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.