10030027CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1 I 1 l l N WOLFE RD STE C
CONTRACTOR: TBD - TO BE
PERMIT NO: 10030027
DETERMINED
OWNER'S NAME: STARBUCKS COFFEE COMPANY
DATE ISSUED: 05/24/2010
OWNER'S PHONE: 4152410256
PHONE NO:
11r_ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRLPTION: RESIDENTIAL COMMERCIAL
License Class rs Lic. N �' 2 `C' Z �P
PARTIAL RENOVATION OF EXISTING STARBUCKS,
Contractor .SNA W44 4 64-,T Date `5 2d to
INCLUDES
AS SHOWN ON PLANS & SCOPE OF WORK PER PAGE G2.0
I hereby affirm that I am licensed under the provisions of Chapter 9
&
(commencing with Section 7000) of Division 3 of the Business & Professions
INCLUDES REPLACING SOME FINISHES,SOME
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
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
Sq. Ft Floor Area:
Valuation: $79000
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
APN Number: 31605072.STEC
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree�to save
180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
S .- 2 l�
Date:
granting of this permit. Additionally, the applicant understands and will comply
Issued by:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature V F Date " z 4 'tom
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(x) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sectio s 25505, 25533 d 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:�7 -2-4 -t-
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I 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 representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source r la tiA a Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date 95 24-10
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pool ICANITTO FILL IN INFORMATION WITHIN RFn LINES, USE BALL POINT PEN ONLY u U I I U L 11J`I
CITY OF CUPERTIN0 BUDDING. ELECTRICAL
BUILDING DIVISION APPLICATION/PERMIT PLUSIPING-nEF[DE IFIC
NI111.DINC PltOJEC'I' IDI:NrIb'IUATION
PERMIT NO.
Gomm
BUILDING ADDRESS:
.ANHARYNO. APPLICA' ION S113MI'I'I'AI, UAE'
/ /ala WIN- F R
— —9 9
OWNERS NAME: p PHONE :
�L I G SES bl�
CONHKACION:S NAMIi: LIC NO:
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N//ice
NIC
❑
CON'IRULk
AHCfI11IiCl'/ENGINI!ER: I,IC NO:
cz7353
)Data: 4
Ek C /O
CONTACT:
BUILDING PI-RMIT INFO
fPHONE:
11/7 76 q�/%AA
�!/ll
❑ Consultant Fecs Paid by Applicant (initial)
BLDG/ ELECT PLUMB M111iC11
Lr -1f
LICENSED CON'rRACTOk:S DECLANA'I'ION
I hereby a1Brm ma 1.m Ban%ed ander morokiuns or chane 9 (commencing
with Section 700001 Ifi,mo. 3oflhcBuxines ua1 ProfiOioaCo .moda neem., is
'tG
oJr�reJafc,'
QTY ELECTRIC PERMIT FEE
JOB DESCRIPTION
RESIDENTIAL'
OSFDIT KITCHEN
1'ERMI'r ISSUANCE
API'hIANCES-HESIDI!NTIAI.
Llcen,xcfull �ana��n,J
Lic.a
Date - Cnntmcair
RE-PIPE
❑ADDITION EISTRU TURAL-PIPE
❑MULT6UNI'I' OSTNUCTURAI.
TION
CH[MMODIN 1C RFIIA
OINTIiRIQR OGHIMNIiY RHI'AIR
IMPROVEMENT ❑SWIMMING POOLS
O HAITI REMODEUREPAIR ElDEMOLII]ON
❑ (TfHIiN
AHCHITF,CTS DF.CI. RAT N
updcmm�J n,Y Plan ll uhlic rcclMs
�.
PANELS
I UP TO 20() AMPS
Li'lumed Pnrl'cs%ional
OWNER -BUILDER DECLARATIONOVEN
I Irehy vfOm, than I ran exmnpl from'he Commanr's License Law fur the
re
fallowing ..,,,a. (Station 7031.5, Bovines, and P.Ic,,ians Code: An, city or coaly
201.1100AMPS
IOIN)AMI'S
SIGNS EL1!MRICAL
which require% a larmla to construct. alter, improve, demolish, or repair any s2ucturc
prior b it, munce.dsorequires lhevpplicanT for such permil to rile a signed aamn,cat
that he is licensed pumuanno the provisions of the Contractors License Law (Chapter 9
(mmn,ancin, all Section YW(pof DI I cion Sol he lLwi req,tod Professions Code) nr
that he Is exempt therefrom and the basis for the alleged exempt..... Any violation of
by any applicant a permit subjects the applican.. a civil penalty of
Section 70315 applicant
not more than rive hundred dollars (451X)).
L as owner of the property, or my employees with wages as their wile compcmmi..q
will du The work, and The suucmm is not Intended afottcred far sale (Sec. 9044, Business
Professions Code: The, ComraSmrs License law does not apply m an owner of
SPECIAL CIRCUI r/MISC,
TEMP METER OR MNALPIn
COMMERCIAL
O NO IDG/ADDITION O DEMOLITION
. �NAItT OI°OODSERVICE
IMPROVEMENT
❑ DTI113R
POWER DEVICES
SWIMMINGPOOLELE
p
IU OUTLET'S -SW H7CHIS-PIXTURILS
and
property who builds or improves themou, and who docs such work himscll'of through
his awn employees, Provided tha such improvements are not intended Or offered far
Ode. l[ however, the building a, imp wilhlnoneycaroformphaina.the
NEW RUSIDEN'I'IAL [LLE
SQ. FT. FLOOR AREA
.
SISQIrl'.
ner.huilb,r will have the burden of proving that he did not build or Improve bur pur-
TOTAL:
posc afaalc.)
