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B-2017-0242CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0242 11260 BUBB RD CUPERTINO, CA 950144979 (362 06 048) CRAFTSMEN'S GUILD INC CUPERTINO, CA 95014 OWNER'S NAME: PHONE NO: (408) 366-1000 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #507159 Contractor CRAFTSMEN'S GUILD INC Date 03/31/2019 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: ADDITION OF NEW MASTER BEDROOM (423 S.F.) HALLWAY I hereby affirm under penalty of perjury one of the following two declarations: BATHROOM REMODEL (67 SF); OTHER REMODEL (187 SF) t. 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 REV # 1 - REDUCE SHEAR WALL LENGTH AT GARAGE REAR performance of the work for which this permit is issued. WALL. ISSUED 4/26/17 2. I have and will maintain Worker's Compensation Insurance, as provided for by REV # 2 - REDUCE SIZE OF FOOTING AT GARAGE - ISSUED Section 3700 of the Labor Code, for the performance of the work for which this 5/4/2017 permit is issued. REV # 3 - CHANGE CEILING FRAMING FOR THE GARAGE CEILING APPLICANT CERTIFICATION AND 2ND FLOOR - ISSUED 7/11/2017 1 certify that I have read this application and state that the above Sq. Ft Floor Area: 423 Valuation: $120000.00 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize APN Number: Occupancy Type: representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the 362 06 048 R-3 (Custom) City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understancip and will comply with all non -point PERMIT EXPIRES IF WORK IS NOT STARTED source regulations per theCupertin unicipal Code, Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR signature Date7/1112017 180 DAYS FROM LAST CALLED INSPECTION. OWNER -BUILDER DECLA 10 Issued by: ABBY AYENDE I hereby affirm that I am exempt from the Contractor's License Law for one of the Date: 04/10/2017 following two reasons: t. I, as owner of the property, or my employees with wages as their sole RE -ROOFS: compensation, will do the work, and the structure is not intended or offered for All roofs shall be inspected prior to any roofing material being installed. If a roof is sale (Sec.7044, Business & Professions Code) installed without first obtaining an inspection, I agree to remove all new materials for 2. I, as owner of the property, am exclusively contracting with licensed inspection. contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: Signature of Applicant: t. I have and will maintain a Certificate of Consent to self -insure for Worker's Date: 7/11/2017 Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 2. 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 HAZARDOUS MATERIALS DISCLOSURE permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 3. I certify that in the performance of the work for which this permit is issued, I California Health & Safety Code, Sections 25505, 25533, and 25534. I will shall not employ any person in any manner so as to become subject to the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Worker's Compensation laws of California. If, after making this certificate of Health & Safety Code, Section 25532(a) should I store or handle hazardous exemption, I become subject to the Worker's Compensation provisions of the material. Additionally, should I use equipment or devices which emit hazardous Labor Code, I must forthwith comply with such provisions or this permit shall air contaminants as defined by the Bay Area Air Quality Management District I be deemed revoked. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 2 05, 25533, and 25534. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is Owner or authorized agent: correct. I agree to comply with all city and county ordinances and state laws Date: 7/11/2017 relating to building construction, and hereby authorize representatives of this city CONSTRUCTION to enter upon the above mentioned property for inspection purposes. (We) agree I hereby affirm that there is a construction lending agency for the performance to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is issued (Sec. 3097, Civ C.) judgments, costs, and expenses which may accrue against said City in Lender's Name consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Lender's Address Code, Section 9.18. ARCHITECT'S DECLARATION Signature Date 7/11/2017 1 understand my plans shall be used as public records. Licensed CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0242 11260 BUBB RD CUPERTINO, CA 95014-4979 (362 06 048) CRAFTSMEN'S GUILD INC CUPERTINO, CA 95014 OWNER'S NAME: PHONE NO: (408) 366-1000 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class @ Lic. #507159 Contractor CRAFTSMEN'S GUILD INC Date 03/31/2019 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: ADDITION OF NEW MASTER BEDROOM (423 S.F.) HALLWAY I hereby affirm under penalty of perjury one of the following two declarations: BATHROOM REMODEL (67 SF); OTHER REMODEL (187 SF) 1. 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 REV # 1 - REDUCE SHEAR WALL LENGTH AT GARAGE REAR performance of the work for which this permit is issued. WALL. ISSUED 4/26/17 z. I have and will maintain Worker's Compensation Insurance, as provided for by REV # 2 - REDUCE SIZE OF FOOTING AT GARAGE - ISSUED Section 3700 of the Labor Code, for the performance of the work for which this 5/4/2017 1 A5 permit is issued. Sq. Ft Floor Area: 423 Valuation: $120000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 362 06 048 R-3 (Custom) 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the pertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 5/4/2017 Issued by: ABBY AYENDE OWNER -BUILDER DECLARATION Date: 04/10/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofmg material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 5/4/2017 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I 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, Sections 25505, 25533, and 25534. be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 5/4/2017 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 5/4/2017 Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11260 BUBB RD CUPERTINO, CA 950144979 CONTRACTOR: PERMIT NO: B-2017-0242 (362 06 048) CRAFTSMEN'S GUILD INC CUPERTINO, CA 95014 OWNER'S NAME: DATE ISSUED: 04/10/2017 OWNER'S PHONE: PHONE NO: (408) 366-1000 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #507159 Contractor QRAFTSMEN'S GUILD INCDate 03/31/2019 X BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH YX 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: I hereby affirm under penalty of perjury one of the following two declarations: ADDITION OF NEW MASTER BEDROOM (423 S.F.) HALLWAY BATHROOM REMODEL (67 SF); OTHER REMODEL (187 SF) i. 