15120038 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:15120038
10265 JUDY AVE CUPERTINO CA 95014(375 08 043) CRAIG A ROGERS
CONSTRUCTION INC
SAN JOSE,CA 95136
OWNER'S NAME:BA1NS KULVINDER SINGH&SUKHVANT DATE ISSUED:07/15/2016
OWNER'S PHONE:(408)891-9637 PHONE NO:(408)978-5484
LICENSEDCONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#9985.58 BLDG—ELECT—PLUMB
Contractor CRAIG A ROGER$CONSTRUCTION INC Date 11/30/2016 —
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH—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:
CONSTRUCT(N)2 STORY SFD WITH 3,774 S.F.
I hereby affirm under penalty of perjury one of the following two declarations: HABITABLE AREA,882 S.F COVERED PORCHES/BALCONIES
i. I have and will maintain a certificate of consent to self-insure for Worker's &443 S.F.ATTACHED GARAGE(SUNNYVALE
Compensation,as provided for by Section 3700 of the Labor Code,for the SANITARY)
performance of the work for which this permit is issued. REV#4-ADD 1/2 BATHROOM AND REVISE ELECTRICAL FOR
`N&have and will maintain Worker's Compensation Insurance,as provided for by KITCHEN-ISSUED 8-15-2018
✓ ---//Section 3700 of the Labor Code,for the performance of the work for which this REV#3-(3-7-17)CHANGE DESIGN OF KITCHEN/LIVING
permit is issued. ROOM/DINGING/STORAGE ROOM-ISSUED 4/24/2017
APPLICANT CERTIFICATION REV#2-REVISE FOUNDATION DETAIL-ISSUED 12/07/2016
1 certify that I have read this application and slate that the above REV#1-INCREASE HEIGHT OF CEILING 9 FT TO 10 FT.;INCREASE
information is correct.I agree to comply with all city and county ordinances HEIGHT OF ROOF LINE;ADD COFFERED
and slate laws relating to building construction,and hereby authorize CEILING 2ND FLOOR-ISSUED 9/27/2016
representatives of this city to enter upon the above mentioned property for
Inspection purposes.(We)agree to save Indemnify and keep harmless the Sq.Ft Floor Area: Valuation:$555000.00
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 APN Number: Occupancy Type:
source regulonper the Cupertino Muni'`pal Code,Section 9.18. 375 08 043
Signature Date 8/15/2018 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
OWNER-BUILDER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION.
I hereby affirm that f am exempt front the Contractor's License Law for one of the
following two reasons:
r, I,as owner of the property,or my employees with wages as their sole Issued by:PAUL O'SULLIVAN
compensation,will do the work,and the structure is not intended or offered for Date:07/15/2016
sale(Sce.7044,Business&Professions Code)
z. 1,as owner of the property,ant exclusively contracting with licensed RE-ROOFS;
contractors to construct the project(Sec.7044,Business&Professions Code). All roofs shall be inspected Is to any roofing material being installed If a roof is
1 hereby affirm under penalty of perjury one of the following three declarations: installed without first obtaining ao inspection,I ngive to removo all new materials for
r, 1 have and will maintain a Certificate of Consent to self-insure for Worker's inspection.
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance critic work for which this permit is issued, Signature of Applicant:
z. I have and will maintain Worker's Compensation Insurance,as Is for by Date:8/15 l
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
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 flue HAZARDOUS MATERIALS DISCLOSURE
Worker's Compensation laws of California.If,after making this certificate of I have read the hazardous materials requirements under Chapter 6.95 of the
exemption,I become subject to the Worker's Compensation provisions ofthe California Health&Safety Code,Sections 25505,25533,and 25534.I will
Labor Code,I must forthwith comply with such provisions or this permit shellmaintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
be deemed revoked. Health&Safety Code,Section 25532(x)should 1 store or handle hazardous
material.Additionally,should I use equipment or devices whicb emit hazardous
APPLICANT CERTIFICATION air contaminants as defined by the Bay Area Air Quality Monagement District I
I certify that I have read this application and state that the above Information is will maintain compliance with the Cupertino Mmdcipal Code, 1=1
9.12 and
correct.I agree to comply with all city and county ordinances and state laws the Health&Safety C e action 255 25533 d 25534.
