B-2018-0165 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0165
21912 LINDY LN CUPERTINO,CA 95014-4832(356 24 015) RIVERPATH
CONSTRUCTION
CORPORATION
SAN JOSE,CA 95127
OWNER'S NAME: DATE ISSUED:01/29/2018
OWNER'S PHONE: PHONE NO:(408)206-3237
LICENSED CT BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#9004519
Contractor RIVERPATH CONSTRUCTION CORPORATION Date 06/30/2019 X BLDG X ELECT_PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X 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:
1ST FLOOR CLOSET REMODEL(28 S.F.);2ND FLOOR LAUNDRY
I hereby affirm under penalty of perjury one of the following two declarations: AND MASTER BEDROOM REMODEL(55 ST.);
r. 1 have and will maintain a certificate of consent to self-insure for Worker's 1ST AND 2ND FLOOR BATHROOM REMODEL(245 S.F.)
Compensation,as provided for by Section 3700 of the Labor Code,for the REV#1-UPGRADE MAIN PANEL(200 AMPS);REPLACE HVAC
performance of the work for which this permit is issued. SYSTEM AND DUCT-SAME LOCATION-ISSUED 3/8/2018
�- I have and will maintain Worker's Compensation Insurance,as provided for by REV#2-CHANGE ORIENTATION OF TUB;CHANGE LOCATION OF
Section 3700 of the Labor Code,for the performance of the work for which this TOILET AND CHANGE LOCATION OF DOOR;CHANGE PANEL TO
permit is issued. (125 AMPS)-ISSUED 5/17/2018
APPLICANT CERTIFICATION Sq.Ft Floor Area: Valuation:$70000,00
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 35624 015
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
/�_._--- 180 DAYS FROM LAST CALLED INSPECTION.
Signature C. ------ "-�" Date 5/17/2018
Issued by:Kim Dunbar
OWNER-BUILDER DECLARATION Date:01/29/2018
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: RE-ROOFS,
r. 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 fust obtaining an inspection,I agree to remove all new materials for
sale(Sec.7044,Business&Professions Cade) inspection.
z. 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: /175 /2018
r. 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,
z. 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
a. 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 Califomia.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 "'maintain compliance with time Cupertino Municipal Code,Chapter 9.12 and
be deemed revoked. the Health&Safety Code,Sections 25505,25533,and 25534.
APPLICANT CERTIFICATION Owner or authorized agent:
I certify that I have read this application and state that the above Information is Date:5/17/2018
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,Clv 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
1 understand my plans shall be used as public records.
Signature Date 511712018
Licensed