B-2017-1219N. O FEE FOR RECORDING PURSUANT TO
GOVERNMENT CODE SECTION 27353
When Recorded MaR To:
City of Cupertino
Community Development Department
10300 Torre Avenue
Cupertino, CA 95014
Regina Aloomendras
Santa Clara County - Clerk -Recorder
05/14/2019 10:43 AES
Titles: 1 Pages: 3
Fees: 0.00
Taxes: 0
Total: 10.00
III PrAr11AWKIRil WAY A UN ,' 1 A 11III
NOTICE OF CITY REQUIREMENT TO MAINTAIN A PROTECTED LANDSCAPE
The undersigned, being the owner(s) of the property shown in the Santa Clara County Assessor'sRoll and identified as
A.P.N. 375-30-006 and addressed as 1110 Newsom Avenue, hereby agree(s) that the approved landscape shall be '
maintained and consistent to the approved plan in conjunction with Building Permit no. B-2017-1219, and shall be in
conformance with the City's Landscape Ordinance. The applicant may consult the City of Cupertino's Planning Department
prior to any modifications to the landscape; however, any proposed tree removals shall require approval by the City of
Cupertino. Changes to the plan may be made under the following conditions:
1. Plants that have water usage requirements consistent with the City's Landscape Ordinance as determined by the
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 Clara Valley
Water District, Santa Clara Valley Chapter of the California Native Plant Society, the Master 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).
People's Republic of China)
PROPER Municipality of Shanghai )SS: Consulate General of the )
United Mates of Ainorica )
Owner's Signature Co -Owner's Signature
Print Owner's Name Print Co -Owner's Name?
Date Date
CITE' AUTHORIZATION:
Erika Poveda, Assistant Planner Date
SdnW d swomL'oti LdLm i rh C0P9uIate jGlen erai
befoleme ,lex Vla& a4a6 ail ff N) Consul a fl a
of to DWAL CONSSIONS DO NOT URIRE
CALHFORNRA ALL -(PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
A notary public or other officer completing this certificate verifies onlythe 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 `` ,
n, r
On - dl'W ICAabeforeme, i upen &A uC
Date Here Insert Name and Title of the 6filcer
personally appeared 1r4jC,
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to e the ers ' (s) whose am (s) sre subscribed
to the
withinA
iment and acknowledged to me that / he they executed the sa e 'nhis/ /their
authorized a(ies), and that by his/lam/their ignat s) on the instrument th pers n(s),-or the entity
upon behalfh the erso (s) acted, executede instrument.
9 m :
y
of sy LAUREN SAPUDAR
Notaq Public - California
Santa Clara County 9a
Commission N 2247155
ARy Comm, Expires Jun 22;.2022
Place Notary Seal and/or Stamp Above
I certify under PENALTY OF PERJURY under the
laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal.
Signature It
Signature of Notary Public
P I InrJ.L
Completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Docs t
r GTitleorTypeofDocument: 11-, C 5 amu' Y w' w -kin
Document Date: r` \A— Number of Pages:
Signer(s) Other Than Named Above:
Cap ecity(ies) 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:
2017 National Notary Association
P.4d
Signer's Name:
Corporate Officer - Title(s):
Partner — Limited General..
El
eneral..
Individual Attorney in Fact
Trustee Guardian of Conservator
Other:
Signer is Representing:
Gjz v_
1 • y s C 4,s
is . H , [' 7 _ Ia I t,, 3 s ! {1s 9 i << l; ± 1 ,; ci n ; a a,a ; a ` ,(
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 Santa Clara
On /U[ Qy l -7 f 'O l before me, Kirsten Squareia
Here insert name and title of the officer)
S
personally appeared l J !il Z_ C( I.,
Notary Public,
who proved to me on the basis of satisfactory evidence to be the person( 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
capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entityupon behalf of
which thp sons) 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.
KIRSTEN SQUARCIA
Notary Public California z
WITNESS my hand and official seal. 54nta Clara County b
Commfssian # 2249322
My Gamm. Expires 01&4'-'2022,,
Notary Seal) ~
SignatAe 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 printed on 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.
o State and County information must be the State and County where the document
signer(s) personally appeared before the notary public for acknowledgment.
o 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).
o 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/ is /are ) or circling the correct forms. Failure to correctly indicate this
information may lead to rejection of document recording.
o 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.
o 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).
m Securely attach this document to the signed document
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a
NO FEE FOR RECORDIlVG PURSUANT TO
GOVERNMENT CODE SECTION 27383
When Recorded. Mail To:
City of Cupertino
Community Development Department
10300 Torre Avenue
Cupertino, CA 95014
Regina A l oomendras
Santa Clara County - Clerk -Recorder
05/14/2019 10:43 AM
Tbtles: I Pages: 3
Fees: 0.00
Taxes: 0
Total: 16.00
1`11.1
NOTICE OF CITY REQUIREMENT TO MAINTAIIN TREE
The undersigned, being the owner(s) of the property shown in. the Santa Clara County Assessor's Roll and
identified as A.P.N. 375-30-006 and addressed as 18710 Newsom Avenue, Cupertino, CA 95014; hereby agrees)
that the following planting shall be maintained as the required front yard tree in the front yard setback: one (1)
Crape Myrtle (Lagerstroemia Tuscarora) This tree shall be maintained in accordance with Two -Story Permit no.
