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07090114 77 77 CITY OF CUPERTINO BUILDING DIVISION PERMIT � QIZ I�QRM�TIE)N' BUILDINQr�D.p13,ESSN WOLFE RD R K ELE TRIC INC PERMIT07090114 OWNER'S lNlAMlE: PERMIT ISSUE DATE STARBUCKS COFFEE 42021 OSGOOD RD 09/18/2007 SANITARY NO. CONTROL NO. INE: (510) 770-5660 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is T. I .ADD OUTLET TO EXISTING COMM'L BUS. t "-'Q- in full force and of ? a t n? License Class Lic.# Date Contractor ARCHITECTS DECLARAT i� a a I understand my plans shall be used as public records >yU U.y Licensed Professional H OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the "a o following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure a ZCA prior to its issuance,also requires the applicant for such permit to file a signed statement < that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 >q.Ft.Floor Area $775 Valuation 2 F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or ,u,5$ that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of316 0 5 0 7 2 A� Number Occupancy Type not more than five hundred dollars(5500). 0 I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Conuactor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I.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- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑1 am exempt under Sec. B&P C for this reason Owner Date WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers compensation In ranee carrier and Policy number are: Carrier: Y6 19 Policy No.: CERTIFICATE OF EXEMPTION FROM RKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of thc work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workcr s Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z En CONSTRUCTION LENDING AGENCY HI hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lendces Name Z Lcoder's Address U 0 1 certify that I have read this application and state that the above information is W t--' correct.I agree to comply with all city and county ordinances and state laws relating to 0 J building construction.and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. f3. (We)agree to save,indemnify and keep harmless the City of Cupertino against F" liabilities,judgments,costs and expenses which may in any way accrue against said City U z in consequence of the granting of this permit. Date ►— APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO -POINT Issued by: SOURCE REG TION . J Re-roofs Signature of Applican Contractor Dare Type Of Roof HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section25532(a)? All roofs ;hall be inspected prior to any roofing material being installed. �Yes co-IN i `/4 If a roof i;installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes u I have read the hazardaus materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Codc,Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the re uirememts whit ust be met prior to issuance of a Certificate of0c anry. Signature of Applicant Date q A K� —Qr—,1 jty All roof coverings to be Class"B"or better Owner or author ized agent t Date CITY OF CUPERTINO 3 ITEMS OF 9 PERMIT' RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN . . . . . . . . . 31605072 . 01 DATE ISSUED. . . . . . . : 09,'18/2007 RECEIPT #. . . . . . . . . : BS000002680 REFERENCE ID # . . . : 07090114 SITE ADDRESS . . . . . : 111.11 N WOLFE RD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : STILRBUCKS COFFEE ADDRESS . . . . . . . . . . : 11 .11-C N. WOLFE ROAD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ROBERT L WEST CONTRACTOR . . . . . . . : ROBINSON, GARY LIC # 10239 COMPANY . . . . . . . . . . : R P: ELECTRIC INC ADDRESS . . . . . . . . . . : 42021 OSGOOD RD CITY/STATE/ZIP . . . : FREMONT, CA 94539 TELEPHONE . . . . . . . . : (510)770-5660 FEE ID UNIT QUANTITY 1.MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BREMMISC FLAT RATE 1. 00 27 .58 0. 00 27 .58 0. 00 BSEISMICOM VALUATION 775. 00 0.63 0. 00 0.63 0. 00 EPERMITFEE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 69 . 00 0. 00 69 . 00 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 207 . 00 VISA --------------- TOTAL RECEIPT 207 . 00 CITY OF CUPERTINO D?D 90// y CUP TYOr O PERMIT APPLICATION FORM APN# 2 j Date: _ 0 Building Address: i ( � ,�r� Mailing Address (if different from building address): Owner's Name: ��� Phone#: 6(0,v` � W— Contractor: � � Q�� License Contact:/�?� / Phone: 10-1 11)-Sbb Cupertino Business License#: T` Fax: Building Permit Info: !^i�'� �� &�y LIA L7Jk lv Bldg ❑ Elect :A- F lumb ❑ Mech ❑ Job Description: Residential ❑ Commercial ok Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: ® � Occupancy Group. R Type of Construction- Please check this box if the project is a ���, 12p?_ second-story addition: ❑ Project Size: Standard, Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Bo:ler<= 100,000 Btu MECHANICAL BBOILER2 Boile:-> 100K to 500K Btu MECHANICAL BBOILER3 Boil,-r> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Co istax-Resi/Mobile BUILDING BELEC 1000 El-1c 600V <= l OOOA ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 s CITY OF C'UPERTINO CITY Of CUPE�TENo PERMIT APPLICATION FORM Quantity Fee ID :Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME Now Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME In 3pection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE I;Idg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Inc Waste Interceptor PLUMBING BPLANCHK ?Ian Check Fee BUILDING BPLANCKADD Plat Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Rig i e Of Fixtures PLUMBING BPSEWAGE ',ewa a Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPSTORM Ston-n/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Insta II/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAHMAN A/C-Jnits<= 10,000 cfin MECHANICAL BREMAPPLI appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT bighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relc Furnace> l OK btu MECHANICAL BREMHEAT Beater Installation MECHANICAL BREMINHOOD Ins tallation of Hood MECHANICAL BREMMISC Vlisc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 A3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO ')uantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs,Marquee ELECTRICAL BREMTHEATR The Arical Lighting Fix ELECTRICAL BREMVENFAN WE t Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Sei>mic Commercial BUILDING BSEISMICRE ',eismic Fee Res BUILDING BSPECIAL S)ecial Inspection BUILDING BSWIM owimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electnical sq foot ELECTRICAL EPERMITFEE Ele,: Permit Issuance ELECTRICAL MPERMFEE M,-chanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ) wvx 3 �)f 3 SA Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 'WEkTINO Building Department JOB ADDRESS: i ( l I �� �l > PERMIT #6?'7 0 '? D// OWNER'S NAME: S i.r�k-t� PHONE # '510 ! v -S .b 1J GENERAL CONTRACTOR: ,`�; FAX # -- T I am not using any subcontractors: f�P Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date