B-2018-0463CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2018-0463
19751 BIXBY DR CUPERTINO, CA 95014-3324 (369 09 049) A G 11 U S A INC
FREMONT, CA 94538
OWNER'S NAME:
DATE ISSUED: 01/04/2019
OWNER'S PHONE:
- - ...... - ------- - -----_-__-
PHONE NO: (408) 417-0456
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. #996314
Contractor A G H U S A INC Date 08/31/2020
X BLDG X ELECT X PLUMB
MECII X RESIDENTIAL COMMERCIAL
f'
I hereby affirm that I am licensed under the provisions oChapter 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:
FIRST FLOOR ADDITION (888 SF); REMODEL OTHER (1350 SF);
I hereby affirm under penalty of perjury one of the following two declarations:
ELEC PANEL UPGRADE (200 AMP); (N) TANK -LESS WATER
I I have and will maintain a certificate of consent to self -insure for Worker's
HEATER.
Compensation, as provided for by Section 3700 of the Labor Code, for the
. 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:
— ---_-----
Valuation: $300000.00
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 09 049
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 WORKI 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 per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 1.4.19
Issued by: SFAN HAFCH
Date: 01/04/2019
OWNER -B ILDERe]JECLARATION
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. 1, 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, 1, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:_
contractors to construct the project (Scc.7044, Business & Professions Code),
Date: 1.4.19
1 hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
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 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. 1 will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3 1 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
air contaminants as defined by the Bay Area 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 Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
bellerevolted.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 1.4.19
CONSTRUCTION
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 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, 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.
1 understand my plans shall be used as public records.
LicensedProfessional
Signature Date 1.4.19
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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0463
19751 BIXBY DR CUPERTINO,CA 95014-3324(369 09 049) A G H U S A INC
FREMONT,CA 94538
OWNER'S NAME: DATE ISSUED:01/04/2019
OWNER'S PHONE: PHONE NO:(408)417-0456
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#996314
Contractor A G H U S A INC Date 08/31/2020 X BLDG X ELECT X 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 Code and that my
license is in full force and effect. JOB DESCRIPTION:
FIRST FLOOR ADDITION(888 SF);REMODEL OTHER(1350 SF);
I hereby affirm under penalty of perjury one of the following two declarations: ELEC PANEL UPGRADE(200 AMP);(N)TANK-LESS WATER
1. I have and will maintain a certificate of consent to self-insure for Worker's HEATER.
Compensation,as provided for by Section 3700 of the Labor Code,for the REV#I -REMOVE FIREPLACE FROM LIVING ROOM,EXTEND(N)
performance of the work for which this permit is issued. FOOTING AND REPLACE FLOOR FRAMING IN FAMILY RM AND
2. I have and will maintain Worker's Compensation Insurance,as provided for by MASTER BATHROOM;RELOCATE AND INSTALL(N)FURNACE;
Section 3700 of the Labor Code,for the performance of the work for which this REMOVE TANK-LESS WATER HEATER FROM SCOPE(EXISTING TO
permit is issued. REMAIN)-ISSUED 06/14/2019
APPLICANT CERTIFICATION Sq.Ft Floor Area: Valuation:$300000.00
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
and state laws relating to building construction,and hereby authorize APN Number: Occupancy Type:
representatives of this city to enter upon the above mentioned property for 369 09 049 R-3(Custom)
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
source regulations per the Cupertino Municipal Code,Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Signature
Date 06/14/2019 180 DAYS FROM LAST CALLED INSPECTION.
OWNER-BUILDER DECLARATION Issued by: SEAN HATCHDate:01/04/2019
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: RE-ROOFS:
1. I,as owner of the property,or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed.If a roof is
compensation,will do the work,and the structure is not intended or offered for installed without first obtaining an inspection,I agree to remove all new materials for
sale(Sec.7044,Business&Professions Code) inspection.
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:
I hereby affirm under penalty of perjury one of the following three declarations: Date:06/14/2019
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 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 HAZARDOUS MATERIALS DISCLOSURE
Section 3700 of the Labor Code,for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6.95 of the
permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will
3. I certify that in the performance of the work for which this permit is issued,I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
shall not employ any person in any manner so as to become subject to 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
the Health&Safety Code,Sections 25505a 25533,and 25534.
be deemed revoked.
APPLICANT CERTIFICATION Owner or authorized agent: �
I certify that I have read this application and state that the above information is Date:06/14/2019
correct.I agree to comply with all city and county ordinances and state laws CONSTRUCTION LENDING AGENCY
relating to building construction,and hereby authorize representatives of this city I hereby affirm that there is a construction lending agency for the performance
to enter upon the above mentioned property for inspection purposes. (We)agree
of work's for which this permit is issued(Sec.3097,Civ C.)
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands Lender's Address
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18. ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date 06/14/2019
Licensed
Professional