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, Owner or authorized agent:
judgments,costs,and expenses which may accrue against said City in Date:8/15/2018 _
consequence of the granting of this permit.Additionally,the applicant understands I
and will comply with all non-point source regulations per the Cupertino Municipal I hereby affirm that there is a to ruction lending agency for the performance
Code,Section 9.18. of work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
Signature Date 8/1 512QJ a Lender's Address
ARCHITECT'S DECLARATION
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228• building@cupertino.o� PEMIT#B- Q� L
CUPERTINO REV# DEF#
❑NEW CONSTRUCTION ❑ADDITION ❑ALTERATION❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJE cARDDRIII A APN I
`
OWNER F., 1 ^ PHONE E-MAIL
STREET AlDDIR�5
�11r CcsJd'Ctl�� �5��
,XCONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
STRE T,A)RESS CITY,STATE,ZIP
E-MAILK PI-TONE BUS.LIC,
C�(?l'I
❑ARCHITECT ❑OWNE2❑OWNERAGENT ❑CONTRACTORAGENT❑ENGINEER El DEVELOPER El TENANT
COAMS NT � E-MAIL
STR 2ADD�RES- � L CI Y,ST ATE,Z./I�P'vry/ .�� ��
DESCRIPdT Ja (B I�I, •� �V \ 1 VV- 51_AI
❑SINGLE-FAMILY/DUPI.FX ❑MULTI-FAMILY ❑INDUSTRIAL ❑COMMERCIAL
EXISTING USE EXISTINGSF NEWPLOOR SP PORCH- DECK SF I DEMOSP I STORMS p TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KI'I'CFIEN REMODELOTHR GARAGE El A'ITAC-IED
BATHROOM SF SF SP SF C]DE'T'ACHED
EXISING ❑YESEIGHLER El YES SECOND STORY ADDI'T'ION El YES
FIRE SPRINKLERS
El ❑NO ❑NO
DWELLING FOUND DWELLING �yES❑ATTACHED❑DETACHED OTHER
UNITSu UNITADDITON: El No SP
El FIBERGLASS ❑VINYLLINED ❑GUMTE E]PREFABRICATED
POOL-SF SPA-SF SPA ATTACHED AYES ❑NO TO'fAl,-SF
RF.CEI TOTAL VALUA'HON:
C1 M!t'F,B 11LB'f8'g 'tf P bl'S ,�P 1 i D I t •t f E •t!H tl F 1
EXISTING ROOF TYPE: L]BUILT-UF ROOF E]ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES Q TILE OTHER(SPECIFY)
REMOVE/REPLACE E]NO iF NO PLYWOOD ❑�h.. ❑3/8" PLYWOODTYPE: PI'T'CH: .12 ROOF CLASS
❑YES W OP LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX D'I'I-IEIZ A
PROPOSED ROOF TYPE:EltFun1'-UPROOF❑ASPHALTSHINGLES❑WOODSHAKES❑WOODSHINGt.E5❑OTHER
*Provide a signed copy of the Cupertino's Tear-Off Polity SF aof SQUARRs
By my signature below I certify to each of the following: lam 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 lac r 'nal es and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified propert f Ins tion pvSe^s. I a owledge and authorize all information contained on this application form
to be made available for public Fee d. •] —
Signature of ApplicanC/Age t Date: 11
SUPPLEMENTAL INFORMA IQN tE E1
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings:Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approval from the Home Owner's Association
BIdgABp_2017.doc revised 08101117
NQ 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
24001248
Regina Abcomendras
Santa Clara County - Clerk -Recorder
08/10/2018 112:35 PM
Titles: I Pages: 3
Fees: 0.00
Taxes: 0
Total: 10.00
ill W11FABIRMNAVMM w1whKat,014 I 11A 11111
NOTICE OF CITY REQUIREMENT TO, MAINTAIN 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. 357-08-043 and addressed as 10265 Judy Ave., hereby agree(s) that the following plantings
shall be maintained as privacy and protected trees to screen the views from the second floor: Six (6) Strawberry
Trees (Arbutus marina) along the northern property line. In addition to the privacy plantings, the following
planting shall be maintained as the required front yard tree m the front yard setback one (1) Crape Myrtle
(Lagerstroemia h.). In the event these plantings die, the owner(s) shall provide replacement.plantings subject to
the approval of the City of Cupertino. This declaration is binding on the successors and assignees of the
CALIFOORfdi,ra ALL-PURPOSE ACKNOWLEDGMENT ClIVIL CODE § 118-3
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 Calif 'a )
County of
On ,t JA n before me, -32 4A
SA&. A
Date Here Insert Name and Title of the Officer
personally appeared l'C(� �� / Sa4nd ie-_ kJ,U 0-
Name(s) of Signer(s)
who proved to me on the basis. of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that fie/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.