❑ I. as Owner of the prapenY. ala nxcw%ively Contracting with licensed eontmctan Of
cnns'mc''he pope, (See. 0144. Businessland Professions Cui 1W Contractors Lt.
cease law does not apply to an owner of property who build air improve%them,,., and
who contracts for such projects with a conumeb r(s) licensed plasm m m the Contractor'%
QTY. PLUMBING PERMIT NEE
Liccns<Law.
I am exempt under Sec. .B&pCIlatM mloln
PERMIT ISSUANCE
'
ALTER - DRAIN & VI7W- WATER IEA)
VALUATION
l( � ,red O O
C/ C
Owner Dulc
BACK FLOW PROTECT. DEVICE
WORKER'S COMPENSATION DECLARATION
1 Ihcreby attirm under p,umy al perjury ane of the following declvtutionn:
I have and will maintain aCerificancof Consenuoself-insme for Wmkcrs Cnlnpem
stolon, as provided far by Section 3701 of the Labor Cale, for the performance of the
work for which 'n ., permil is :soca
O I have and will maintain WmkSrs Compensation Insurance, as retained by Section
37uOofane laMa Cde,'rnrthe N&....,anccofthe wkak for which' his permit knivid,
DRAINS- FLOUR, HOOP. AREA, GOND.
S'IGRE7
TYPE CONSI'RUCUO
FIXTURES - PER E'RAP
GAS-EA.SYS'18h1-I INC.4OlIT1.hTS
OCC GHOUL'
APN
GAS- RA. SYSTEM.OVER 4(EA)
My Workers Compensation insurance carrier and Policy number arc:
Cartier: Policy Nix:
CERTIFICATE OF EXIiMPr1ON FROM WORKERS
COMPENSATION INSURANCE
-74
os
GRFASRANDUSTRL WAS TE INTERCEPTOR
BUILDING DIVISION FEES
GREASETRAP
PLANCI[ECK FEE
Obisse<'innnced not Mcomplumlatheperait islinuncbunJr<J JollvrslSllxp
or less.l
km subject spcnni'ie'iss'Courp°I1
Loy any that in be any Inmme%I) as
not employ any person in any manncno as m became subject tar the Workers' Cumpcn-
sa'iun laws of Cxlilirrniu. Di 11
Applicant I
bOf CE TO APPLICANT IL after making this Certificate of Exemption, you should
becoax %object to The Worker Compensation provisions at the laMrm Code, you must
form. till comply with such provisions or'his permh shall he dented revoked.
SIiWEB- SAN] 'rANY-SInRM Iib 21x117.
T:NENGV FEE
WATER HEATER WNENTMLECTR
WATER SYSTEM?REATING
GRADING FEE!
SOILS FEE
WATER S17RVICE
CONSTRUCTION LENDING AGENCY
I'ND
R
NEW RESID17NTIAL PLMB. SQ. Fr.
I na5ny alarm mon m5ra ix a 5ooxweaa2leading ngcn<r or the n5rronnan<e of
the work lar which this permit is issued (Sec. 3097. civ. C.)
DIAL
Lenders Name
Ll Lender's Addresv
1 codify the 1 have lead 'his application and slam mar he above information is
0 comm. Iagree Iacomply withall cityandcounty ordinances and state laws reaminglo
building ca ratmelion, and hereby all h tiire mpremntatives oftins city to, enter upon The
TOTAL:
EUILDIN
1
SEISMIC 17,1 /
QTY. MECHANICAL PERMIT FEE
move-muntioncd property for inspection purpose..PERMIT
ISSUANCE
IiLF,CT TE
(We) IRme m mv5. bodenmify and keep harmless the City of Cupertino again%'
liabilitic,judgments, costs and expenses which may in any way accrue against said City
ALTERORADDTOMECL
PLUMHI
incnnsequenaoftheg ntingofthis ..nit
APPLICANT UNDP STANDS ) WILL COMPLY WITH ALI. NON2'OIN'r
AIR HANDLING UNIT OT) 10.000 CPM)
MECHANICALFEE
SOl1NCli kE I IO S. / �� ��
!/�V/
AIR HANDLING UNIT (LIVER 10.(110)ChM)
HXHAUST HOOD(WIDUC)
CONS 'I'NUCTION'I'AX
Signa of Applicant/ unit t Dam I
H . 1) US MATERIALS DISCI.OSUNE
Will the applicant or future talking occupant mom or handle hueuNom mvtcrial
as defined by he Cupcam. Municipal Code, Chapter, 9.12, and the Ilcalin and Safety
Code. Struma 25532(u)'I
❑Yes C] NO
I LOUSING MITIGATION FEE
I [EATING UNIT (TO 100.00013'1 U)
HEATING UNIT(OVER IOO.gly, BTU)
_
PAID
Doc Heccipt a
VENTILATION FAN(SINGLE BESIDE
Will the applicant or future building Occupant use equipment or devices which
rani' harurdous air conanninxnts as defined by the Bay Area Air Quality Management
BOILER -COMP (3HP OR 100.000 BTU)
TOTAL' U�% a
BOILER -COMP (OVER 11105tH Bill)
District'
E] yes ❑No
AIR CON[)I'I'ION ER
ISSUANCE DATE,
�I
/ / r % 7/ 9
1/ ` ( /
^�
1 have rem[ me rdous materials 5. 25emema 12553 Chapter,,. of the if Call-
lirmiu Her' & Sof Code. Se 'nos 25905, 25573 nnA 255]4. undcrxtanh ma if the
building& me, By la cnan'.'bnt it is my reaponulaity to anti the Cupant
ofd cna rich act Pnor t(,cr erircq� O ye
`fL
NEW NESIDI!Nl'IAI. MI!CH. SQ. FB
TOTAL:
/ L
ISSUED BY:
)wn :mthurie<d- ate
of-b-lut