12120107CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7852 BELKNAP DR
CONTRACTOR: AVA CONSTRUCTION
PERMIT NO: 12120107
OWNER'S NAME: SUBAGIO PUTU H AND MAR BRENDA M TRU
21060 HOMESTEAD RD APT 216
DATE ISSUED: 01/29/2013
OWNER'S PHONE: 4083156168
CUPERTINO, CA 95014
PHONE NO: (408) 387-0999
El LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class ic.
DEMOLITION OF EXISTING RESIDENCE (1479 SQFT)AND
Contractor
ATTCH'D GARAGE (437 SQFT)
I hereby affirm that I am licensed un er the provisions of Chapter 9
(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 penalty 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
Sq. Ft Floor Area:
Valuation: $14000
performance of the work for which this permit is issued.
1 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: 36210042.00
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 buildingconstruction, and hereby authorize representatives of this city to enter
y p ty
upon the above
$ DAY CALL�ED_ INSPECTION.
enifynd eePwhchess �Ct3f upertin aga�ist lsta,judgments,
e
Irvµ
.-__�..,
cdx expenses may against n consequenceof the
2
granting of this permit. Additionally, the applicant understands and will comply
ss Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
¢ %
RE -ROOFS:
Signature Date
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
❑ 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:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, 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
HAZARDOUS 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:
Health & Safety Code, Section 25532(a) should I store or 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 I
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 Health & Safety Code, Sections 2O5, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agent: Date: /
1 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, after making this certificate of exemption, [
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor 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. 1 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
ARCHITECT'S DECLARATION
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
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
TAPN:ADDRESS: 7852 Belknap Dr
FEE
DATE: 12/20/2012
REVIEWED BY: Sean
P
BP#:
1
/111�6/07
*VALUATION: 1$14,000
,'PERMIT TYPE: Demolition Permit
CI/1V :A:i ", P/1"
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 SFDWL-DEM
PERMIT TYPE: A
WORK
Demolition of existing residence (1479 sq ft) and (437 sq ft garage.
T0.0Thrs
SCOPE
$0.00
FEE ID FLR AREA
(S -f)
1DEMORES 1,916
-
NOTE: This estimate does not include fees due to other Departments (ie. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are only an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1112)
FEE
QTY/FEE
MISC ITEMS
Pho-", Che",
WON
-
NOTE: This estimate does not include fees due to other Departments (ie. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are only an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1112)
FEE
QTY/FEE
MISC ITEMS
Pho-", Che",
Permit Fee:
$534.00
Suppl. Insp. Fee -.0 Reg. Q OT
T0.0Thrs
$0.00
fps E,)1If !'Fi(hone
Strony Motion Fee. IRSEISMICR
$1.40
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SURTOTALS:
$536.40
$0.00 'fOTA 'Fit
$536±0
Revised: 1010112012
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS:
PERMIT # -
OWNER'S NAME: a„0
PHONE # •-,
GENERAL CONTRACTOR: %�
BUSINESS LICENSE #
ADDRESS: 2�.-
CITE'/ZIPCODE: ;. r
*Our municipal code requires all businesses working ,in the city to have a City of Cupehino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUB TRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. 12
I am not using any subcontractors:�
Signature Date
Please check applicable subcontractors and complete the following information:
/ Contractor Signature
,� Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
/ Contractor Signature
,� Date
10900 No. Blaney Avenue
Cupertino, CA 95014
City of Cupertino
10300 Torre Avenue
Cupertino, Ca. 95014
To Whom It May Concern:
SUBJECT REMOVAL OF GAS AND / OR ELECTRIC FACILITIES
The gas and electric facilities have been removed and / or abandoned at:
on
If you have any further questions, please contact me at (408'725-3325
Sincerely,
Service Planning
CUPERTINO
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingaa cupertino.org
[I
DemoApp_2011.doc revised 03/16/11
4S
40"
TYR POST
ZLEVsATIQN
NOTES,
1. THE DEVELOPER SHALL INSTALL THE -TREE PROTECTION " DEVICES
PRIOR TO THE START OF GRADING OR CLEARING WORK.
2. THE CITY RESERVES THE RIGHT TO ISSUE A "STOP WORK" NOTICE IF
THE "TREE PROTECTION" DEVICES ARE NOT INSTALLED OR IF THE
DEVICES ARE NOT MAINTAINED PROPERLY.
3. SEE THE PROJECT GRADING PLAN FOR SPECIFIC TREES THAT REQUIRE
PROTECTION. ALL SPECIMEN TREES REQUIRE PROTECTION UNLESS
OTHERWISE NOTED.
4. NO EXCAVATIONS WITHIN THE "TREE PROTECTION AREA" ARE ALLOWED
UNLESS UNDER THE SUPERVISION OF A REGISTERED TREE SERVICE COMPANY.
S. ANY FILLING WITHIN THE "TREE PROTECTION AREA" SHALL BE DONE IN
ACCORDANCE WITH A DETAILED IMPROVEMENT PLAN APPROVED BY THE CITY.
6. NO TRIMMING, CUTTING,OR PRUNING OR DESIGNATED TREES CAN OCCUR
WITHOUT A REGISTERED TREE SERVICE COMPANY.
7. CONSULT ORDINANCE 778 OF THE CITY OF CUPERTINO FOR PERMIT
REQUIREMENTS AND EXCEPTIONS,
8. TEMPORARY CHAIN LINK FENCING IS AN ACCEPTABLE SUBSTITUTE TO
THE WOOD CONSTRUCTION. 4
TREE PROTECTION STANDARDS
CITY OF CUPERTINO-
APPROVED BY : DATE : 11!1 6-4
STANDARD *DETAILS I CI EAll
w�< City of Cupertino
i Public works Department
a
Environmental Programs Division
10300 Torre Ave
Cupertino, CA 95014
curEnT gram 4 (408) 777-3354
Prt�war�c
Construction and Demolition Recycling Diversion
Requirements and Instructions
Covered projects, or all construction, demolition and renovation projects that are 3,000 square feet or more
are required to complete a Waste Management Plan for the City of Cupertino demonstrating that 60% of the
material generated is recycled, in compliance with ordinance CMC 16.72.050. At the conclusion of the project
a Construction Recycling Report must be filed with the Public Works Department/Environmental Division
showing the tons recycled and disposed by material type. Use tonnage information from weight tags provided
by facilities to quantify total estimated waste and percentages for materials. Weight Tags of all material
recycled and disposed must be submitted with the final report in order to receive a Final Building
Inspection.