R-2017-13 and Building Permit no. B-2017-1219. In the event that these plantings die, the owner(s) shall provide
replacement; plantings subject to approval of the City of Cupertino. This declaration is binding on successors
and assigns of the owner(s).
y
PROPERY ® EPQSD:
Owner's Signature
Print Owner's Name
7 H —20,/
Date
CI'T'Y AUTHORIZATION:
1AA
Erika Poveda, Assistant Planner
People's Republic of China) Municip9;1itY of ShanghaiConlateGenetalofthe SSS:
United States of I Inerica )
efOPe ffie Alex Viadichak Litichevsky (f1ct) Cons
U p '69 .
of le Wted S , . f i
dssioaed and qualified, 0 dad of . 920 '
Co -Owner's Signature
Q,
CALIFORNIA ALL-PURPOSE CERTIFICATE OF ®i
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document towhichthiscertificateisattached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Santa Clara
on (3 X19 before me, _ Kirsten Squarcia
Here insert name and title of the officer) Notary Public,
Personally appeared
who proved to me on the basis of satisfactory evidence to be the persons whose names ithewithininstrumentand, acknowledged to me that he/she/th ecutedthe same in O sure subscribed to
capacity(ies), and that by his/her/their signature(s) on the instrument the person s), or e
entityr/
t
ueloriuthorized
which thep on, s acted, executed the instrumet -, p. behalf of
I certify under PENALTY OF PERJURY under the laws of the State of California thatistrueandcorrect. at the foregoing .paragraph
WITNESS my hand and official seal.
e
Signature of Notary public (Notary Seal)
ADDITIONAL OPTIONAL INFORMATION
roocary puplic"; California -z' . o Santa.Clara -County.•,
Cnrnmission #:2257322,'.
Ay Co Eicpires Oct ',,20
INSTRUCTIONS FOR COMPLETING THIS FORMDESCRIPTIONOFTHEATTACHEDDOCUMENTAnyacknowledgmentcompletedinCaliforniamust ;contain verbiage exactlyappears asaboveinthenotarysectionoraseparateaclazowledgmentform.must.beproperlycompletedandattachedtothatdocument., The
Title or description of attached document)
only exception zs t' a - document is to be recorded outside of California. In such, instances, any alternative ': .: acknowledgment verbiage as may be printed on such a document. so long as theverbiagedoesnotrequirethenotarytodosomethingthatzsillegalforanotaryin - California (i.e. certifying theTitleordescriptionofattacheddocumentcontinued) authorized capacity of the -Signer):; Please check thedocumentcarefullyforpropernotarialwordingandattach<this form if required.'
Number of Pages Document Date 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
Additional' ation) nform
signer(s) personally appeared whichmustalsobethesamedatetheacknowledgmentiscompleted.
a The notary public must print his or her name as it appears within his or hercommissionfollowedbyacommaandthenyourtitle (notary
CAPACITY CLAIMED BY
public). 9 Print the name(s) of document signer(s) who personally appear at the time of ` notarization.
THE SIGNER
Individual {s) m Indicate the correct singular or plural forms by crossing off incorrect forms (i.e, he/she/they -,- is /afe ) or circling theCorporateOfficer correct forms. Failure to correctly indicate thisinformationmayleadtorejectionofdocument
Title)
recording.
O The notary seal impression must be clear and photographically. reproducible. Impression must not cover text lines.
Partner(s)
or If seal impression smudges; re -seal if a - sufficient area permits, otherwise complete a different acknowledgment forii. Signature
Attorney -in -Fact of the notary public must match the signature on file with the office `ofthecountyclerk. ..,
Trustee(s)
Other Additional information is not required but could help to ensure thisacknowledgmentisnotmisusedorattachedtoadifferentdocument.' V' Indicate title or type of attached document, number ofpages and date. Indicate the capacity claimed by the signer. If the claimed capacity is acorporateofficer, indicate the title (i.e. CEO, CFO, Secretary). Securely attach this document to the signed document
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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1219
18710 NEWSOM AVE CUPERTINO,CA 95014-3855(375 30 006) NILSENE BUILDER
INC
CUPERTINO,CA 95014
OWNER'S NAME: LIANG QIBIN AND WEI LIU TRUSTEE DATE ISSUED:10/12/2017
OWNER'S PHONE: PHONE NO:(408)993-1229
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#1019073 BLDG _ELECT _PLUMB
Contractor NILSENE BUILDER INC Date 10/31/2018
MECH XC 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:
CONSTRUCT(N)2-STORY SFD(2378SF);2-CAR ATTACHED
I hereby affirm under penalty of perjury one of the following two declarations: GARAGE(449 SF);PORCH-(490 SF);BALCONY(60 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
.erformance 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:2827 Valuation:$450000.00
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 375 30 006 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. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the apI,licant understands and will comply with all non-point
source regulations'.erthe Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Soto' Lure Irl Date 10/12/2017 Issued by:AbbyAyende
Date: 10/12/2017
F
i% rt •" \
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 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,es owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code), Date:10/12/2017 •
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
shill notemploy 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 C per ino Municipal Code,Chapter 9.12 and
exeniption,'I become subject to the Worker's Compensation provisions of the the Health&Safety Code,j.ec q'ons 25505,25533,and 25534.
Labor Code;I must forthwith comply with such provisions or this permit shall /
I certify that I;have,read this application and state that the above information is CO S lt; IOC LE I kG:G C_
correct.I agree to conply with all city and county ordinances and state laws I hereby affirm that there is arnstruction lending agency for the performance
relating to buildingconstruction,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. I understand my plans shall be used as public records.
Licensed
Signature Date 10/12/2017
Professional