B-2017-2072CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: I PERMIT NO: B-2017-2072
6652 CLIFFORD CT CUPERTINO, CA 95014-4554 (369 24 055) ALPS CONSTRUCTION
& REMODELING INC
SAN JOSE, CA 95129
OWNER'S NAME: SRI RAMKUMAR V TRUSTEE & ETAL I I DATE ISSUED: 05/29/2018 1
OWNER'S PHONE: 1 I PHONE NO: (
LICENSED CONTRACTOR'S DECLARATION
License Class B Lic. #909433
ContractorALI'S CONSTRUCTION & REMODELING INC Date 01/31/2020
t 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.
I hereby affirm under penalty of perjury one of the following two declarations:
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
erfemnance 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
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
and state laws relating to building construction, and hereby authorize
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, jut�jgrrreM, costs, and expenses which
may accrue against said City in cerlsequenoe of the granting of this permit.
Additionally, the applicant u erstands atlb will comply with all non -point
source regulations per tj>d Cuperting4dunicipal Code, Section 9.18.
Signature Date 05-29-2018
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
t. 1, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the stricture is not intended or offered for
BUILDING PERMIT INFO:
BLDG X ELECT X PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
2ND STORY- ADD (1042 SF); ADD COVERED BALCONY (42 SF);
1 ST FLOOR - ADD (533 SF); BATHROOM REMODEL X 2 (107 SF);
KITCHEN REMODEL (152 SF); OTHER REMODEL (1526 SF);
COVERED PORCH (88 SF); (N) FURNACE (2 TOTAL); (N) A/C (2
TOTAL); UPGRADE ELECTRICAL PANEL (200 AMPS); TANKLESS
WATER HEATER; FULLY SPRINKLER BUILDING
Sq. Ft Floor Area: 1575 1 Valuation: $750000.00
APN Number: Occupancy Type:
369 24 1 R-3 (Custom)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Kim Dunbar
Date: 05/29/2018
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
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 Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code). Date: 05-29-2018
1 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
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this pen -nit is issued.
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
permit is issued.
s. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, 1 become subject to the Worker's Compensation provisions of the
Labor Code, I trust forthwith comply with such provisions or this permit shall
be deemed revoked.
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 and state laws
relating to building construction, and hereby authorize 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. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signatu
Date 05-29-2018
ALL ROOF COVERINGS TO BE CLASS "A" OR
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino un ipal Code, Chapter 9.12 and
the Health & Safety Code, Section25 5, 25533, and 25534.
Owner or authorized agent: - ~ --
Date: 05-29-2018
CONSTRUCTION
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professic
* 4
NO FEE, FOR RECORDING PURSUANT TO
GOVERNMENT CODE SECTION 27383
When Recorded Mail To,:
City of Cupertino
Community Development Department
10300 Torre Avenue
Cupertino, CA 95014
z1#z62_ 123
Regina Alcomendras
Santa Clara County - Clerk -Recorder
08/22/2019 03:23 PM
Titles: I Pages: 3
Fees:0.00
Taxes: 0
Total: 10.00
NOTICE OF CITY REQUIREMENT TO MAINTAIN, TREES
The undersigned, being the owner(s) of the property shown in the Santa Clara County Assessor's Roll and
identified as A.P.N. 369-24-055 and addressed as 6652 Clifford Court, Cupertino CA 95014, hereby agree(s) that
the following plantings shall be maintained as privacy and protected trees to screen the views from the second
floor: a total of four (4) Marina Madrone (Arbutus 'Marina') and two (2) Camphor Trees (Ci-hnamomum camphora)
along the rear (southern) property line. In addition to the privacy plantings, the following planting shall be
maintained as the required front yard tree in the front yard setback: one (1) Eastern Redbud (Cercis canadensis).
These I plantings shall be maintained in accordance with Two -Story Permit No. R-201.7-01 and Building, permit
No. B-2017-2072. In the event these plantings die, the owner(s) shall provide replacement plantings subject to,
the approval of the City of Cup6rtino. This declaration is binding on the successors and assignees. of the
owners(s).
PROPERTY OWNERN:
OWner!s Signature
Print Owner's Name
Date
CITY AUTHORIZATION.:
Erika Poveda, Assistant Planner
Date
CALIi°ORNiA ALL-PU9P0S, ACKNOWLEDGM.'EN 1' CIVIL CODE § 1189
A notary public or other officer completing this certificate v 11 erifies 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 Jcw-z�,
On huoM �_2, before me, Lau c f ctPc,je,r f ljo+lf�r�1 T11
Date Here Insert Name and Title of the Officer .
personally appeared
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the erso� s) whose am' (s)Oare subscribed
to the within instrument and acknowledged to me that he/ hdD/they executed the same in Nisar/their
authorized cif ac' ies), and that by his/ec/their,s natu�e(s) on the instrument the erso s), or the entity
upon behalf of which the(perso s) acted, executed the instrument.
e l certify under PENALTY OF PERJURY under the
Rry - tAukEW 5OufiAR' laws of the State of California that the foregoing
Nobry.Public • California * paragraph is true and correct..
Santa Clara County
r Commission 112241155 WITNESS my hand and official seal.
My Comm. Expites Jun 22, 2022-
Signatur .
Place Notary Seal and/or Stamp Above Signature of Notary Public
Completing this information torr delel ulleruliurf of Lhe ducul,tent or'
fraudulent reattachment of this form to an unintended- document.