Recology is the only debris bin service provider franchised to do business in Cupertino.
Debris from a project 3,000 square feet or more in Cupertino can be collected and
disposed by using:
Ple4sV check all that apply:
I am not using a Recology debris bin, however, the project is less than 3,000 s.f., e.g. buildings, patios,
sidewalks, driveways.
❑ I will use a Recology debris bin. By Agreement with the City, Recology will prepare my required
Waste Management Plan & Recycling Report. Contact Recology: (408) 725-4020.
I am not using a Recology debris bin. I will provide the following submittals to the City's Public
Works Department, showing that I have recycled at least 60% of all construction demolition material:
Ask for the Construction & Demolition Recycling Packet from the Building Department and
complete the following:
✓ Submit a Construction and Demolition Waste Management Plan with your building permit
application. No fee for this plan. Forms are available at the Building/Public Works counter and online
at www.cupertino.org/environmental. Report the tonnage recycled and disposed, by material type.
Recycling facilities must be selected from the City's approved list of Recycling Resources.
✓ Submit a Construction Recycling Report form. The report is required before the Building
Department will schedule a final inspection. The report form is available at the Building/Public
Works Countel- and online www. cupertino. org/environmental.
Signature:
Name:
Title:
Phone:
Project
Date:
This form to remain in the project's building permit file for the duration of the project.
Revised 317112 1
AN //%
—/ -
2 t—
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COMPLIANCE &
3
ENFORCEMENT
B A Y A R [ A
/_
AiRCZIALITY
DIVISION
iM1 "GFM @moi'
I-) 1 C I P. I C._ T
AVA Construction
21060 Homestad Avenue #216
Cupertino, CA 95014
Regulation 11, Rule 2
Acknowledgement of
Notification and
Payment of Fees
12/13/2012
Job No: 3Y182
Invoice No: 3BD26
The Bay Area Air Quality Management District (BAAQMD) acknowledges receipt of your payment and
your Asbestos Removal or Demolition Plan described as: Demolition
Site address 7852 Belknap
Cupertino, CA 95014
Start Date December 25, 2012
Completion Date January 5, 2013
Removal amounts of friable ACM 0 linear feet 0 square feet 0 cubic feet
Should it become necessary to revise this plan, please do so in the spaces provided below and immediately
copy the District by fax or by mail.
REGULATION 11-2 REVISION BAAQMD J# 3Y182
REVISION # START DATE COMPLETION DATE
1
—/ -
2 t—
--------- _
3
4 /_
/_
NOTE: This.form is not intended as a verification o/ either the completeness of your original notification
or of its compliance with BAAQMD Regulation 11-2. f you have any questions about this
acknowledgment, please call our office at (415) 749-4762.
a
WOOD DESTROYING PESTS AND ORGANISMS INSPECTION REPORT
Building No. Street, City, Tp
Date of Inspection
Page
7852 BELKNAP DR, CUPERTION, CA 95014
12/17/2012
1
TERMINIX INTERNATIONAL, BRANCH #2223
5860 W LOS POSITAS BLVD STE 19
PLEASANTON, CA 94588
PH: (408) 283-0492 Fax: (408) 283-0230
Firm Registration No. PR 0801
Report No. 4935-0205472
Escrow No.
Ordered By:
Property Owner/Party of Interest
Report Sent To:
A V CONSTRUCTION
A V CONSTRUCTION
7852 BELKNAP DR
7852 BELKNAP DR
CUPERTION, CA 95014
CUPERTION, CA 95014
COMPLETE REPORT ® LIMITED REPORT ❑ SUPPLEMENTAL REPORT ❑ REINSPECTION REPORT ❑
General Description:
Inspection Tag Posted:
One story, single family dwelling, unoccupied, unfurnished.
Other Tags Posted:
An inspection has been made of 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 ❑ Drywood Termites ❑ Fungus/Dryrot ❑ Other Findings ® Further Inspection ❑
If any of the above boxes are checked, it indicates that there were visible problems in accessible areas. Read the report for details on checked items.
(PLEASE SEE THE GRAPH DIAGRAM ON THE FOLLOWING PAGE)
Inspected By STEVEN T. BOBBY License No. fr35219 Signature:
You are entitled to obtain copies of all reports and completion notices on this property reported to the Structural Pest Control Board during the preceeding two years. To obtain copies contact: Structural
Pest Control Board, 2005 Evergreen St. Suite 1500, Sacramento CA. 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 at (916) 561-8708, (800) 737-8188 or www.pestboard.ca.gov. 43M-41 (Rev. 10/01)
C;ill 1,800 F"EFUINIX (jr v A Iei ninix.cx)cn
TERMINIX INTERNATIONAL, BRANCH #2223
TERMINIX 5860 W LOS POSITAS BLVD STE 19
PLEASANTON, CA 94588
(408) 283-0492
Inspection Date:
Customer:
SCALE: 1:1
Inspection Graph
Contract #: 4935-0205472
12/17/12
A V CONSTRUCTION
7852 BELKNAP DR CUPERTION, CA 95014
This graph is a record of a visual, non-destructive inspection by Terminix of certain readily accessible areas of the identified property for visible termite
infestation/damage. Terminix is not responsible for repairs to damages disclosed above. In addition, hidden damage may exist in concealed, obstructed or
inaccessible areas. No attempt to remove siding, plastic or sheetrock insulation, carpeting, paneling, etc. to search for hidden damage was made. Terminix
cannot guarantee that the damage disclosed by visual inspection of the premises shown above represents the entirety of the damage which may exist as
of the date of the initial control application. Terminix shall not be responsible for repair of any existing damage including without limitation, any damage
which existed in areas or in structural members which were not accessible for visual inspection as of the date of this graph. If X (circled or not) appears
on the graph, it is advisable that a qualified building expert inspect the property to determine what effect, if any, the infestation/damage has upon the
structural integrity of the property.
(.;aff1.a 0O f'E=RCviNP Xorvisit 7etrninix,(,oir'i
TIRMINIX.
