03080023 I CITY OF CUPERTINO
BUILDING DIVISION PERMIT rcONTRACTOR6I NFORMATION �?
I BUILDINGADDRFSS: SOUTH BAY REFRIGERATION , PERMIT"°03080023
OWNER'S NAME: 1014 MORSE AVE, STE $#21 PERMIT ISSUE DATE
HAAS RAYMOND L AND JUL 003
NE: (408) 267-4503 SANITARY NO. CONTROLNO.
ARCHITEC(ENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUME MECH
0 0 l� o
1000 LICENSED CONTRACTOR'S DECLARATION
F u I hemby affirm that 1 am licensed order pmvi,ons of Chap¢l9(commencing Job Description
I.
Section 7")of Divislon 5 of the Business and Profession Code,and my license is r�p r�f�y
infIt
011loreemdef I 9 30 FURNACE /ADD A/C IN .REAR YARD�nC'InQa mkt J
j Y1G Lkr, s LIa X
+ V BIC I V DE IN
e ARCHITECTR TS DECLARATION
A ATION S F,„, p 4 2001
C 1 understand my plans shall he used n recordspuhlicrecordsr�{// l7 L [J:J
a G Licensed Professional 1�� 9 p y��pI,��/�
pI y
OWNER-BUILDER BUILDER OE CLARATION &714HhlLg,d'gtlVl`77
1 hereby.(firm that I R-euro t from the RATION f License Uw for the �I
0 following reason.(Section 7031.5,Businessud Professions Code:Any city or county
5§2 which requires a Permit to construct,alter,improve,demolish,Or repair any Structure $4612
Zsn prior to itsissuance,also requires she applicant for such permit to file a signed statement
2 that he is licentod pursuant to the previsions of the Contractor's License Law(Chapter 9 Sq, Ft. Floor Area Valuation
2 $ (commencing with Section 7")ofDivision]ofthe Business and ProfusionsCode)or 36918007 . 00
s, that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5byany applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type
not more Nan Eve hundred dollars
❑I,As owner of the property,or my employees with wages A;their sole compensation,
will do the work and timmucmrt is not intended or offered for sale(Sm.7044,Business — ta
and Pmfeasions Code:The Contractor.License low dons not apply to an owner of 3UNA
Q 3 — ROUGH YO property who builds or improves thereon,and who does such work himself or through his L
own employees.provided that such Improvements Are not imendedcautioned formic.If, 304 - ROUGH ELECTRICAL
however.the building or improvement is sold within one you of completion,the owner. -
builder will have the burden of proving that he did out Wild or improve for purpose of 505 - -FINAL ELECTRICAL
sal`')' 507 - FINAL PLUMBING
❑L as owner of the property,am exclusively contracting with licensed contractors a 5 0 8 - FINAL MECHANICAL
construct the project(Sec.7044,Business and Professions Code:)The Conuacmr's Li
cents law docs not apply to an owner of property who builds or improves Ihertnn,and
who contracts for such pjeda with a contractor(,)licensed pursuant o the Contractor's
License I. '
I am exempt under Sec. ,B&PC for this moon
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 Anaby elffrm under penally of perjury ono of the following d dot,tions:
I haw and will mnoaln a CertlEcem of Consent to self-insure for Workch Compere
salon,As provided for by Section 5100 of the labor Code,for the performance of the
work for which this permit It issued.
1 hats and will maintain Worker's Compensation Inuamce.u mquirtd by Section
31%, w
1 ofihe cubo,Code,for MepeRormmmefthe work forwhich lhispermit is lssonQ
My Wnrkces Compmenumm Inxnemart;uy ai�d PP number art:
Cartier. t'onk IkrsuOAnLFAKo,'�Flo: wKWIotR26[�
CE IAn FlCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu xenon reed not Mcomploed trthe permit 1,furore hundred dollen(SIM)
or less.)
1 certify that in the performance of the work for which this permit is Issued,I shall not -
employ Any penoninmyon n sou�off hernme subjmuo thcWoftinf Comfecesmon
Lawsof Califomia.Do 3..
NCFnCEa OAPPLI A te gB�A Isr�
NOTICE TO APPLICANT:If,Compensation
this Certificate or w Labor Exemption,you should
�,Zbecome subject to the Worker's Coons or this provision,of we labor Code,you must
forthwith comply with such provision or Permit shell be ticemcd rtvnkctl.
tiO CONSTRUCT ION LENDING AGENCY
1 hereby allium Nat Chert it a ronwninn lending agency for the p ow.ance of
24 the work for which this permit Is issued(Sec,3M.Ch,Cd
4 Q Lenders Name
ddress
Z corder:Agrees
J 0 1 cenify that 1 have read Ihis application and sure that the.hove information is
Ljw cooccngonstrutcomply with all city and courtly ordinances and sou Iowa enter
upon the O V buildingconsuui;ogAnd hereby Injection
n mthoaimrcpresenlnivu of this City mcmer upon Nc
ahovcmc ei agree
propane for emnify an purposes. h'l
We)agree x costs indemnify and hcep harmless the City of Cupertino against
r N judgments.trawling Of
expenses;which may in my way attnc against aid City _
J z A APPLICANT
of the UNDERSTANDS
of Nis D WILL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
SOURCE REGULATIONS,
Re-roofs
HAZARDOUS
Signature afAppliceDau
HAZARDOUDOU S MATERIALS DISCLOSURE Type Of ROOF
Will the applicant nor mforum building Occupanthmrc of handl, Health
odSafrmaterial
u one,
by the Cupertino Municipal Code,Chapur 9.17.and the Health and Safety
ak.Section 25sy2(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes ❑Na
r" 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
III bmafdaus air mramninmu u dc6ncd by the Bay Area Air Quality Management all new materials for inspection.
iatricl?
❑Yes ON.
I have nail the harardrosmaterials wriubco ents under Chapa:r 6.95 of the Cables-
nia eslth h Safety Codc.S as25505.25517 and 25534.l undcmnnd thmifdu ilding
d net cram mly haw u n th u se m}raponihi,ity m entry t Occup t rf Ne
re urcMe hic us1 Ip lin ;ssuanccafa CcrtiOceu of uacy0 S ignature of Applicant Date
' D m All roof coverings to be Class "B"or better
4AT.I.thmi,.md age
CITY OF CUPERTINO o�
FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
APN 11 & ?/(F5/00
O/OO -7 1 Date: ��U3
Building Addre /
r o Co lu woo �)r —Ce16,, c
Owner's N P ne
C, C,C, o� o7S.3-- 7-SS Y
Contractor Phone: 2c(�g'4/10 License#: 3,2 c�
Contact: one: b Cupertino Business License#:
�a n 68) Z.6 7—ct..Su3
Building Permit .
Bldg ❑ Elect-ODPlumb ❑ Mech
Job Description: c c M 54r,e Sian' (u« fi�,a - k�e G�SCF �OJU�U13?G�S
Residential Commercial ❑
For Re idential In Ilations: 15�u�y
Attic LJ I" floor 2nd floor El /
• Adhere to min set back requirement❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required
Cost of Project, �6r Z Type of Construction: Occupancy groups
Strapped ❑ On Platform 0 Bonded 0
n ' Sq.Ft. Floor Area:
New Location ❑ Replacement
Qty. if
Applicable Fee 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
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERN=E Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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