Description of Attached Document
Title or Type of Document:
Document Date: Number of Pages:
Signer(s) Other Than Named Above:
Capacity(les) Clai,Med by Signer(s)
Signer's Name: Signer's Name:
❑ Corporate Officer:7 Title(s): ❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited_ ❑ General ❑ Partner— ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact ❑ <Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian of Conservator [].'Trustee ❑ Guardian of Conservator
❑ Other: ❑ Other:
Signer is Representing: Signer is Representing:
02017 National Notary Association
CALIFORNIA ACKNOWLEDGMENT
f,1LrJT 1189
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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
g
OnA before me, 1 C_ca�i ,
Date -7 6 Here Insert Name and Tdofof the Officer
personally appeared
of Signer(s)
who proved to me on the basis of s4tisfactory 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/their signature(s) on the instrument the person(s), or the entity
upon behalf of which the person(s) acted, executed the instrument.
eELOrr RIC LOUIE
s Notary Public - California
Santa Clara County >
Z �O:
Commission €f 2248218
`""p My Comm. Expires Jul 26, 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.
WITNE'
Signati
Completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Doc, urnent --
Title or Type of Document:
Document Date:�f'Gg r7 6��_� ,- �� �`� Number of Pages: )
Signer(s) Other Than Named Above:
a
Capacity(ies) ClarmecibY igner(sy
Signer's Name.'i ?; �"`�;x�� Signer's Name:
EI Corporate Officer — Title(s) ❑ Corporate Officer — Title(s):
Li/Partner ❑ Limited ❑ General N ❑/Partner - El Limited ❑ General
[o Individual ElAttorney in Fact U Individual ❑ Attorney in Fact
❑ 'Trustee p Guardian or Conservator ❑ Trustee ❑ Guardian or Conservator
El Other: El Other:
Signer is Representing Signer is Representing:
fo-
02018 National Notary Association
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2017-2072
6652 CLIFFORD CT CUPERTINO,CA 95014-4554(369 24 055) ALPS CONSTRUCTION
&REMODELING INC
SAN JOSE,CA 95129
OWNER'S NAME:SRI RAMKUMAR V TRUSTEE&ETAL DATE ISSUED:05/292018
OWNER'S PHONE: PHONE NO:(408)441-0967
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.4909433
Contractor ALPS CONSTRUCTION&REMODELING INC Date 01/31/2020 X BLDG X ELECT X PLUMB
I hereby,affirm that I am licensed under the provisions of Chapter 9(commrcing X MECH X RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fall force and effect. JOB DESCRIPTION:
2ND STORY-ADD(1042 SF);ADD COVERED BALCONY(42 SF);
1 hereby affirm under penalty of perjury one of the following two declarations: I ST FLOOR-ADD(533 SF);BATHROOM REMODEL X 2(107 SF);
t. 1 have and will maintain a certificate of consent to self-insure for Worker's KITCHEN REMODEL(152 SF);OTHER REMODEL(1526 SF);
Compensmimu,as provided for by Section 3700 of the Labor Code,for the COVERED PORCH(88 SF);(N)FURNACE(2 TOTAL);(N)A/C(2
performance ofthe work for which this permit is issued. TOTAL);UPGRADE ELECTRICAL PANEL(200 AMPS);TANKLESS
1 have end will maintain Worker's Compensation Insurance,as provided for by NATER HEATER;FULLY SPRINKLER BUILDING
Section 3700 of the Labor Code,for the performance ofthe work for which this
permit is issued. Sq.Ft Floe-Area:1575 Valuation:$750000.00 -
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 369 24 055 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,jurgmerits,costs,and expenses which PERMIT EXPIRES IIP WORK IS NOT STARTED
may accrue against said City in of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands ad will comply with all non-point
source regulations pert€Cupertin 'unicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature _ _ — -- Data 05-29-2018 Issued by:Kim Dunbar
Date:05/29/2018
OW ER-B'I DII I O
I hereby affirm that I ani 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 renmve zll new materials for
ompensation,will do the work,and the structure is not intended ar offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. 1,as owner ofthc property,em exclusively contracting with licensed Siguanue ofAppliram:
contractors to construct the project(Sec.7044,Business&Professions Code). Date 05-29-2018
I hereby affirm under penalty of perjury one of the following Three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. 1 have and will maintain a Certificate of Consent toself-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performmicc ofthe work for which this permit is issuccl. 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 ofthe
Section 3700 of the Labor Code,for the perfarmence of the work for which this California liealth&Safety Codq Sections 25505,25533,and 25534.livid
permit is issued. m aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and tae
a- 1 certify drum the performance ofthe work for which this permit is issued,I Health&Safety Code,Section 25532(a)should 1 stn a m-handle hazardous
shall not employ any person in any mamuer at,as to become subject to the material.Additionally,should 1 use equipment or devices which emit hazardous
aircontaminents as defined by the Bay Area Air Quality Management District 1
Worker's Compensation laws of California.If,ager making this certificate of will maintain compliance with the Cupertino }�pal Code,Chapter 9.12 and
exemption,l become subject to the Worker's Compensation provisions of the the Health&Safi Code,Sectian 25rrO5,r25533,mrd 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. - Owner or authorized agent: _-- ---- -- --,.__
APPLICANTCERTd FICATION Date:05-29-2018
I certify that I have read this application and state that the above information is CONSTRUCTION I,RNDJNG 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,Cie 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 ARCBiTLcT,s DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as publ is records.
Licensed
Signature Date 05-29-2018
Professional