4TH PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
7852 BELKNAP DR, CUPERTION, CA 95014 12/17/2012 4935-0205472
BUILDING NO. STREET, CITY, STATE, ZIP INSPECTION DATE REPORT NO.
GENERAL NOTES:
NOTE: THE FOLLOWING AREAS, WHEN THEY EXIST, ARE CONSIDERED INACCESSABLE FOR INSPECTION: THE INTERIORS OF
HOLLOW WALLS AND ALL ENCLOSED SPACES BETWEEN A FLOOR OR PORCH DECK AND THE CEILING OR SOFFIT BELOW; AREAS
BETWEEN ABUTTING/ ATTCHED ROW HOUSES, TOWNHOUSES, CONDOMINIUMS AND SIMILAR STRUCTURES; PORTIONS OF THE
ATTIC CONCEALED OR MADE INACCESSIBLE BY INSULATION; PORTIONS OF THE ATTIC CONCEALED OR MADE INACCESSIBLE BY
DUCTING; PORTIONS OF THE ATTIC OR ROOF CAVITY CONCEALED DUE TO AN INADEQUATE CRAWL SPACE; THE INTERIORS OF
BOXED EAVES; EAVES CONCEALED BY PATIO COVERS OR OTHER ABUTMENTS; PORTIONS OF THE SUBAREA CONCEALED OR MADE
INACCESSIBLE BY INSULATION; PORTE COCHERS; ONCLOSED BAY WINDOWS; AREAS BENEATH WOOD FLOORS OVER CONCRETE;
AREAS CONCEALED BY BUILT-IN CABINET WORK; AREAS CONCEALED BY FLOOR COVERINGS, SUCH AS WALL-TO-WALL CARPETING,
LINOLEUM, CERAMIC TILE, ETC.; AND AREAS CONCEALED BY "BUILT-IN" APPLIANCES.
NOTE: THE FOLLOWNG AREAS, WHEN THEY EXIST, ARE CONSIDERED INACCESSIBLE FOR INSPECTION: AREAS CONCEALED BY
INTERIOR FURNISHINGS; AREAS CONCEALED BY FLOOR COVERINGS, SUCH AS AREA RUGS, THROW RUGS, BATH AND KITCHEN
MATS, ETC.; AREAS CONCEALED BY "FREE STANDING" APPLIANCES; AREAS CONCEALED BY STORAGE; AREA CONCEALED BY HEAVY
VEGETATION; AND AREAS WHERE LOCKS PREVENTED ACCESS. THESE AREAS WILL BE INSPECTED FOR A FEE, IF THEY ARE MADE
ACCESSIBLE AT THE OWNER'S EXPENSE. A SUPPLEMENTAL REPORT WILL BE ISSUED AND ANY FINDINGS AND RECOMMENDATIONS
WILL BE LISTED ALONG WITH ESTIMATES FOR REPAIR AND/OR TREATMENT, IF WITHIN THE SCOPE OF THIS COMPANY'S
OPERATIONS. NO OPTION IS RENDERED CONCERNING CONDITIONS IN THESE AREAS AT THIS TIME.
NOTE: INSPECTIONS ARE MADE AND REPORTS ARE ISSUED ON THE BASIS OF WHAT WAS VISIBLE AND ACCESSIBLE AT THE TIME OF
THE INSPECTION. THE ABSENCE OF VISIBLE EVIDENCE OF WOOD DESTROYING ORGANISMS IN THE VISIBLE AND ACCESSIBLE
PORTIONS OF THE STRUCTURE IS NO ASSURANCE THAT THE WOOD DESTROYONG ORGANISMS ARE NOT PRESENT IN ACCESSIBLE
AREAS NOR THAT FUTURE INFESTATIONS WILL NOT OCCUR. THEREFORE, WE DO NOT ASSUME ANY RESPONSIBILITY FOR THE
PRESENCE OF WOOD DESTROYING ORGANISMS, OR DAMAGE DUE TO SUCH ORGANISMS, IN AREAS THAT WERE NOT VISIBLE AND
ACCESSIBLE AT THE TIME OF THE INSPECTION OR THAT MAY OCCUR IN THE FUTURE.
NOTICE. THIS COMPANY WILL REINSPECT REPAIRS DONE BY OTHERS WITHIN FOUR MONTHS OF THE ORIGINIAL
INSPECTION. A CHARGE, IF ANY, CAN BE NO GREATER THAN THE ORIGINIAL INSPECTION FEE FOR EACH INSPECTION.
THE REINSPECTION MUST BE DONE WITHIN TEN WORKING DAYS OF REQUEST. THE REINSPECTION IS A VISUAL
INSPECTION AND IF INSPECTION OF CONCEALED AREAS ARE DESIRED, INSPECTION OF WORK IN PROGRESS WILL BE
NECESSARY. ANY GUARANTEES MUST BE RECEIVED FROM PARTIES PERFORMING THE REPAIRS.
NOTE: A VISUAL INSPECTION WAS PERFORMED AND THE INSPECTOR DID NOT DEFACE NOR PROBE INTO FINISHED WINDOW OR
DOOR FRAMES, TRIM WORK, FLOOR COVERINGS, WALLS, CEILINGS OR OTHER FINISHED SURFACES.
NOTE: THE EXTERIOR AREAS OF THIS STRUCTURE WERE VISUALLY INSPECTED FROM THE GROUND LEVEL. AREAS OF THE EXTERIOR
THAT EXHIBITED VISIBLE SIGNS OF INFESTATION, INFECTION OR DAMAGE FROM SAME WILL BE DESCRIBED IN THE BODY OF THIS
REPORT.
NOTE: IF ANY INFESTATION, INFECTION OR DAMAGE IS DISCOVERED IN A CONCEALED AREA DURING THE COURSE OF PERFORMING
ANY RECOMMENDATION IN THIS REPORT, THIS COMPANY WILL ISSUE A SUPPLEMENTAL REPORT. THIS COMPANY IS NOT
RESPONSIBLE FOR CONTROLLING SUCH INFESTATIONS OR INFECTIONS NOR FOR REPARING SUCH DAMAGE. IF THE ADDITIONAL
WORK REQUIRED IS WITHIN THE SCOPE OF THIS COMPANY'S OPERATIONS, A COST ESTIMATE WILL BE PROVIDED WITH THE
SUPPLEMENTAL REPORT.
NOTE: THE OWNER OF THIS PROPERTY HAS CERTAIN RESPONSIBILITIES REGARDING THE NORMAL MAINTENANCE THAT PERTAINS
TO THE DETERRENCE OF WOOD DESTROYING ORGANISMS. THESE NORMAL MAINTENANCE PROCEDURES INCLUDE, BUT ARE NOT
LIMITED TO; MAINTENANCE OF THE ROOF, GUTTERS, AND DOWNSPOUTS; CAULKING AROUND DOORS, WINDOWS, VENTS, TUB AND
SHOWER ENCLOSURES; KEEPING SOIL LEVELS BELOW THE TOP OF THE FOUNDATIONS; KEEPING STORED ITEMS (INCLUDING
FIREWOOD) AT LEAST TWELVE (12'1 INCHES AWAY FROM THE STRUCTURE; ADJUSTING SPRINKLERS SO THAT THEY DO NOT SPRAY
ONTO THE STRUCTURE; AND PREVENTING VEGETATION OR OTHER ITEMS FROM BLOCKING VENTS.
<;�;�.lf Y.t�St,)C),IFSi�I"vtIYwJlXcarvr'ei. (a'r'rruiu7<c>oirr
TERM/NiX
5TH PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
7852 BELKNAP DR, CUPERTION, CA 95014 12/17/2012 4935-0205472
BUILDING NO. STREET, QTY, STATE, IIP
INSPECTION DATE REPORT NO.
Pre Items Notations
NOTE: N35 This is to certify that the property described herein is free of evidence of active infestation of rodents.
Substructure
NOTE: N104 Substructure was dry and accessible.
Stall Showers
NOTE: N201 Limited inspection.
Foundation
NOTE: N305 Foundation is concrete and above grade.
Porches & Steps
NOTE: N405 Porches/steps are concrete/earth-filled and appears sealed.
Ventilation
NOTE: N506 Ventilation appears adequate and above grade.
Abutments
NOTE; N604 No abutments present.
Attic Spaces
NOTE: N705 Attic space is accessible.
Garages
NOTE: N807 Garage is accessible.
Decks & Patios
NOTE: N904 No decks/patios present.
Other Interiors
NOTE: N1007 Accessible.
Other Exteriors
NOTE: N1106 Accessible.
("6' l L8C)O 1 C_HYV INJIX <:xr vi; t 7 'm r'rinix.com
TERMINIX.
6TH PAGE OF STANDARD INSPECTION REPORT ON PROPERTY AT:
7852 BELKNAP DR, CUPERTION, CA 95014 12/17/2012 4935-0205472
BUILDING NO. STREET, CITY, STATE, ZIP INSPECTION DATE REPORT NO.
GENERAL NOTES
READ THIS DOCUMENT: It explains the scope and limitations of a Structural Pest Control Inspection and Wood Destroying Pest Organism
Inspection Report.
A Wood Destroying Pest and Organism Inspection Report contains findings as to the presence or absence of evidence of wood destroying
insects or organisms (fungi/rot) in visible and accessible areas on the date of inspection. It contains our recommendations for correcting any
infestations, infections or conditions found. The contents of the Wood Destroying Pest and Organism Inspection Report are governed by the
Structural Pest Control Act and the rules and regulations of the Structural Pest Control Board.
Some structures may not comply with building code requirements or may have structural, plumbing, electrical, heating and air conditioning,
or other defects that do not pertain to wood destroying organisms. A Wood Destroying Pest and Organism Inspection Report does not
contain information about such defects as they are not within the scope of the license of the inspector or the company issuing this report.
Nor does a Wood Destroying Pest and Organism Inspection Report contain information about asbestos or any other environmental or safety
hazard. Should interested parties desire opinions regarding these items, it is recommended that the owner engage the services of a reputable
"whole house" inspection company.
MOTE: THE EXTERIOR SURFACE OF THE ROOF WAS NOT INSPECTED. IF YOU WANT THE WATER TIGHTNESS OF THE ROOF
DETERMINED, YOU SHOULD CONTACT A ROOFING CONTRACTOR WHO IS LICENSED BY THE CONTRACTOR'S STATE
LICENSE BOARD.
NOTICE: REPORTS ON THIS STRUCTURE PREPARED BY VARIOUS REGISTERED COMPAINES SHOULD LIST THE SAME
FINDINGS (i.e. termite infestation, termite damage, fungus damage, etc.) HOWEVER, RECOMMENDATIONS TO CORRECT
THESE FINDINGS MAY VARY FROM COMPANY TO COMPANY. YOU HAVE A RIGHT TO SEEK A SECOND OPINION FROM
ANOTHER COMPANY.
NOTICE TO OWNER: UNDER THE CALIFORNIA MECHANICS' LIEN LAW, ANY STRUCTURAL PEST CONTROL COMPANY WHICH
CONTRACTS TO DO WORK FOR YOU, ANY CONTRACTOR, SUBCONTRACTOR, LABORER, SUPPLIER OR OTHER PERSON WHO HELPS TO
IMPROVE YOUR PROPERTY, BUT IS NOT PAID FOR HIS OR HER WORK OR SUPPLIES, HAS A RIGHT TO ENFORCE A CLAIM AGAINST YOUR
PROPERTY. THIS MEANS THAT AFTER A COURT HEARING, YOUR PROPERTY COULD BESOLD BY A COURT OFFICER AND THE PROCEEDS
OF THE SALE USED TO SATISFY PEST CONTROL COMPANY IN FULL IF THE SUBCONTRACTOR, LABORERS, OR SUPPLIERS REMAIN UNPAID
TO PRESERVE THEIR RIGHT TO FILE A CLAIM OR LIEN AGAINST YOUR PROPERTY, CERTAIN CLAIMANTS SUCH AS SUBCONTRACTORS OR
MATERIAL SUPPLERS ARE REQUIRED TO PROVIDE YOU WITH A DOCUMENT ENTITILED "PRELIMINARY NOTICE". PRIME CONTRACTORS
AND LABORERS FOR WAGES DO NOT HAVE TO PROVIDE THIS NOTICE. A PRELIMINARY NOTICE IS NOT A LIEN AGAINST YOUR
PROPERTY. ITS PURPOSE IS TO NOTIFY YOU OF PERSONS WHO MAY HAVE A RIGHT TO FILE A LIEN AGAINST YOUR PROPERTY IF THEY
ARE NOT PAID.
