Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
B-2016-2728
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2728 10120 LEBANON DR CUPERTINO, CA 95014-2646 (342 14 024) HOME BUILDERS & DEVELOPMENT INC CUPERTINO, CA 95015 OWNER'S NAME: DATE ISSUED: 08/04/2017 OWNER'S PHONE: PHONE NO: ( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #1025M Contractor HOME BUILDERS & DEVELOPMENT INC Date 04/30/2019 X BLDG _ ELECT _ PLUMB MECH X RESIDENTIAL COMMERCIAL I,hereby affirm that I am licensed under 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. JOB DESCRIPTION: N TWO STORY HOME (4031 SF); ATTACHED GARAGE (451 SK); I hereby affirm under penalty of perjury one of the following two declarations: PORCH (342 SF); DECK (336 'SF); m. 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 of the work for which this permit is issued. Yfrfommance ave and will maintain Worker's Compensation Insurance, as provided for by lisection 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: 4482 Valuation: $480000.00 permit is issued. 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 APN Number: 342 14 024 Occupancy Type: R-3 (Custom),R-3 (Custom),U (Private Gar /Ag Bldg),U and state laws relating to building construction, and hereby authorize (Private Gar /Ag Bldg) representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence.of the granting of this permit. PERMIT EXPIRES IF WORK IS NOT STARTED Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. ature Date 8/4/2017 Issued by: Abby Ayende OWNER -BUILDER DECLARATION Date: 08/04/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE -ROOFS: m. I, as owner of the property, or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed. If a roof is compensation, will do the work, and the structure is not intended or offered for installed without first obtaining an inspection,.I agree to, remove all new materials for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner.of the property, am exclusively contracting with licensed contractors to construct the project'(Sec.7044, Business & Professions Code). Signature of Applicant: Date: 8/4/201 I hereby affirm under penalty of perjury one of the following three declarations: m. I have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by HAZARDOUS MATERIALS DISCLOSURE Section 3700 of the Labor Code„ for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6.95 of the permit is issued. California Health & Safety Code, Sections 255051, 25533, and 25534. I will a. I certify that in the performance of the work for which this permit is issued, I maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the shall not employ any person in any manner so as to become subject to the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of,California. If,.after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to.the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety Code, Sections 25505, 25533, and 25534. be deemed revoked. APPLICANT CERTIFICATION wrier or authorized agent: Date: 8/4/2017 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 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance to enter upon the above mentioned property for inspection purposes. (We) agree of work's for which this permit is issued (Sec. 3097, Civ C.) to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands Lender's Address and will comply with all non -point source regulations per the Cupertino Municipal , Code, Section 9.18. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date $/4/7017 Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2728 10120 LEBANON DR CUPERTINO, CA 95014-2646 (342 14 024) HOME BUILDERS & DEVELOPMENT INC CUPERTINO, CA 95015 OWNER'S NAME: DATE ISSUED: 08/04/2017 OWNER'S PHONE: 650-823-6567 PHONE NO: ( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #1025631 Contractor HOME BUILDERS & DEVELOPMENT INC Date 04/30/2019 X BLDG _ ELECT _ PLUMB _ I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH X RESIDENTIAL COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: (N) TWO STORY HOME (4031 SF); ATTACHED GARAGE (451 SK); I hereby affirm under penalty of perjury one of the following two declarations: PORCH (342 SF); DECK (336 SF) 1. I have and will maintain a certificate of consent to self-insure for Worker's REV#1 CHANGES TO EXTERIOR FINISHED - ISSUED 10-15-2018 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area.: 4482 Valuation: $480000.00 APPLICANT CERTIFICATION I certify that I have read this application and.state that the above information is correct. ) agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 342 14 024 R-3 (Custom),R-3 (Custom),U (Private Gar / Ag Bldg),U representatives of this city to enter upon the above mentioned property for (Private Gar /Ag Bldg) inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. PERMIT EXPIRES IF WORK IS NOT STARTED Additionally, the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE source regulations per the .Cupertino OR Municipal Code, Section 9.18. O Date 10-15-2018 g Issued by: Abby Ayende OWNER-BUILDER DECLARATION Date: 08/04/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE-ROOFS: 1. I, as owner of the property, or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed. If a roof is compensation, will do the work, and the structure is not intended or offered for installed without first obtaining an inspection, I agree to remove all new materials for sale.(Sec.7044, Business & Professions Code) inspection. 