/2012 47430
BUILDING NO, STREET.CITY.STATE.ZIP INSPECTION DATE REPORT N0.
For further information, contact anyof the following:
Antique Termite Inc. (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 41500,Sacramento,CA
95825.The following list of chemicals may be used by Antique Termite Inc. in the treatment of the above
mentioned property
Chemical: Manufacturer: Active Inaredlents:
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 Dow AgroSciences Sulfuryl Flouride
•
•
•
ANTIQUE.TERMITE, INC. -- License No. PR 1187
' 11th
PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
21740 OLIVE AVENUE, CUPERTINO CA 95014 5/14/2012 47430
BUILDING NO. STREET.CITY,STATE.ZIP INSPECTION DATE REPORT NO.
FUMIGATION NOTICE
Structural fumigants are colorless,odorless, and do not affect.paints, 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 fume ation with any fumigant. Persons, plants, pets, baby,mattresses
enveloped with plastic covers. All food and medicines not scaled 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 andshrubs 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 timingdevices (sprinklers,
lights, etc.) must be disconnected dring fumigation. Solar systems must be urned 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 ypu the name and phone number of a company which can perform
the necessary prep work for a fee. It is the responsibility of the owner to take care of all necessary
prep work. Il 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
sometime during the first day and opened the next dayafter proper exposure to the fumigant. The
time for ventilation varies and in most cases the buildng 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 tams will be put up the date scheduled, removed the following date, aired out, and hien 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 come back
out to theropertyy 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. hG&E will not turn service back
on unless they are shown the re-entry notice which the fumigation company has posted at the.
structure stating when it is safe to re-enter. Its mandatory that the owner/agent snow this notice to
PG&E or theywillleave the property and reschedule to come back out to the structure once that
notice is madavailable to them. Electricity will remain on.
The utmost care will be taken duringfumigation's to avoid any possible roof or plant damage.
However, in the case of brittle wooshingles or tiles there is always the possibility of some
breakage. Where climbing plants and vines must be detached from the buildings or trellises removed,
damage may be unavoidable. Plants that are too close to the structure to allow 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 poisonous gases. All persons and animals MUST vacate the
premises when the fumigation crew arrives. Under NO circumstances can anyone enter the structure
until the fumigation company s notice is posted giving the timeand date for safe re-entry. Fumigation
cannot commence without a signed notice "Occupants Fumigation Notice in fumigators possession
which will be sent out 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 OCCUPAN I .
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
A
•
' 12th
PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
21740 OLIVE AVENUE, CUPERTINO CA 95014 5/14/2012 47430
BUILDING NO. STREET.CITY,STATE.ZIP INSPECTION DATE REPORT NO.
FACT SHEETFOR 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 tunnel-into the.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.elim fes a io f ood es ng insects.
� t��11�Min
E FUMIGAT
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 will remain sealed for 4to 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 out the 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 on your building 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 parts per million.for 2 weeks with no adverse effects). Because Vikane is a true gas
and not a vapor, aeration is rapid. Recentstudies 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 is a 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 yourexperience 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 Fluoride
Safety. Precautions and Homeowner Preparation
-Discuss the treatment programinradvance with your pest control company so you fully understand what will be
done and what you need to do.
-Carefully follow the instructions you are given about what items you are to remove from your building.
-If you are interested or concerned, you should ask your pest control company to show the records of how your
building was aerated before if was cleared for re-entry.
-Call DowElanco Customer Information Service 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;ZINC: 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: 21740 OLIVE "AVENUE, CUPERTINO CA 95014
Inspection Date: 5/14/2012 „
Report 4: 47430
Title Co. 6 Escrow 4: Escrow ft _
•
SECTION 1 SECTION 2 FURTHER INSPECTION
1D $ 3975.00 - 1C $ 200.00 1I $ 150.00
1E $ 3009.00 - 10A OTHERS 8A $ 150.00
1F $ 150.00 • 108 $ 175.00
10 $ 310.00 - 11A OTHERS
1H $ 310.00 11B OTHERS
11D $ 195.00 11C OTHERS
11E $ 310.00
11F $ 475.00 -
110 INCL. W/ 1F
11H $ 210.00
111 $ 875.00
11J OTHERS
111< $ 695.00
111, $ 210.00
11M SEE lE
We Authorized the Following We Authorized the Following We Authorized the Following
Se ion Items to a Performed. Section 2 Items to be Performed. Items for Further Inspection.
_ t' � r9 x
Proposed Cost Section 1: Proposed Cost Section 2: Proposed Cost Fur-Insp.:
•
- 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 opinion concerning 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 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—coals-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 read and understand the termsof this work authorization contract and hereby agree to all terms thereof.
c30 --ea4 2 r -12_
APPROVED AND READ BY:' "= • )1•DATE ACCEPTED FOR: DATE
ANTIQUE TERMITE, INC.
ANTIQUE TERMITE/INCs�, Page:2 of 2
1913 Stone Avenue, San Jose;,CA 95125
Ph: (408) 995-6300 (408)995-0517 Fax
WORK-AUTHORIZATION CONTRACT
Address of Property: 21740 OLIVE 'AVENUE, CUPERTINO CA 95014
Inspection Date: 5/14/2012
Report 0: 47430
Title Co. S Escrow If: 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 quoted in 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(or 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 bepaid 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 or portion of any month beyond the (30)days after completion of work by our company.
3: Owner grants to Antique Termite, Inc. a security 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 accept Visa 8 Mastercard.A 2%service charge will be added onto all credit card payments.
BOTH PARTIES AGREE: .
1: If additional damage is discovered by Antiquejermite'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 not be done without written authorization from owner or owners agent.
NOTICE TO PROPERTY OWNERS: (Under California Contractors License Law)
Provides under the Mechanic'sLien Lawany 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 soldiby 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 not to be used until all funds due to ANTIQUE TERMITE INC as outlined above are
in escrow and supplied with full authorisation 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 addresshave
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.
ANTIQUE TERMITE,INC. -- License No. PR 1187