NOTE: IF DURING THE COURSE OF PERFORMING ANY REPAIRS, ANY FDCTURE OR PLUMBING IS FOUND TO BE UNSERVICEABLE,
DAMAGED OR DEFECTIVE, THERE WILL BE AN ADDITIONAL CHARGE FOR REPAIR AND/OR REPLACEMENT, AS NECESSARY.
NOTE: IT IS RECOMMENDED THAT BUILDING PERMITS BE OBTAINED FOR ALL WORK REQUIRING PERMITS, PRIOR TO BEGINNING THE
RECOMMENDED REPAIRS. FOR INFORMATION CONCERNING THE BUILDING DEPARTMENT AND PERMIT REQUIRMENTS, CONTACT THE
LOCAL BUILDING DEPARTMENT. WORK PERFORMED AS REQUIRED UNDER PERMIT FROM THE BUILDING DEPARTMENT PRIOR TO
CONSIDERING SUCH TO BE COMPLETED. BUILDING DEPARTMENT MAY REQUIRE INSTALLATION OF SMOKE/HEAT DETECTORS AS A
CONDITION OF OBTAINING A BUILDING PERMIT.
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 or fungi, you should contact an industrial hygenist.
The Structural Pest Control Board Mold Policy Statement is as follows:
"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 related regulations."
This statement is being provided to you for informational purposes
TERNINIX3
NOTICE TO OWNER/TENANT
State law requires that you be given the following information:
CAUTION - PESTICIDES ARE TOXIC CHEMICALS. Structural Pest Control Operators are licensed and regulated by the Structural Pest Control Board, and
apply pesticides which are registered and approved for use by the California's 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.
Marin
(415) 499-6700
San Luis Obispo
(805) 781-5910
Alpine
If within 24 hours following
application, you experience headache, dizziness, nausea, tearing, coughing, nose
and throat irritation or develop shortness
of breath, double vision,
unusual drowsiness and weakness, or tremors, contact your physician or poison control center (see below) and your pest
control operator immediately. If rodenticide ingestation occurs, you may experience symptoms of mild shock and/or bleeding.
(209) 223-6487
For further information, contact any of the following:
(707) 463-4208
Santa Barbara
(805) 681-5600
Butte
Terminix International.......................................................................
Merced
(209) 385-7431
(800) TERMINIX
(408) 918-4600
Calaveras
Poison Control Center.....................................................................
Modoc
(530) 233-6401
(800) 876-4766
(831) 763-8080
Colusa
Regulatory Information
— Structural Pest Control Board ................................
See Inyo County
(916) 561-8700
(530) 224-4949
Contra Costa
2005 Evergreen Street, Suite 1500, Sacramento, CA 95815-3831
Monterey
(831) 759-7325
Sierra
Health Questions - California County Health Departments:
Del Norte
(707) 4647235
Napa
(707) 253-4357
Alameda
(510) 267-8000
Madera
(559) 675-7893
San Luis Obispo
(805) 781-5500
Nene
(530) 694-2146
Mann
(415) 499-36%
San Mateo
(650) 573-2346
Amador
(209) 223-6407
Mariposa
(209) 966-3689
Santa Barbara
(805) 681-5102
Butte
(530) 538-7581
Mendocino
(707) 472-2600
Santa Clara
(408) 885-4214
Calaveras
(209) 7546460
Merced
(209) 381-1200
Santa Cruz
(831) 454-4000
Colusa
(530) 458-0380
Modoc
(530) 233-6311
Shasta
(530) 225-5591
Contra Costa
(925) 957-5400
Mono
(760) 932-7485
Sierra
(530) 993-6701
Del Norte
(707) 4643191
Monterey
(831) 755-4500
Siskryou
(530) 841-4040
EI Dorado
(530) 621-6100
Napa
(707) 253-4231
San Diego
(Press 0)
Fresno
(559) 445-0666
Nevada
(530) 265-1450
Solano
(707) 784-8600
Glenn
(530) 934-6588
Orange
(714) 834-8180
Sonoma
(707) 565-4567
Humboldt
(707) 445-6200
Placer
(530) 889-7141
Stanislaus
(209) 558-5670
Imperial
(760) 482-4438
Plumas
(530) 283-6337
Sutter
(530) 822-7215
Inyo
(760) 783-7868
Riverside
(951) 782-2974
Tehama
(530) 527-6824
Kern
(661) 868-0302
Sacramento
(916) 875-5881
Trinity
(530) 623-8209
Kings
(559) 5841402- Asir for "Nurse
San Benito
(831) 637-5367
Tulare
(559) 737-4660
Lake
(707) 263-8929 of the day'°
San Bernardino
(909) 387-6280
(Press 0)
Lassen
(530) 251-8183
San Diego
(619) 515-6555
Tuolumne
(209) 533-7400
Long Beach City
(562) 570-4000
San Frandsco
(415) 5542500
Ventura
(805) 677-5200
Los Angeles
(213) 240-8177
San Joaquin
(209) 468-3411
Yolo
(530) 666-8645
Yuba
(530) 741-6366
Application Information - California County Agricultural Commissioners:
Alameda
(510) 670-5232
Marin
(415) 499-6700
San Luis Obispo
(805) 781-5910
Alpine
(see EI Dorado)
Mariposa
(209) 966-2075
San Mateo
(650) 363-4700
Amador
(209) 223-6487
Mendocino
(707) 463-4208
Santa Barbara
(805) 681-5600
Butte
(530) 538-7381
Merced
(209) 385-7431
Santa Clara
(408) 918-4600
Calaveras
(209) 7546504
Modoc
(530) 233-6401
Santa Cruz
(831) 763-8080
Colusa
(530) 458-0580
Mono
See Inyo County
Shasta
(530) 224-4949
Contra Costa
(925) 646-5250
Monterey
(831) 759-7325
Sierra
See Plumas County
Del Norte
(707) 4647235
Napa
(707) 253-4357
Siskiyou
(530) 841-4025
EI Dorado
(530) 621-5520
Nevada
(530) 273-2648
Solano
(707) 7841310
Fresno
(559) 456-7510
Orange
(714) 447-7100
Sonoma
(707) 565-2371
Glenn
(530) 9346501
Placer
(530) 889-7372
Stanislaus
(209) 525-4730
Humboldt
(707) 445-7223x0
Plumas
(530) 283-6365
Sutter
(530) 822-7500
Imperial
(760) 482-4314
Riverside
(951) 955-3045
Tehama
(530) 527-4504
Inyo
(760) 873-7860
Sacramento
(916) 875-6603
Trinity
(530) 623-1356
Kern
(661) 868-6300
San Benito
(831) 637-5344
Tulare
(559) 685-3323
Kings
(559) 582-3211#2831
