03090011 CI'T'Y OF CUPERTINO
HUILDING,DI VISION PERMIT CONTRACTORINFO,RMATION
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a BUILDING ADDRESS: SOUTH BAY REFRIGERATION PERMIT NO 03090011
ER'S NAME: 1014 MORSE AVE, STE 421 PBRMITISSUEDATE
RAYMOND EPSTEIN 2a
ONE:
(408) 267-4503 SANITABY NO. n CONTROL NO.
ARCHMC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
IOp LICENSED CONTRACTOR'S DECLARATION
4 I hereby affirm that 1 re licensed under provisions of Chapter 9(commencing Job Description
with Section 7")of Division 3 of the Businjaxand Professions Code.and my license is
+ „ infu11frceandc00 Q REPLACE FURNACE
License �C. Lic.D 1
q Dam Cunlmctor
Ig-7W ARCHITECTSDEC��,A��N$1ION
I W Ur 1 u dcrstamd my plans shall bat used u puPlio men", V.�7fp `
110 Licensed Pntfcasinnel �
OWNER-BUILDER DECLARATION
2<f 1 hereby affirm that 1 am exempt from the Contractor's License Low rot the
p O following mason.(Section 7131.5,Business and Professions Calc:Any city or county
which require a Permit to construct,alter,improve,demolish,or repair any structure rnn
prions its issuance.also requires the applicant for such permit to file a signed statement
,z< that he is scented pursunm to the pmaiamns or the Contractor's License Law(Charms 9 Sq.Ft. Floor Area ValuJt
r1-0 (commencing with Section 7000)nr Division 3 or the Business and Professions Cae)ser
that he is exempt therefrom and the hub for Ne alleged exemption.Any violation of 36211042 . 00
Section 7031.5 by a"applicant for a permit subjects the applicant lP a civil penalty of ,APN Number _-_ Occupancy Type
not more than five hundred dollars(SSW). - - - - - - - -- ------- - � —
01,as owner of dr,property,or my employees with wages as their are compensation, .fgy�77pL7 7��TT
will do Be work.and Ne nocum,is not intended or offered for sale(Sec.7044,Business - uTre'g 113 CtlOn$
and Professions Codc:The Contractors Licetsse Law data not apply to an owner of 3 03 - ROUGH M CRANI AL
property who builds or improves themon.and who doesmch work himself orthrough his
own employees,provided that such improvements are not intended mortared forsake.If, 304 - ROUGH ELECTRICAL
however,the building or improvement Is sold within one year of completion.Ne owner.
builder will have the burden of proving Out he did net build or improve for Output.of 505 - FINAL ELECTRICAL
sale')' 507 - FINAL PLUMBING
El k,as Owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and professions Code:)The Contractor's Li. 508 - FINAL MECHANICAL
center law does not apply to an owner of progeny who builds or improves menton,and, -
whocontractsfursuchprojectswithaeom ortons)licensed pursuant to the Contractor's
License Law.
❑1 am eaempt under Sec. B k P C for this reason
137MI Data
WORKER'S COMPENSATION DECLARATION
I hereby aflimt under penalty of perjury oat Of the following decla iamme:
ave and will maintain a Certificate of Consent set biuum for WorkehCompen-
,u provided for by Section 37W Of the LsOor Code,for the performance of the - .. ..
for which Nis permit is issued.'
ave and will maintain Workeh Compensation boardroom,u myimd by Section
of the labor Code,for the performance of the work for which this permit is issued,
orker' oat oration nese a artieradPolity nun ram:r. Polity No.
CERTIFI ATE OF EI EMPTION ORKER '
COMPENSATION IN JR CE
(This section need mol bat completed if the permit is foronc hundred collars(51 W)
or les..)
I eenify that in the perfmmancc of the work for which this permit is issued,1 shall nut
employ any peon in any manner an as to become subject loth Workent Comp rsallon
Laws of California.Dela
Applicant
NOTICE TO APPLICANT:IL after making this Ccdifem of Exemption,you should -
become subject to the Worker's Com Notation proviainu Of the labor Code,you muse
D O forthwith comply with such provisions or this permit ihall M deemed revoked. `
7-C/1 CONSTRUCTION LENDING AGENCY
I hereby affirm that mere is a construction lending agency rat the performance of
]d> the work for which this permit is issued(Sec.3097,Civ.C.)
YQ Lemon's Name
z Lender's Addmas
J Q 1 eenify that I have read this application and state Nat the above information is
Y
correct.I agree he comply with all city and county ordinances and sum laws relating to
building construction,and hereby aothorim represenmtives of this city to cnmr upon the
1 above-mentioned property for iupeetion pugmses.
(We)agree m um noc are and It Ir harmless the City of Cu onst s against v"')
r y liabiliti(We)grenb,c mmunpen "It keep
mgginanyway ty or C.erom,aag City (/\
..I z APPLICA4(1.hT
DfND TWILL COMPLY WITH ALL NONPOINT Issued by: Dale
Re-roofsntrazmr am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hazardous material
u derated by the Cupertino Municipal Core.Chapter 9.17,and the Health and Safely
.ScetiYeen
s 7ss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑ C24.
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
4emit hazardous it conmminenb u dcfincJ by the Bay Arca Air Quality Management all new materials for inspection.
'Dinrict7
D ye, �rRO
I ban dad the loarammummutarials raquimmenks voter Chapter 6.95 ofthe Califor.
silt HcalNffi afety CoESO5515,75533 and 255341 understmNthm if the buildingJ c tly haat it b my respomihility to nod'y tM Preupanl of the
or to issuance Of.Cemf cm��m�y'/L, Signature of Applicant Date
o�orarmnnix'Jagent D to All roof coverings to be Class "B" or better
CITY OF CUPERTINO
FURNACE/AC
. CUPEkTiNO PERMIT APPLICATION FORM
APN# DYZ Date: '?131D
Building Address:
S a, o 'br CA 9 So/ c/
Owner's N S / MIT
Co ractor: n T Phone: q(j 8 License#:
� �iz„ 7� v3 2�3 O
Contact: Phone: (U(JT) Cupertino Business License#:
3'e-nm r,76;2, Q50 20-7 42
Building Permittinfo:
Bldg ❑ Elect Plumb ❑ Mech
Job escription: 2P ae.e crncc Q 5u� oce Tick P �40h c (JT4 o�u00 YCrf
w �7
Residential 12f) Commercial ❑
For Rg idential Insiallations:
Attic LJ 1" floor 42nd floor❑
Adhere to min set back requirement[]
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculatio uired for new installation ❑
New installalieffflanning oval Required ❑
Cost of Pject�S5Q Type of Constructioii: Occupancy gro r
Strapped LiW On P onn ❑ ( Bonded Sq.FtJ. Floor Area:
New Location Replacement
Qty. if
Applj6-4ble, 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
EPERN=E Elec Permit Issuance ELECTRICAL
MPERMUTFEE Mech Permit Issuance MECHANICAL
PPERMUTFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING