B-2017-0896CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0896
11092 CANYON VISTA DR CUPERTINO, CA 95014-5405 (356 28 03 1)
SHAWN P BETTEGA
CONSTRUCTION INC
CLOVERDALE,CA
95425
OWNER'S NAME: CLAYTON J B 3 AND LINDA G
DATE ISSUED: 06/06/2017
OWNER'S PHONE: 408-257-9026
PHONE NO: (707) 884-4713
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class a Lic. #585905
Contractor SHAWN P BETTEGA CONSTRUCTION INC Date 09/30/2017
X BLDG X ELECT _PLUMB
X MECH X RESIDENTIAL COMMERCLAL
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:
KITCHEN REMODEL (143 ST.); INSTALL 28 (N) LIGHT FIXTURES
I hereby affirm under penalty of perjury one of the following two declarations:
AND 11 (N) SWITCHES; (N) HVAC
1. I have and will maintain a certificate of consent to self -insure for Worker's
REVISION #1- SUBPANEL UPGRADE (200 AMPS)- ISSUED 7/6/2017
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
Sq. Ft Floor Area:
Valuation: $50000.00
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:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
356 28 031
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.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations per Cup ipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 7/6/2917
Issued by: JASMINE ARCHBOLD
Date: 06/06/2017
I
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 sale
installed without fust 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: 7/6/2017
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. 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
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 Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health &Safety Code, S �%n 2 534.
Labor Code, I must forthwith comply with such provisions or this permit shall%/5�0
/
be deemed revoked.
Owner or authorized agent:] /
APPLICANT CERTIFICATION
Date: 7/6/2017 ` j'
I certify that I have read this application and state that the above information is
CONST
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a nstr ion ending 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
Signature Date 7/6/2017
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
1�1 I (408) 777-3228 • FAX (408) 777-3333 • buildingP-cupertino.org
CUPERTINO
[:1 NEW CONSTRUCTION [_-1 ADDITION ❑ALTERATION / TI V REVISION/
ORIGINAL PERMIT #
PROJECT ADDRESS 11� (� ^ n ,.� � �c�^
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APN #
OWNER NAME
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CONTACT NAME V,yok `W
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.FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE
LICEr TYPE
BUS. LIC #
COMPANY NAME,
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FAX
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PHONE
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME ---- E-MAIL
FAX
STREET ADDRESS CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
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EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT E] YES
SECOND STORY E] YES
BEING ADDED? []NO
ADDITION? ❑ NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVED BY:
ION:
PLANNING ADPL# NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑NO
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I onz representatives of Cupertino to enter the above-iden ified property for inspection purposes.
Signature of Applicant/Agent: Z Date:
SUPPLE D
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
_ New SFD or Multifamily dw li ly�fordemo=itionpermit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
—Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
1-1STANDARD
ElPUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
El MAJOR
El SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp 2011.doc revised 06/21/11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0896
11092 CANYON VISTA DR CUPERTINO, CA 95014-5405 (356 28 03 1)
SHAWN P BETTEGA
CONSTRUCTION INC
CLOVERDALE,CA
95425
OWNER'S NAME: CLAYTON J B 3 AND LINDA G
DATE ISSUED: 06/06/2017
OWNER'S PHONE: 408-257-9026
PHONE NO: (707) 884-4713
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class @ Lic. #585905
Contractor SHAWN P BETTEGA CONSTRUCTION INC Date 09/30/2017
X BLDG X ELECT —PLUMB
X 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:
KITCHEN REMODEL (143 S.F.); INSTALL 28 (N) LIGHT FIXTURES
I hereby affirm under penalty of perjury one of the following two declarations:
AND 11 (N) SWITCHES; (N) HVAC
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.
z. 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
`
Sq. Ft Floor Area:
Valuation: $50000.00
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:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
356 28 031
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.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations p the Cu i unicipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 6/6/2017
Issued by: AbbyAvende
0 WN E R -BUILD E WC Li�ION
Date: 06/06/2017
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
t. 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: 6/6/2017
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
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
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 Municipal C e; qpter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505 2 R 534.
Labor Code, I must forthwith comply with such provisions or this permit shall
9
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
Date: 6/6/2017
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 6/6/2017
Licensed
Professional
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a-cupertino.org
B_Z0k—+_C)$
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS g j
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CONTACT NAME
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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DESCRIPTION OF WORK�
id
\
`dffivin
II
ftoc' l i
IST G USE
PROPOSED USEJ CONSTR_
TYPE
# STORIES
USE
T
OCC.
SQ.FT.
VALUATION (S)
NEW FLOOR DEMO TOT
AREA
1 J
BATHROOM
REMODEL AREA
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA 2
'SOL)
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41 AS ` Ouo '
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACHFl
❑ ATTACH
# DWELLING UNITS
IS A SECOND UNIT E]YES
BEING ADDED? 'DIO
SECOND STORY ❑YES
ADDITION? TCU
(�
PCO.
PRE -APPLICATION ❑ S IF YES, PROVIDE COPY OF
PLANNING APPL # XO PLANNING APPROVAL LETTER
IS THE BLDG ANEl YES
EICHLER HOME?
RKEIVED BY:
TOTAL jVALUATION-
Ks
g Sum
By my signature below, I certify to each of the following: I am the property owner or authorized agent IP act oA the property owner's behalf. I have read this
application and the information I have provided is correct. I have rpdTffiLPescription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil n nstr 'on. I au o ep se tives of Cupertino to enter the above dentifi d property for inspection purposes.
Signature of Applicant/Agent: Date:9101
SUPPLEMENT FO RE
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
—Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
1-1STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ mAJoR
❑ SANrrARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVHIONMENTAL HF.AI.TH
B1dgApp 2011.doc revised 06/21/11
t1
lecs�a�.
Rancho Deep Cliff
Homeowners Association
June 5, 2017
Brad Clayton
Linda Clayton
11092 Canyon Vista Drive
Cupertino, CA 95014
REGARDING PROPERTY
11092 Canyon Vista Drive
Cupertino, CA 95014
Subject: V00068978 - Architectural Approval (Kitchen Remodel/Patio/Recessed Lighting)
Dear Homeowner(s),
The Board of Directors reviewed your request to remodel and upgrade your kitchen, replace your existing bed and
bench on the your patio and install new recessed lighting on your unit, located at 11092 Canyon Vista Drive.
Please be advised that the Board of Directors has approved your application subject to the following conditions:
• The unit owner assumes all responsibility for costs associated with this installation.
• The unit owner assumes all responsibility, both legal and financial, for any and all damages to any exterior
surfaces or damages of a structural or personal nature caused by the installation.
• The unit owner is responsible for all future maintenance, repair and replacement work associated with such
installation. The obligation runs with the lot and must be disclosed to any potential purchaser of the unit.
If you have any questions regarding this approval please call me at (408) 226-3300.
Sincerely,
RAN O DEEP CLIFF HOMEOWNERS ASSOCIATION
Jason Overhulse
Association Manager
Cc: Board of Directors
Unit File
Compass Management Group, Inc. 77 Las Colinas Lane, San 3ose, CA 95119 Business (408) 226-3300 Fax (408) 226-3406
Abby Ayende
06/06/17