San Bemardino
(909) 387-2105
Tuolumne
(209) 533-5691
Lake
(707) 263-0217
San Diego
(858) 694-2739
Ventura
(805) 933-8415
Lassen
(530) 251-8110
San Francisco
(415) 252-3830
Yolo
(530) 666-8140
Los Angeles
(626) 575-5466
San Joaquin
(209) 468-3300
Yuba
(530) 749-5400
Madera
(559) 675-7876
One or more of the following chemicals may be applied to your property:
ADVANCE (Diflubenzuron) BOR -RAM (Disodium Octaborate Tetrahydrate) BORA-CARE (Disodium Octaborate Tetrahydrate) BORATHOR (Disodium
Octaborate Tetrahydrate) CY-KICK (Cyfluthrin) DRAGNET SFR(Permethrin) DRIONE INSECTICIDE DUST (Amor, Silica Aerogel, Pyrethrins, Piperonyl
Butoxide) PHANTOM (Chlorfenapyr) PRELUDE (Permethrin) PREMISE 75 INSECTICIDE (Imidadoprid) PT TRI -DIE DUST (Amor, Silica Aerogel, Pyrethrins,
Piperonyl Butoxide) TAP INSULATION (Orthoboric Add) TEMPO WP (Cyfluthrin) TEMPO SC ULTRA (Cyfluthrin) TIM -BOR (Disodium Octaborate
Tetrahydrate) TERMIDOR (Fipronil) VIKANE (Sulfuryl Fluoride) NOTE: Chloropicrin is use as a warning agent on all structural fumigations.
Thank you for calling Terminix. Should you have any questions regarding this report, please call 1-800-TERMINIX.
(;tzN 1.800 I E:E. 1fAlYffX o visit 1 t:,rrnir iix,cc-) 'r
BAY AREA Terms and Conditions
TERMINIX, 5860 W L05 POSITAS BLVD STE 19
PLEASANTON, CA 94588
(408) 283-0492
MANDATORY ARBITRATION. Any claim, dispute or controversy, regarding any contract, tort, statute, or otherwise ("Claim"), arising out of or relating to this agreement or the relationships among the
parties hereto shall be resolved by one arbitrator through binding arbitration administered by the American Arbitration Association ("AAA"), under the AAA Commercial or Consumer, as applicable, Rules
in effect at the time the Claim is filed ("AAA Rules"). Copies of the AAA Rules and forms can be located at www.adr.org, or by calling 1-800-778-7879. The arbitrators decision shall be final, binding,
and non -appealable. Judgment upon the award may be entered and enforced in any court having jurisdiction. This clause is made pursuant to a transaction involving interstate commerce and shall be
governed by the Federal Arbitration Act Neither party shall sue the other party other than as provided herein or for enforcement of this clause or of the arbitrator's award; any such suit may be brought
only in Federal District Court for the District or, if any such court lacks jurisdiction, in any state court that has jurisdiction. The arbitrator, and not any federal, state, or local court, shall have exclusive
authority to resolve any dispute relating to the interpretation, applicability, unconscionability, arbitrability, enforceability or formation of this Agreement including any claim that all or any partof the
Agreement is void or voidable. However, the preceding sentence shall not apply to the clause entitled "Class Action Waiver."
CLASS ACTION WAIVER. Any Claim must be brought in the parties' individual capacity, and not as a plaintiff or plass member in any purported class, collective, representative, multiple plaintiff, or
similar proceeding ("Class Action"). The parties expressly waive any ability to maintain any Class Action in any forum. The arbitrator shall not have authority to combine or aggregate similar claims or
conduct any Class Action nor make an award to any person or entity not a party to the arbitration. Any claim that all or part of this Class Action Waiver is unenforceable, unconscionable, void, or
voidable maybe determined only by a court of competent jurisdiction and not by an arbitrator. THE PARTIES UNDERSTAND THAT THEY WOULD HAVE HAD A RIGHT TO LITIGATE THROUGH A
COURT, TO HAVE A )UDGE OR JURY DECIDE THEIR CASE AND TO BE PARTY TO A CLASS OR REPRESENTATIVE ACTION, HOWEVER, THEY UNDERSTAND AND CHOOSE TO HAVE ANY CLAIMS
DECIDED INDMDUALLY, THROUGH ARBITRATION.
SEVERABILITY. If any part of this agreement is held to be invalid or unenforceable for any reason, the remaining terms and conditions of this agreement shall remain in full force and effect
CHANGE IN LAW. Terminix performs its services in accordance with the requirements of law. In the event of a change in existing law as it pertains to the servioes herein, Terminix reserves the right to
revise the annual renewal charge, or terminate this Agreement
NON-PAYMENT, DEFAULT. In case of non-payment or default by the Purchaser, Terminix has the right to terminate this Agreement. In addition, cost of collection shall be paid by the Purchaser, whether
suit is filed or not. In addition, interest at the highest legal rate will be assessed for the period of delinquency.
CHANGE IN TERMS. At the time of any renewal of this agreement, Terminix may change this agreement by adding, deleting or modifying any provisions, except for the annual renewal charge. Terminix
will notify the Purchaser in advance of any such change, and Purchaser may decline to accept such a change by declining to renew this agreement Renewal of this agreement will constitute acceptance
of any such changes. As to the annual renewal charge, after the second annual period and each annual period thereafter, Terminix reserves the right to revise the annual renewal charge without
notifying the purchaser in advance of such change.