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 REV # 1 - REDUCE SHEAR WALL LENGTH AT GARAGE REAR _ performance of the work for which this permit is issued. WALL. ISSUED 4/26/17 i. 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: 423 Valuation: $120000.00 APPLICANT ANT RTIFI ATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 362 06 048 R-3 (Custom) 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting this permit. Additionally, the applicant un rstands and will comply with all ll non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the ertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature----) Date �) ;l&/ ) -r Issued by: MELISSA NAMES I-M Date: 04/10/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without frost obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (See.7044, Business & Professions Code). Date: I hereby affirm under penalty of perjury one of the following three declarations: i. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I 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 will maintain compliance with the Cupertino M 'cipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 2 O5, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: -4 j- I certify that I have read this application and state that the above information is GyCONSTRUCTION EN correct. I agree to comply with all city and county ordinances and state laws I hereby affir that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lenders Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0242 11260 BUBB RD CUPERTINO, CA 950144979 (362 06 048) CRAFTSMEN'S GUILD INC CUPERTINO, CA 95014 OWNER'S NAME: PHONE NO: (408) 366-1000 LI N D CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class !I Lic. #507159 Contractor CRAFTSMEN'S GUILD INC Date 03/31/2019 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: ADDITION OF NEW MASTER BEDROOM (423 S.F.) HALLWAY I hereby affirm under penalty of perjury one of the following two declarations: BATHROOM REMODEL (67 SF); OTHER REMODEL (187 SF) 1. I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. M ez.G= - 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: 423 Valuation: $120000.00 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: Occupancy Type: and state laws relating to building construction, and hereby authorize 362 06 048 R-3 (Custom) 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said in consequence of the granting of this permit. Additionally, the applicar) rids and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per 7,a Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST PECTION. Signature_ Date 04/10/2017 Issued by: MEI OWNER- Date: 04/10/201 I hereby affirm that I 4 exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 04/10/2017 I hereby affirm under penalty of perjury one of the following three declarations:ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE z. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I 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 air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino NAnicipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: ' APPLICANT CERTIFICATION Date: 04/10/2017 ' 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 ION LE41ING AGENCY I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed SiSignature Date 04/10/2017 9 Professional k. FEE FOR RECORDING PURSUANT TO GOVERNMENT CODE SECTION 27383 When Recorded Mail To: City of Cupertino Community Development Department 10300 Torre Avenue Regina Alcomendras Santa Clara County - Clerk -Recorder 02/23/2019 02:24 PM Titles: I Pages: 3 Fees:10.00 0.00 Taxes: 0 Total: III �P�AI Wd F, C11 1111AA4111KIL 111111 Cupertino, CA 95014_—__ --- NOTICE OF CITY REQUIREMENT TO MAINTAW.TREE The undersigned, being the owner(s) of the property shown in the Santa Clara County Assessor's ''Rolland identified as A.P.N. 362-06-048 and addressed as 11260 Bubb Road,. Cupertino, CA 95014, hereby, agrees) that the following planting shall be maintained as the required front yard tree in the front yard setbacka one (1) Purple Hopseed (Dodonea vicosa). This tree shall be maintained in accordance with Two -Story Permit no: ' R-2016747 and i Building Permit no. B-2017-0242. In the event that these plantings die, the owner(s) shall protide replacement plantings subject to approval of the City of Cupertino. This declaration is binding on successors and -a'ss'ign s of the owner(s). PROPERTY WNER(S): Owner's Signature Print Owner's Name ah c boq' Date CITY AUTHORIZATION: dlz� Jeffrdy sumura, Assistant Planner CALPFORNHA ALd=PURPOSIE ACKNOWLEDGMENT CIVIL CODE § 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 California County of Ta-11� clmrG On c� before me, IV ate Here Insert Name and Title of the Officer personally appeared :ffnkA., �5�. Mwe Names) of Signer(s) who proved to me on the basis of satisfactory, evidence to be theerso (s) whose ame . i are subscribed to the within instrument and acknowledged to me that e she/they executed the same in /her/their authorizedapad (ies), and thatbGD/her/thei signatu (s) on the instrument t er (s); or.theentity upon bel' h th er s) acted, executed the instrument. certify under PENALTY OF PERJURY under the oFTa LAUREN SAPUDARlaws of the State of California that the foregoing `. Notary Public - California z paragraph is true and correct. z Santa Clara County Commission # 22�7t55 WITNESS my hand and official sea[ "`�"�P My Comm. Expires Jun 22, 2022, Signature Place Notary Seal and/or Stamp Above Signature of Notary Public Completing this information :can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Descrription of Attached Document Title or Type of Document: Iv��t.SL"� coq_ �� e�,, %�Or�✓!Zi�%,✓�. Document Date: Pi I Number of Pages: Signer(s) Other Than Named Above: Capacpty(ues) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: 02017 National Notary Association Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney. in Fact ❑ Trustee ❑ Guardian of '.Conservator ❑ Other: Signer is Representing: C"'ALIFORNIA ALL- PURPOSE 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 thetruthfulness, accuracy, or validity of that document.