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). Signature of Applicant: Date: 10-15-2018 I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by HAZARDOUS. MATERIALS DISCLOSURE Section 3700 of the Labor Code, for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6.95 of the permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will 3. I certify that in the performance of the work for which this'permit is issued, I maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of. California, If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety Code, Sect'on 25505, 25533, and 25534. be deemed revoked. APPLICANT CERTIFICATION Owner or authorized agent: I certify that I have read this application and state that the above information is Date: 10-15-2018 correct. I agree to comply with all city and county ordinances and state laws CONSTRUCTION LENDING AGENCY relating to building construction, and hereby authorize representatives of this city I hereby affirm that there is a construction Fending agency for the performance to enter upon the above mentioned property for inspection purposes. (We) agree of work's for which this permit is issued (Sec. 3097, Civ C.) to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name judgments, costs, and. expenses which may accrue against said City in consequence .of the granting of this permit. Additionally, the applicant understands Lender's Address and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. ARC:H:I:TECT'S DECLARATION I understand my plans shall be used as public records. Signature Date 10-15-2018 Licensed Professional NO FEE FOR RECORDING PURSUANT TO GOVERNMENT CODE -SECTION 27383 When xco Mail ®: City of Cupertino Community Development Department 10300 Torre Avenue C'iinarfinn CA A.q n14 Regina Aboomendras Santa Clara County - Clerk -Recorder 12/03/2018 10:OS AM Titles: I Pages: 3 Fees:10.00 0.00 Taxes: 0 Total: III Kirldwif RIMPIN I h L 411` AV' HSI MINA 11111 A L R Finti !` A ALL-PURPOSE ACKHOWLEDGMiENT CIVIL y :OD: § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of CalifarniA ) County ofG On�. �� _ before me, -0,-4 /L lk�l AtL(a, Date Here Insert Name and Title of the OTAT personally appeared (,:12j, . CLQ (DG� Name(s) of Signers) , who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to `me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/theirsignature(s) on the instrument the person(s), or the entity upon behalf of which the persons) acted, executed the instrument. - I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. GRACE SCHMIDT WITNESS my hand and official seal. ° Commission # 2095030 . d Notary Public - California ` Santa Clara County Signature M Comnt. Eupires Feb 21, 2019 Signature of (Votary Public Place Notary Seal Above Though this section is optional, corapleting t fraudulent reattachment of Description of Attached Document Title or Type of Document , Number of Pages: Signer(s) Other Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): El Partner — ❑ Limited ❑ General ❑ individual ❑ Attorney in Fact ❑Trustee ❑ Guardian or Conservator; ❑ Other: Signer Is Representing: )PT"IONAL his information can deter alteration of the document or this form to an unintended document. S Document Date: Than Named Above: Signer's Name: Corporate Officer — Title(s):. Partner — ❑Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: ©2014 National Notary Association ° wwxN.NationalNotary.org ° 1 -800 -US NOTARY (1-800-876-6827) item #5907 CALIFORNIA IA AEE -P ®SE CERTIFICATE OF ACKNOWLEDGMENT a Fry public or other officer completing this certificate verifies only the identity of the individual who signed the document to ch this certificate is attached, and not the truthfulness, `accuracy, or validity of that document. State of California County of _�_C' On before me, �(�' J 7 e �U CL.4 C_ q , Notary Public, (Here insert name and title of the officer) personally appeared t' , who proved to me on the basis of satisfactory evidence to be the person whose name(Kis/are. subscribed to the within instrument and acknowledged to that he/she/they executed the same in his/her/their authorized capacity'and that by his/her/their signatur�A on the instrument the persoxfio, or the entity upon behalf of which the persoacted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. KIR9ENSQUARCIA WITNESS m hand and official seal. Notary Public • California Z y ZSanta Clara County a Commission # 2257322 y Comm, res 0 ' 2022 Sign e of Notary Public .� (Notary Seal) ADDITIONAL OPTIONAL INPOPMATION INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative (Title or description of attached document) acknowledgment verbiage as may be printed onsuch a document so long as the. verbiage "does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the (Title or description of attached document continued)" document carefully for proper notarial wording and attach this form if required. e State and County information must be the State and County where the document Number of Pages Document Date signer(s) personally appeared before the notary public for acknowledgment. e Date" of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed; (Additional information) e The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). © Print the name(s) of document signer(s) who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER a Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he/shehhe3 -,- is /are ) or circling the correct forms. Failure to correctly indicate this ❑ Individual (s) information may lead to rejection of document recording. ❑ Corporate Officer e The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re -seal if a (Title) sufficient area permits, otherwise complete a different acknowledgment form. ❑ Partner(s) a Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney -in -Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. ❑ Other Indicate title or type of attached document, number of pages and date. •. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e: CEO, CFO, Secretary). e Securely attach this document to the signed document C 2004-2015 ProLink Signing Service, Inc. — All Rights Reserved www.TheProLink.com — Nationwide Notary Service NO FEE MR RECORDING PURSUANT TO GOVERNMENT CODE SECTION 27.383 -pig� ��- �y� C-h� When Re orded 1®' aH To' City of Cupertino Community Development Department 10300 Torre Avenue Cupertino, CA 95014 24074172 Regina A l cormendras Santa Clara County - Clerk -Recorder 12/03/2018 10:06 AVS Titles: I Pages: 3 Fees: 0.00 Taxes: 0 Total: 10.00 III W)FAU17�i Water Use Classifications of Landscape Species manual; or 2. Plants that are low-water using, native to California and appropriate for use in the area by the Santa C1ara.Valley Water District, Santa Clara Valley Chapter of the California Native Plant Society, the 1Vlaster' Growers Santa Clara County, or a certified Landscape Architect or ISA certified Arborist; or 3. Preparation of new landscape and irrigation plans in conformance with Chapter 14.15: (Landscape Ordinance) This declaration is binding on successors and assigns of the owner(s). PROP lE T ®7S) - Owner's Signa e Co-Owner'sSignature �—I y C� r )qAf Print Owner's Name Print Co -Owner's Name 3Z, -7 - Date Date CITE' AUTLATION: Gian Paolo'Martire, Associate Planner Dare C,mLiFORfdlA ALL-PURPOSE Ar:rid UW!_L.DC'Mtli QIVIL CODE § I ,;. A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is atfached, and not the truthfulness, accuracy, or validity of that document. State of Califo a } } County of On),A) . 30, c-ZO I before me, Dae F Here Insert Name and Title of the i r personally appeared 1 ( pao/ f) UY� °) I%ia Name(s) of Signer(s) who proved to meon the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknoWedged to me that he/she/they executed the same in his/her/their authorized capacity(ies)r and that by his/titer/theirsignature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. - I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. GRACE SCHMID Commission 2095030 WITNESS my hand and official seal. # notary Public - California ® Santa Clara County Signature _ My Comm. Ettpires, Feb 29, 2019 W Signature of Notary Public Place Notary SealAbove OPTIONAL Though this section is optional, cor apleting this- information can deter alteration of the document or fraudulent reattechdmnt of this form to an unintended dcocurnent. Description of Attached Doour n rC 3 V,? _. I ld 6 Title or Type of Document: V1 Document ate: Number of Pages: Signer(s) OtheryThan Named Above: Capacity(fes) Claimed by Signer(s) Signer's Name: Signer's Name: ❑' Corporate Officer - Title(s): ❑ Corporate' Officer Title(s): Partner — ❑ Limited ❑ General ❑ Partner ❑ Limited ❑ General ❑ Individual ❑ Attomey in Fact ❑ Individual ❑ Attorney in Fact ❑Trustee ❑ Guardian or Conservator ❑Trustee ❑ Guardian or Conservator ❑ Other: ❑ Other: Signer Is Representing: Signer Is Representing: 02014 National Notary Association ° www. National%tary.org ^ 1 -800 -US NOTARY (1 -800-876-6827) Item #5907 CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of -S� (4 Ia C 14L On Deceo46 e' 3..,'2-1 before me, ki "_54e " . :� I., rt c t 41 , Notary Public, (Here insert name and title of the officer) personally appeared ►w who proved to me on the basis of satisfactory evidence to be the personA whose name is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacityO, and that by his/her/their signatureo on the instrument the person;, or the entity upon behalf of which the personal acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. ,ssi•'�'e-�,rys K{RSTENSQUARCiA -. WI ESS my hand and official seal. Notary.Public • California Z W Santa Clara County n Z Commission # 2257322 C�lIF06N (Notary Seal) My Comm Expires Oct 4, 2022 Signature of Notary Public ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or description of attached document continued) Number of Pages Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer (Title) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only :exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printedon such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. e State and County information must be the state and County where the document signer(s) personally appeared before the notary public for acknowledgment. e Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. m ` The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). ® Print the name(s) of document signer(s) who personally appear at the time of notarization. o Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he/she/thea , is /a£e) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording: e The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form. e Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by the,signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). e Securely attach this document to the signed document C 2004-2015 ProLink Signing Service, Inc. — All Rights Reserved www.TheProLLnk.com — Nationwide Notary Service