I certify under PENALTY OF PERJURY under -the laws
of the State.of California that the foregoing paragraph
a
GCE SCFlMBO> is true and correct.
Commission '# 2098030 WITNESS my hand and official seal.
Notary Public - California
° Santa Clara County d
t
IViy C®tni. Ex ir¢s Falx 2, 2019 tSignature C
Signature of Notary Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached) Docum ) � �� 1A
Title or Type of Document: Mn_� Document Date:
Number of Pages: Signer(s) Other Than Named Above:
Capacity(les) Claimed by Signer(s)
Signer's Name:
❑Corporate Officer — Title(s):
❑ Partner — 0 Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
Signer's Name:
❑ Corporate Officer Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
02014 National Notary Association ^ www.NationaiNotary.org ^ 1 -800 -US NOTARY (1-800-876-6827) Item #5907
CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT
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 San )tet C�aM
On 5 1 `Z�i before me, Notary Public,
v (Here insert name and title of the officer)
personally appeared
who proved to me on the basis of satisfactory evidence to be the son )s) whose` s) Bare subscribed to
the within instrument and acknowledged to me tha e ' he/they executed the same j�/her/their authorized
a ac �es), and that by ii `her/their 'gnf`a (s) on the instrument th erson ), or the entity upon behalf of
which the erson :) 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.
COLLEEN LETTIRE
COMMMOR # 2078124
W1TTjF,SSmy hand and officia Warypub91e, e Cgiltdrnia ZK
v (Notary Seal)
Signature of Notary Public
ADDITIONAL, OPTIONAL INFORMATION
INSTRUCTIONS FOR COMPLETING THIS FORM
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
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 forproper 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.
• Date of notarization must be the date that the signer(s) personally appeared which
must also be the same date the acknowledgment is completed,
o 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).
a Print the name(s) of document signer(s) who personally appear at the time of
notarization.
a Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.
he/she/#I*- is /are ) or circling the correct forms. Failure to correctly indicate this
information may lead to rejection of document recording.
a 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.
a Signature of the notary public must match the signature on file with the office of
the county clerk.
Additional information is not required but couldhelp 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).
o Securely attach this document to the signed document.
C2004-2015Prol.inkSigning Service, Inc. —All Rights Reserved www.ThePrnLink.com—NationwideNotaryService
--NO FEE FOR RECORDING PURSUANT TO
GO4t,N
ME T CODE SECTION 27383
do
When Recorded 1M aH To:
City of Cupertino
Community Development Department
10300 Torre Avenue
Cupertino, CA 95014
24001247
Regina P l oomendras
Santa Clara County - Clerk -Recorder
08/10/2018 12:35 PM
Titles: I Pages: 3
Fees: ®.®®
Taxes: 0
Total: 0.00
III � tia � A I V1 rri' ®l 1411 HLO, 11II
NOTICE OF CITY REQUIREMENT TO MAINTAIN A PRO`J'ECTED LA SCALE
The undersigned, being the owner(s) of the property shown in the Santa; Clara' County Ass
essor''s Roll and identified`a's
A.P.N. 357-08-043 and addressed as 10265 Judy Ave., hereby agree(s)'that the approved landscape shall be maintained
and consistent to the approved plan in conjunction with BuildingPermit no: 1512003 8,and shall be in conformance with.
the City's Landscape Ordinance. The applicant may consult .the City of Cupertino's Plamiing Department prior to any
modifications to the landscape; however, any proposed tree removals shall require approval bv_1 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).
