B-2017-0803-DPCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0803
20375 CLIFDEN WAY CUPERTINO, CA 95014-4460 (369 37 011)
A G H U S A INC
FREMONT, CA 94538
OWNER'S NAME; LIN JUN M AND MU T CHEN
DATE ISSUED: 07/27/2017
OWNER'S PHONE:
PHONE NO: (408) 417-0456
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO'
License Class 5 Lic. #9.96314
Contractor A G H U S A INC Date 08/31/2018
X BLDG _ELECT X 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
INTERIOR REMODEL (1050 S.F) INCLUDING KITCHEN REMODEL
I hereby affirm under penalty of perjury one of the following two declarations:
(220 S.F) AND BATHROOM REMODEL (150 SY ); (N) ATTACHED
t. I have and will maintain a certificate of consent to self -insure for Worker's
DECK (336 S.F); INSTALL (I) FURNACE IN ATTIC; INSTALL EV
Compensation, as provided for by Section 3700 of the Labor Code, for the
240V OUTLET (NEMA 14-50) IN GARAGE, INSTALL (N) TANKLESS
performance of the work for which this permit is issued.
WATER HEATER IN GARAGE.
2. have and will maintain Worker's Compensation Insurance, as provided for by
0 Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Sq. Ft Floor Area:
Valuation: $150000.00
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
369 37 011
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.
PERMIT EXPIRES IF WORK IS NOT STARTED
Additionally, the applicant understands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature_ Date 712712Q1Z
Issued by AbbyAyende
Date: 07/27/2017
ovy'NER-B iDz DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF 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, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
Signature of Applicant:
Date: 7/27/2017
I hereby affirm under penalty of perjury one of the following three declarations:
t. I have and will maintain a Certificate of Consent to self -insure for Worker's
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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. 1 have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 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 2553434., 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
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
exemption, I become subject to the Worker's Compensation provisions of the
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Labor Code, I must forthwith comply with such provisions or this permit shall
the Health & Safety Code, Sections 25505, 25533, and 25534.
be deemed revoked. ,
APPLICANT CERTIFICATION
Owner or authorized agent:
Date: 7/27/2017
I certify that I have read this application and state that the above information is
CO,,.. ON LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
lending
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, 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 Muni !pal
ARCHTTECT'S ARCHITECT'SDECLARMON
Code, Section 9.18.
1 understand my plans shall be used as public records.
Signature Date 7L27/2017
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0803
20375 CLIFDEN WAY CUPERTINO,CA 95014-4460(369 37 011) AG H U S A INC •
FREMONT,CA 94538
OWNER'S NAME: LIN JUN M AND MU T CHEN DATE ISSUED:07/27/2017
OWNER'S PHONE: PHONE NO:(408)417-0456
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#996314 X BLDG _ELECT X PLUMBContractorA G H U SA INC Date 08/31/2018
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:
INTERIOR REMODEL(1050 S.F.)INCLUDING KITCHEN REMODEL
I hereby affirm under penalty of perjury one of the following two declarations: (220 S.F.)AND BATHROOM REMODEL(150 S.F.);(N)ATTACHED
i. I have and will maintain a certificate of consent to self-insure for Worker's DECK(336 S.F.);INSTALL(N)FURNACE IN ATTIC;INSTALL EV
Compensation,as provided for by Section 3700 of the Labor Code,for the 240V OUTLET(NEMA 14-50)IN GARAGE;INSTALL(N)TANKLESS
+erformance of the work for which this permit is issued. WATER HEATER IN GARAGE.
I have and will maintain Worker's Compensation Insurance,as provided for by REV#1-REMOVE DECK AND SKYLIGHT IN KITCHEN FROM
Section 3700 of the Labor Code,for the performance of the work for which this SCOPE OF WORK-ISSUED 10/27/2017
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above Sq.Ft Floor Area: Valuation:$150000.00
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 APN Number: Occupancy Type:
inspection purposes. (We)agree to save indemnify and keep harmless the 369 37 011
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 PERMIT EXPIRES IFWORK IS NOT STARTED
source regulations per the Cupertino Municipal Code,Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
�" 180 DAYS FROM LAST CALLED INSPECTION.
"(attire ` Date 10/27/2017
OWNER-BU - ER DECLARATION Issued by:Abby Avende
Date:_ 07/27/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
t.
L.as owner of the property,or my employees with wages as their sole RE-ROOFS:
compensation,will do the work,and the structure is not intended or offered for All roofs shall be inspected prior to any roofing material being installed.If a roof is
sale(Sec.7044,Business&Professions Code) installed without first obtaining an inspection,I agree to remove all new materials for
2. I,as owner of the property,am exclusively contracting with licensed inspection.
contractors to construct the project(Sec.7044,Business&Professions Code).
Signature of Applicant:
I hereby affirm under penalty of perjury one of the following three declarations: Date: 10/27/2017
1. 1 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
performance of the work for which this permit 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 HAZARDOUS MATERIALS DISCLOSURE
permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
3. I certify that in the performance of the work for which this permit is issued,I California Health&Safety Code,Sections 25505,25533,and 25534. I will
shall not employ any person in any manner so as to become subject to the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,Section 25532(a)should I store or handle hazardous
Worker's Compensation laws of California. If,after making this certificate of material. Additionally,should I use equipment or devices which emit hazardous
exemption,I become subject to the Worker's Compensation provisions of the air contaminants as defined by the Bay Area Air Quality Management District I
Labor Code,I must forthwith comply with such provisions or this permit shall will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
be deemed revoked. the Health&Safety Code,Sections 25505,25533,and 25534.
APPLICANT CERTIFICATION •
I certify that I have read this application and state that the above information is sorarner or authorized agent:
correct.I agree to comply with all city and county ordinances and state lawsDate: 10/27/2017 �
relating to building construction,and hereby authorize representatives of this city CONSTRUCTLENDING AGENCY
to enter upon the above mentioned property for inspection purposes. (We)agree I hereby affirm that there is a construction lending agency for the performance
to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is issued(Sec.3097,Civ C.)
judgments,costs,and expenses which may accrue against said City in Lender's Name.
consequence of the granting of this permit:Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal Lender's Address
Code,Section 9.18. '
ARCHITECT'S DECLARATION
• I understand my plans shall be used as public records.
Signature Date 10/27/2017
•
• Licensed
' Professional