FORCE MAJEURE. The liability of Terminix under this Agreement will be terminated if Terminix is prevented from fulfilling its responsibilities under the terms of this Agreement by reason of delays in
transportation, shortages of fuel and/or materials, strikes, embargoes, fires, floods, quarantine restrictions, earthquakes, hurricanes, or any other act of God or circumstance or cause beyond the control
of Terminix. Terminix reserves the right to adjust the service charge in the event of any such occurrences or happenings.
ADDITIONS, ALTERATIONS. This Agreement covers the Structures descried on the Inspection Graph as of the date of initial inspection. In the event the premises are structurally modified, altered or
otherwise changed or if soil is removed or added around the foundation, Purchaser will notify Terminix prior to such event and will arrange for an additional inspection required by the changes incurred
Failure to do so will terminate the Agreement automatically without further notice. In the event of any such change, Terminix reserves the right to adjust the annual renewal charge. The failure of
Terminix to notice any such changes does not release Purchaser from the obligations set forth in this paragraph.
LIMITED ASSIGNABILITY. This Agreement is assignable by Purchaser to a new owner of the property for period of one year from the Effective Date of this Agreement and thereafter, upon the written
request of the Purchaser, and only in the sole discretion of Terminix after its inspection of the property which consent, if given, shall be in writing, signed by Terminix and accepted in writing by
Purchaser.
EXISTING DAMAGE. Terminix is not responsible for the repair of either visible damage or hidden damage existing as of the date of this Agreement or occurring prior to the Effective Date of this
Agreement Damage discovered after the Effective Date of this Agreement with no verified live and active infestation present shall be deemed to have been caused before the date. Because damage
may be present in areas which are inaocessible to visual inspection, Terminix does not guarantee that the damage disclosed on the Inspection Graph represents all of the existing damage as of the date
of this Agreement.
DISCLAIMER:
EXCEPT AS OTHERWISE PROHIBITED BY LAW, TERMINIX DISCLAIMS AND SHALL NOT BE RESPONSIBLE FOR ANY LIABILITY FOR DIRECT, INDIRECT, SPECIAL, INCIDENTAL, CONSEQUENTIAL,
EXEMPLARY, PUNITIVE, AND/OR LOSS OF ENJOYMENT DAMAGES. THE OBLIGATIONS OF TERMINI( SPECIFICALLY STATED IN THIS AGREEMENT ARE GIVEN IN LIEU OF ANY OTHER OBLIGATION OR
RESPONSIBILITY, EXPRESS OR IMPLIED, INCLUDING ANY REPRESENTATION OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
This plan does not guarantee, and Terminix does not represent, that pests and/or termites will not return.
Should Terminix perform treatment on this property, Terminix will provide the Purchaser with a copy of the manufacturer's specimen label and other state required documents for the pesticide
(s)/termiticide(s) which will be used to treat the above-named property.
This Agreement does not cover and Terminix will not be responsible for damage resulting from or services required for:
(1) any and all damage resulting from termites and/or any other wood destroying organisms except as specifically provided herein.
(2) moisture conditions, including but not limited to fungus and/or water leakage caused by faulty plumbing, roofs, gutters, downspouts and/or poor drainage.
(3) masonry failure or grade alterations.
(4) inherent structural problems, including but not limited to, wood to ground contacts.
(5) termites entering any rigid foam, wooden or cellulose containing component in contact with the earth and the Stn aures regardless of whether the component is part of the Structures.
(6) the failure of Purchaser upon notice from Terminix to property cure at Purchasers expense any condition which prevents proper treatment or inspection or is conducive to terminate infestation.
EASY PAY AGREEMENT. In payment for services performed by Terminix I (we) hereby authorize you to initiate debit entries to my specified account, within five (5) business days after my (our) account
has been charged, as indicated in the Sales Agreement, at the depository financial institution named herein and to debit the same to such amount. I (we) acknowledge that the amount may increase
subsequent to the Sales Agreement's second anniversary date. This Authorization will remain in effect until I (we) notify you in writing to cancel it in such time as to afford the financial institution a
reasonable opportunity to act upon that notification. I (we) understand that cancellation of this authorization does not cancel my (our) service agreement or my responsibilities thereunder.
WATER LEAKAGE. Purchaser is responsible for making timely repairs as necessary to stop water leakage in interior areas or through the roof or exterior walls of the Structure as identified by Terminix.
Purchaser understands that such leakage may destroy the effectiveness of treatment rendered by Terminix and is conducive to new infestations. Purchasers failure to make timely repairs as identified
by Terminix will terminate this Agreement automatically without further notice. Terminix shall have no responsibility for repairs with respect to water leakage.
�.EI 1 ,13(/0 l EFIMINIX 0-r vi >it I a`r;rn m iix,(.x)j r)
{ X4 i'
AMERISCI
AmeriSci Los Angeles
24416 S. Main Street, Ste 308
Carson, California 90745
TEL: (310) 834-4868 • FAX: (310) 834-4772
PLM Bulk Asbestos Report
Environmental Remediation Tech
Attn: Mr. Fanelli
6472 Camden Ave.
Ste. 102B
San Jose, CA 95120
Date Received 12/03/12 AmeriSci Job # 912121035
Date Examined 12/04/12 P.O. #
Page 1 of 4
RE: TH1211-22A; Ava Construction; 7852 Belknap Dr. Cupertino,
CA. 95014
Client No. I HGA Lab No. Asbestos Present
Total % Asbestos
001 912121035-01.1
No
NAD
Location: Sheetrock/Tape/J.Comp. (Interior Walls)
(by CVES)
by Raymundo Orozco
on 12/04/12
Analyst Description: Beige/Brown, Homogeneous, Fibrous, Drywall
Asbestos Types:
Other Material: Cellulose 10 %, Non-fibrous 90 %
001 912121035-01.2
Yes
Trace (<1 %)
Location: Sheetrock/Tape/J.Comp. (Interior Wails)
(by CVES)
by Raymundo Orozco
on 12/04/12
Analyst Description: Beige, Homogeneous, Non -Fibrous, Joint Compound
Asbestos Types: Chrysotile <1. %
Other Material: Non-fibrous 100 %
002 912121035-02.1
No
NAD
Location: Sheetrock/Tape/J.Comp. (Interior Walls)
(by CVES)
by Raymundo Orozco
on 12/04/12
Analyst Description: Beige/Brown, Homogeneous, Fibrous, Drywall
Asbestos Types:
Other Material: Cellulose 10 %, Non-fibrous 90 %
002 912121035-02.2
Yes
Trace (<1 %)
Location: Sheetrock/Tape/J.Comp. (Interior Walls)
(by CVES)
by Raymundo Orozco
on 12/04/12
Analyst Description: Beige, Homogeneous, Non -Fibrous, Joint Compound
Asbestos Types: Chrysotile <1. %
Other Material: Non-fibrous 100 %
003 912121035-03.1
No
NAD
Location: Sheetrock/Tape/J.Comp. (Interior Walls)
(by CVES)
by Raymundo Orozco
on 12/04/12
Analyst Description: Beige/Brown, Homogeneous, Fibrous, Drywall
Asbestos Types:
Other Material: Cellulose 10 %. Non-fibrous 90 %
See Reporting notes on last page
AmeriSci Job #: 912121035
Client Name: Environmental Remediation Tech.