PROPERTY OWNER(S):
Owner's Signature<�
Ku. LVit-,\ L-) CA- S, Bref61s
Print Owner's Name
�?rIG-/�
Date
CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT
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 f . ac&g(
before me, ICNotary Public,
(Here insert name and title of the officer)'
personally appeared �i�(,�. `�N) ,
who proved to me on the basis of satisfactory evidence to be th erso '(s) whose am ))e0are subscribed to
the within instrument and acknowledged to me tha &she/they executed the same R 1er/their authorized
capacity les), and that by-. Vher/their 'gnature s) on the instrument the ers�n), or the entity upon behalf of
Ylich the erson s) 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.
�64XE�I:L ET9�J
��ls�fiu78924
r
WITNESS my hand and off ' • se 1. z. - WOUpublic a cownia
:, 9tre 46 2090
_ (Notary Seal)
Signature of Notary Public f
ADDITIONAL OPTIONAL INFORMATION
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as
DESCRIPTION OF THE ATTACHED DOCUMENT 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
(Title or description of attached document) acknowledgment verbiage asmaybe 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 ae. certifying the authorized capacity of the signer). Please check the
(Title or description of attached document continued) 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
Number of Pages Document Date 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,
(Additional information) o The notary public must print his or her name as it appears within his or her
commission followed by comma and then your title (notary public).
o Print the name(s); of document signer(s) who personally appear at the time of
notaiization
CAPACITY CLAIMED BY THE SIGNER a Indicate the correct singular or plural forms by crossing off incorrect forms (i.e.
he/she/tkey; is /are) or circling the correct forms. Failure to correctly indicate this
❑ Individual (s) information may lead to rejection of document recording.
❑ Corporate Officer o The notary seal impression must be clear and photographically reproducible.
Impressionmust not cover text or lines. If seal impression smudges, re -seal if a
(Title) sufficient area permits, otherwise complete a different acknowledgment form.
�
CALOPORMA AL -PURPOSE ACKHcoW'MROr..Er MIL CODE , 1189
A notary public or otherofficercompleting 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, L-kO, )
p21
�
On �� [ before me, -0 4t-4 Ul
Date ` Here Insert Name
e and Title of the O>Yc r
personally appeared �C l'� i�1 , K, azds� -L, )-a
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose names) iX/are
subscribed to the within instrument and acknowledged to that hg/�Ke/they executed the same in
his/V6/their authorized capacity(ies), and that by hig/hr/their signatures) on the instrument the person(s),
or the entity upon behalf of which the person(s) acte , executed the instrument.
:GRACESCl MIDT
COMMISSIM 2096030
®�rotary Public
California
anta Clara county
C®porn. IM Fein 21, 2019,
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
Signature of Notary Public
Place Notary Seal Above
OPTIONAL.
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Docura t p-
Title or Type of Document: j�iC� �`1` Document Date: 2�Jf
Number of Pages: - Signer(s) Other Th
Capacity(ies) Claimed by Signer(s)
Signer's. Name:
❑ Corporate Officer Title(s):
❑ Partner — ❑ Limited El General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
an Named Above:
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — 0 Limited ❑ General -
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer is Representing:.
02014 National Notary Association < www.NationalNotary*.org ^ 1 -800 -US NOTARY (1-800-876-6827) Item #5907
Extended
$0.00
24001247
3
false
�A/?. nn
$32.00
$42.00
($10.00)
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6850
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Regina ADcomendras
Santa Marra County
Merle -Recorder
- (408) 299-5688
https://www.clerkrecorder.org
Receipt. 18-1164458
Product
Name
NOTI
NOTICE
Document #
# Pages
Home & Job Act Fee
RECCOPY
OFFICIAL RECORDS COPIES
# of Pages
# of Copies
NOTI
NOTICE
Document #
# Pages
Home & Job Act Fee
RECCOPY
OFFICIAL RECORDS COPIES
# of Pages
# of Copies
Total
Tender (Cash)
Paid By
KULVINDER BAINS
Change (Cash)
Extended
$0.00
24001247
3
false
�A/?. nn
$32.00
$42.00
($10.00)