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03070034 CITY OF CUPERTINO rr ' ar BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION r l'1w-.x$3 BUILDING ADDRESS: SOUTH BAY REFRIGERATION PERMIT"°03070034 OW NER'S NAME: 1014 MORSE AVE, STE #21 PERMIT Issue DATE ONE: (408) 267-4503 SANITARY NO. CONTROL NO. ARCH1TECnENGINEER: BUILDING PERMIT INFO BLDG ELELT PLUMB MECH +00 LICENSED CONTRACTOR'S DECLARATION Job Description u 1 hereby affirm that I am limited under provisions of Chapter 9(commencing P .� with Section? c)of DiAsion3ofthe Basin a and Pmfcaium Code.mdmy Iwcnwu LLlcease C a S REPLACE FURNACE/ADD A/C ��? License Contractor Dau ndcRlaod AR CHE my % h .,plNha l W lic. us ,S 4 s m Licensed Prof cssIntel n OWNER-BUILDER DECLARATION 11 ^Qa'1 <I I hereby aRrm that I am exempt from the Contractors License Law for tW COO fallowing mamn.(Section 7031.5.Business and Pmiom fessCode:Any city or county H r which requires a permit In construct,slot,improve m,demolish, repair any structure 5ZC prior tit its issance,also requires the applicant for such permit to file a signed statement p is that he is licensed purmanitoNeprevisionsrd'the Contractor's License law(Chapur9 Sq. Ft. Floor Area �V`tua,II n3 e (commencing with Section 70)01 of Division 3 ofthe Businca and Profcainns GNB)or 4 i $ that he is exempt theefmm and Ne basis for the alleged exemption.Any violation of 316330 52 . 00 Section 7031.5 by any applicant for a permit subjects the applicant to a civil femlty of APN Number Occupancy Type not mart than fie hundred doll...($500). ❑1,as owner of the penitently.or my employees with wages as their sole eampenation, will do Ne wads and the mucture is not intended w offend forale(Sec.7014,Business — ctlons and Professions Cade:The Commelor's Lieenu Law does not apply to an owner of 303 - ROUGH M CRANI AL property who builds or improwa thercon,and who docsauch work hiamairm Through his owncmployees,provided that such improvements are net intended or offered for sale If. 304 — ROUGH ELECTRICAL however.the Wilding or improvement is sold within one year of completion,Ne owner- builder will have we burden of proving Nat he did not Wild or Improve for purport of 505 - FINAL ELECTRICAL s1. 507 - FINAL PLUMBING ❑1. a owner of the pmpery,.Business exclusively contracting with littnsedianommr. Ir ccom L l ote es not pply t an werofand Rohaoons Code:)The, as clamors u- SOB — FINAL MECHANICAL whom law does not apply loan owner of property who Wilds or improvhe Contractor.and who contracts for such projects with a conuector(s)licensed pursuant m Nc Comrecrors License Lew. ❑1 un exempt under See. .B A P C for Nb maven Owner Data 73011WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following dedararions: I have and will resonant a CeNfiateof Caae.t to self-insure for Workers Compen. 0 io.,u prmidcd for by Section 3700 of the LOwr Code,for Ne Performance of the k for which this permll is issued. 1 haw ad will maintain Workeh Compensation Insurance.a required by Section ofNe laborCode.for the performance of de work for which Nis permit is issued. Workers Compenallon launnce artier and Policy number am: rier: k S all y CERTIFICATE OFEX.A. MWORKERS' 06 COMPENSATION INSURANCE (This motion need not W completed done panni(Is foronc hundred doll...($101) Mss.) 1 certify that In the pcKmentnee of the.,it for which this permit is woad.10.11 not employ any person in any mater an as as become abject to the Worten'Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Certificate of Emmeline.you should became subject m me Worker's Compensation provisions M the IsWr Critic.you mux .JO forthwith comply with such pmvisiom or this pefmil shall W deemed revntcd. .zi 4 CONSTRUCTION LENDING AGENCY F+ I hereby aRrm Nat them its construction lending agency for the perfurranec of . D:► the.,it for which this permit is issued(Sec.)091,Civ.C.) 41 A Lattices Nun. z Lenders Addrias U Q 1 mildly Nal 1 have mad this application and sou that the show information is L4 F correct.I qme to comply with all city and county onlinaoc s and sue laws misting to 0U Wilding construction,and hereby whodm mprcaenuovea of this city in enter upon the W above-mentioned property for inspection purports gy (We)agree m ave,indemnify and keep harmless tW City of Cupcnino.gains( N liebilitles Judgmentsyc su and mpenus hi ch may'am n ay way see against old City V z in creuquenweof ratingaflhe I. �—" APPLICA U RSTAND WILL COMPLY WITH ALL NOWPOINT Issued by: Date SOURCE 10 Re-roofs Si . fApplicantlCmitactorthue, HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will we applicant or future Wilding omup rt Imre or handle haardous material Zinn]by the Cupenlao Municipal,Code.Chapter 9.12.and the Health and Safety ode, ❑lroesn25532(a)1 ,a+c All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It hazardous air conmmimms at&food by me Be,Arca Air Quality Management all new materials for inspection. "im"i ❑Ya Nu I haw mad the h IfNtws mauriaumyujjjjjj'mmen"under Ch r&95 of the Califon tie FbelN/k Safhy Co c,Sections 25505R9'3i v126534.Iunf.1tad Nal if Ort Wilding awsnm carnal, "a atenen4 Nnh sffnn res ponsihilitymnaol'ymeasupal ofthe require=. uh'fIt untie rpdor ori atm of.Cenifa:we of 'cup cy Signature of Applicant Date 0 erre uthorizcdagenl All roof coverings to be Class "B"or better 1 CITY OF CUPERTINOo307ao3 - C, FURNACE/AC Uff OF CUPERTINO PERMIT APPLICATION FORM APN# W- ,-,- * Date: U� � 7 7 Building Address: Owner's Name: / L v l/C� �j� Phone#: Contracto Phone:/ License#: S utir -l5 // 91)'ao J Contact: Phone: Cupertino Business License#: - S! Building Permit fo: Bldg ❑ Elect Plumb ❑ Mech 9-- Job Description: Residential ©' Commercial ❑ For Rel�ssidential In tions: Attic L, I"floor 2°d floor❑ Adhere to min set back requirement❑ For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calcula ' s requi or new installation ❑ r_ 7 New installatio Plannin ApprovN Required. Cost of Proje t: 6,� T eaf Construction: I Occupancy gro Strapped ❑ atform ❑ Bonded Sq.Ft. Floor Area: New Location ❑ Re lacemenC`l Qty AppVcFee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL BREMRECEPT Rec tl, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMfI'FEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING ITI 11 ;1 �S'�. 2, 2