PLM Bulk Asbestos Report
TH1211-22A; Ava Construction; 7852 Belknap Dr. Cupertino,
CA. 95014
Page 2 of 4
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
003 912121035-03.2 Yes 2%
Location: Sheetrock/Tape/J.Comp. (Interior Walls) (by CVES)
by Raymundo Orozco
on 12/04/12
Analyst Description: Beige, Homogeneous, Non -Fibrous, Joint Compound
Asbestos Types: Chrysotile 2.0 %
Other Material: Non-fibrous 98 %
004 912121035-04
Location: Skim Coat Texture
Analyst Description: Beige, Homogeneous, Non -Fibrous, Bulk Material
Asbestos Types: Chrysotile <1. %
Other Material: Non-fibrous 100 %
R
912121035-05
Location: Linoleum In Hall Bath
Analyst Description: Off-White/Grey, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 20 %, Non-fibrous 80 %
M
912121035-06.1
Location: Linoleum In Kitchen w/Mastic
Analyst Description: Brown, Homogeneous, Fibrous, Linoleum
Asbestos Types:
Other Material: Cellulose 20 %, Non-fibrous 80 %
006 912121035-06.2
Location: Linoleum In Kitchen w/Mastic
Analyst Description: Black, Homogeneous, Non -Fibrous, Mastic
Asbestos Types: Chrysotile 2.0 %
Other Material: Non-fibrous 98 %
007
912121035-07
Location: Linoleum In Master Bath
Analyst Description: Beige, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 20 %, Non-fibrous 80 %
See Reporting notes on last page
Yes Trace (<1 %)
(by CVES)
by Raymundo Orozco
on 12/04/12
No NAD
(by CVES)
by Raymundo Orozco
on 12/04/12
No NAD
(by CVES)
by Raymundo Orozco
on 12/04/12
Yes 2%
(by CVES)
by Raymundo Orozco
on 12/04/12
No NAD
(by CVES)
by Raymundo Orozco
on 12/04/12
AmeriSci Job #: 912121035
Client Name: Environmental Remediation Tech.
PLM Bulk Asbestos Report
TH1211-22A; Ava Construction; 7852 Belknap Dr. Cupertino,
CA. 95014
Page 3 of 4
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
008 912121035-08 Yes 2%
Location: F/T In Half Bath (by CVES)
by Raymundo Orozco
on 12/04/12
Analyst Description: Beige, Homogeneous, Non -Fibrous, Bulk Material
Asbestos Types: Chrysotile 2.0 %
Other Material: Non-fibrous 98 %
009 912121035-09
No
NAD
Location: Acoustic Ceiling
(by CVES)
by Raymundo Orozco
on 12/04/12
Analyst Description: Beige, Homogeneous, Non -Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 100 %
010 912121035-10
Yes
Trace (<1 %)
Location: Exteiror Stucco
(by CVES)
by Raymundo Orozco
on 12/04/12
Analyst Description: Beige/Grey, Homogeneous, Non -Fibrous, Cementitious, Bulk Material
Asbestos Types: Chrysotile <1. %
Other Material: Non-fibrous 100 %
011 912121035-11.1
No
NAD
Location: F/T In Garage
(by CVES)
by Raymundo Orozco
on 12/04/12
Analyst Description: Beige, Homogeneous, Fibrous, Floor Tile
Asbestos Types:
Other Material: Non-fibrous 100 %
011 912121035-11.2
No
NAD
Location: F/T In Garage
(by CVES)
by Raymundo Orozco
on 12/04/12
Analyst Description: Yellow, Homogeneous, Non -Fibrous, Mastic
Asbestos Types:
Other Material: Cellulose 2 %, Non-fibrous 98 %
012 912121035-12
No
NAD
Location: Roofing Felt
(by CVES)
by Raymundo Orozco
on 12/04/12
Analyst Description: Black, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 80 %, Non-fibrous 20 %
See Reporting notes on last page
AmeriSci Job #: 91 21 21 035
Client Name: Environmental Remediation Tech.
PLM Bulk Asbestos Report
TH1211-22A; Ava Construction; 7852 Belknap Dr. Cupertino,
CA. 95014
Page 4 of 4
Reporting Notes:
Analyzed By: Raymundo Orozco ; Date Analyzed: 12!4!2012 7!%�
'NAD =no asbestos detected; Detec o Limit <1%; Reporting Limits: CVES = 1%, 400 Pt Ct = 0.25%, 1000 Pt Ct = 0.1%; NA =not analyzed; NAPS
= not analyzed / positive stop; NVA = No Visible Asbestos; PLM (polarized light microscopy) Bulk Asbestos Analysis by EPA 600/M4-82-020 per 40
CFR 763 (NVLAP Lab #200346-0, CA ELAP lab #2322); Note: PLM is not consistently reliable in detecting asbestos in floor coverings and similar NOB
materials. TEM is currently the only method that can be used to determine if this material can be considered or treated as non -asbestos -containing in
New York State (also s� EPA Advisory for floor file, FR 59, 146, 38970, 8/1/94). NIST Accreditation requirements mandate that this report must not be
reproduced except in f 1 with the approv I of Oe laboratory. This PLM report relates ONLY to the items tested.
Reviewed By:^� z 4 P
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