B-2018-0337 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0337
10301 MENHART LN CUPERTINO,CA 95014-3668(375 15 033) NILSENE BUILDER
INC
21060 HOMESTEAD
RD 216 CUPERTINO,
CA 95014
OWNER'S NAME: DATE ISSUED:06/12/2018
OWNER'S PHONE: PHONE NO:408-4994595
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lia#10190 3
Contractor NILSENE BUILDER INC Dale 10/31/2018 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 Cade and that my
license is In full force and effect. JOB DESCRIPTION:
NEW TWO STORY SFD(1844 SF)ATTACHED GARAGE(445 SF)2
I hereby affirm under penalty of perjury one of the following two declm•atbms: PORCH(390 SF)BALCONY(55 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
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance,as provided for by
permit is issued. Sq.Ft Floor Area:1844 Valuation:5500000.00
APPLICANT CERTIFICATION
1 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 15 033 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 applicant understands and will comply with all non-point
source regulations p r th upertinoMunicipal Cade,Section 9.16. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 06-12-2018 Issued by:Kim Dunbar
Date:06/12/201.8
OWNER-BUILDE ECLARATION
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. 1,as owner of the property,or my employee with wages as their sole nstaIIad without in obtaining an inspection,1 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. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Data:06-12-2018
I hereby affirm under penally of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. I have and will maintain a Certifleate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 or the Labor Code,for the
performance ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hnzardons materials requirements under Chapter 6.95 of the
Section 3700 ofthe Labor Code,for the performanoa 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
s. I certify that in the performance of the work for which this permit is issued,1 Health&Safety Cade,Section 25532(n)should 1 store or handle hazardous
shall noCemploy arty person in any manner so as to become subject to the material.Additionally,aha',dl use equipment or devices which emit hazardous
air contaminants as defined by the Bay At an 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 Hmdth&Safety Code, ct 05,25533,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:06-12-2018
I certify that I have read this application and state that the above information Is CONSTRUCTION YENTUNG AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a cons rue Ion lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit Is is (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-polnt source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Data 06-12-2018
Licensed
NOFEE FOR RECORDING PURSUANT TO
GOVERNMENT CODE SECTION 27383
When ecd ded Mail To:
City of Cupertino
Community Development Department
10300 Torre Avenue
Cupertino, CA 95014
Regina Alcomendras
Santa Clara County - Clerk -Recorder
05/30/2019 03:07 PM
Titles: 1, Pages: 3
Fees:0.00
Taxes: 0
Total: 10.00
NOTICE OF CITY REQUIREMENT TO MAINTAIMTREE2S
The undersigned, being the owner(s) of the property shown in the Santa Cla' ra County Assessor'sRoll and
identified as A.P.N. 357-15-033 and addressed as 10301 Menhart Lane, Cupertino CA 95'014.ihor6by: ee(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) Strawberry Madron (Arbutus Marina) along the rear (northern)property line. In addition
to the privacy plantings, the following planting shall be maintained as the required front yardtreein frontree'* the
yard setback: one (1) Crape Myrtle (Lagerstroemia indica). In the event these plantings die, the owner(s) " shal
provide replacement plantings subject to the approval of the City of Cupertino. This ,declaration.'T's. b
I
mdm*vr on
the successors and assignees of the owners(s).
PROPERTY OWNER(S):
Owner's Signature
Print Owner's Name
Date
CITY AUTHORIZATION:
4ck Serrano, Associate Planner
Date
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personally appeared 6-; ra-
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Ki EM SQUARCIA
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Santa{lara County
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