B-2017-1739 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1739
20735 STEVENS CREEK BLVD CUPERTINO,CA 95014(326 32 054) RTJN ENTERPRISES
INC
CONCORD,CA 94519
OWNER'SNAME: DATE ISSUED:05/02/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#898514
Contractor RTJN ENTERPRISES INC Dale 10/31/2019 X BLDG—ELECT_PLUMB
1 hereby affirm that I.am licensed under the provisions at Chapter 9(commencing MECH_RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code unit that my
license is to full force and effect. JOB DESCRIPTION:
HABIT BURGER-CONSTRUCT PERMANENT COVER OVER
I hereby affirm under penalty of perjury one of the following two declarations: EXISTING TRASH ENCLOSURE
r. I have and will maintain a certificate of conscm to self-insure for Worker's REV#1 RELOCATE FOOTINGS-ISSUED 05/31/2018
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 ofthe Labor Code,for die perfm mance of the work for which this
permit is issued Sq.Ft It...Area: Valuation:$0.00
APPLICANT CERTIFICATION
I certify that I have read this appllcatlon and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and slate laws relating to building construction,and hereby authorize 32632 054 A(Tenant Improvements)
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 per the Cupertino Municipal Code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature Dale 05/31/2018 Issued by:Jasmine Archbold
Date:05/02/2018
OWNER-BUILDER DECLARATION
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 rooris
1. 1,as owner of the property,or my employees with wages as their sole installed without first 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(Scc.7044,Business&Professions Code)
z. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec,7044,Business&Professions Code), Date:05/31/2018
1 hereby affirm under penalty of Perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 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 Cade,for the
performance of the work for which this permit is issued. 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 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
s. 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 n person in an to become subject to the material.Additionally,should 1 use equipment m-devices which emit hazardous
p y a y pe y manner se as J air contaminants as defined by the Bay Area Air Quality Management District 1
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 beconne subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked Owner or authorized agent: (� .
APPLICANT CERTIFICATION Date:05/31/2018
1 certify that I have read this application and state that the above information Is CONSTRUCTION LENDING 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,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 ARCHITEC'1"S DF,CLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 05/31/2018 Licensed
Professional