15050182It
Philz Coffee will allow the employees of Capezio and Howard's Shoes for Children to use thea restroom
during the period of restroom construction at Main. St.,
within 30-45 days. m Cupertino. The restroom. should be constructed
Signature:
(oIJ451'1�
t �c VII C4q�-��
fc---- Li
F t
6--/3�i�
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19439 STEVENS CREEK BLVD
CONTRACTOR: OAKSTONE
PERMIT NO: 15050182
CONSTRUCTION INC
OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR
4065 YOSEMITE PL
DATE ISSUED: 08/27/2015
OWNER' HONE: 5083602650
PLACERVILLE, CA 95667
PHONE NO: (530)642-8858
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL F]
PHILZ COFFEE - T.I.MAIN STREET (PAD 1) TO BUILD
License Class Lie. #
OUT SHELL 2,121 S.F.
Contractor
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
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
i
pe rf ance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $350000
ave and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 31620085.19439
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
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
180 D_ ALLED INSPECTION.
upon the above mentioned property for inspection purposes. (We) agree to save
_ _
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
--
Issued Date:
granting of this permit. Additions , the applicant understands and will comply
with all non -point rce regul 'ons per the Cupertino Municipal Code, Section
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
9.18.
_ r--
Signature Date " 2
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ ER -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. 1 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(a) 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 Qu ty Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Mu ' ipal Code, Chapter 9.12 and
Section 5,255 and 25534.
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, ,
� e)
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: '
permit is issued.
i
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I 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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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 regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildincl aOcupertino.ora / roS 0/ Z
❑ NEW CONSTRUCTION ❑ ADDITION M ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
IM]
PROJECT ADDRESS19439 Stevens Creek Blvd.
APN # 31620085.19439
OWNER NAME Philz Coffee
PHONF 508.360.2650
E-MAIL lilygray@philzcoffee.com
STREET ADDRESS 1258 Minnesota St.
crrY, STATE, ZIP San Francisco, CA 94107
FAX
CONTACT NAME Christopher Preovolos
PHONE 415.852.4903
E-MAIL christopherp@msasf com
STREETADDRESs 642 Harrison St, 3rd Floor
CITY, STATE, ZIP San Francisco, CA 94107
PF
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT M ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME /j 0
•
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANYNAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECTBNGINEER NAME Christopher PreovoloS
LICENSE NUMBER 026740
BUS. LIC #
COMPANY NAME MSA architecture + design
E-MAIL christopherp@msasf.com
FAX
STREET ADDRESS 642 Harrison St., 3rd Floor
CITY, STATE, ZIP San Francisco, CA 94107
PHONE 415.852.4903
DESCRIPTION OF WORK
Tenant improvement of existing shells ace to include: New Toilet Room, parititions,
casework, electrical, lighting, HVAC, plumbing, equipement and finishes
fAor- / — 04/l1s lZ//UU�G
EXISTING USE
None
PROPOSED USE CONSTR-
Coffee Shop
TYPE
IIB
# STORII3S
USE TYPEOCC.
1($)
SQ.FT.
VALUATION
AMAG 2,121
FLOOR 0
DARER O
IOTAL
NET AREA 2,121 Coffee Shop rL 0: B/A2
2,121
$350,000
BATHROOM KITCHEN 1
REMODEL AREA 0 REMODEL AREA O
OTHER
REMODEL AREA 0
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA: UDETACH
❑ ATTACH
#DWELLINGUNITS:
IS ASECOND UNIT [3YES
SECONDSTORY ❑YES
0
BEING ADDED? MNO
ADDITION? MNO
PRE -APPLICATION [:I YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES - _r
VALUATION:
TOTAL VALUATION:
PLANNING APPL # C4NO PLANNING APPROVAL LETTER
EICHLER HOME? ,ti0 _ . _ - "" ,.� — _
$ 0
By my signature below, I certify to each of the following: I am the property owner or authorized agent roperty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and vdrcurate. I agree to comply with all applicable local
le—dr-t-11se-
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL tqrORNfATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑, ovER-TH&COUNTER
❑ BIIILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ 'EXPRESS
PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous. Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOit -
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_MLdoe revised 06/21/11
CITY OF CUPERTINO
� FEE ESTIMATOR — BUILDING DIVISION
1AADDRESS:
19439 STEVENS CREEK BLVD DATE: 05/29/2015
APN: 31620085.19439 BP#: PAD 1 - 12110086
REVIEWED BY: MELISSA
*VALUATION: 1$350,000
*PERMIT TYPE: Building Permit
PLAN CIIECK TYPE: Tenant Improvement
PRIMARY Commercial Building
USE: g
BP FEE ID
PENTAMATION
PERMIT TYPE: 1A T�
WORK
MAIN STREET PAD 1 PHILZ COFFEE - T.I. TO BUILD OUT SHELL 2121 S.F.
SCOPE
IATIPLNCK
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
A (Tenant Improvements)
II-B,III-B,IV,V-B
2,121
$2,499.39
IATIPLNCK
$1,294.95
]ATIINSP
Ekx. Insl>, Fee:
$1,294.95
Suppl. Insp. Feer Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C"onsiruction Tor:
l6hnirfistrofive free:
0
E)
Work Without Permit? O Yes 0 No
$0.00
TOTALS:
2,121
$2,499.39
= -
$1,294.95
Strong Motion Fee: 1BSEISMICO
ME CH, HOURLY ®Yes :`, No _
PLUMB H
, QURLY . Yes No.
,
ELEC, HOURLI' Q; Yes No:_
Afech. Pian Check
Phimb. Plan Check
Elec..Plan Check
;Llech. Pernfil Fee:
Phonh. Permit Fee:
Elec. PL'1'7Telr bee:
Orher ,&c'h. Insp.ED__L_
Other Plumb Imp.
Usher Elec. Imp. Li
Hcech, Ins/;'. Fc:e.:
Plumb. hisp. Fee:
Ekx. Insl>, Fee:
IVUIE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are hated nn the nreliminary infnrmatinn availahla and ara anh? an octimata_ d-nntart tha Dont fnr adds 'l infa-
FEE ITEMS (Fee Resolution 11-053 E . 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,499.39
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (j) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,294.95
Suppl. Insp. Feer Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C"onsiruction Tor:
l6hnirfistrofive free:
0
E)
Work Without Permit? O Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential G
Building or Structure 0
�
Ii�iat,el Doc°uunerataticrrt Fees:
Strong Motion Fee: 1BSEISMICO
$98.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$14.00
StTBTOTALS
$3,906.34
$0.00 TOTAL FEE .
$3,906.34
Revised: 05/07/2015
CUPERTINO
(I
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3223
Fax:40S-777-3333
.4013 ADDRESS: 20085 STEVENS CREEK BLVD
PERMIT 415110098
OWNER'S NAM E: APPLE INC
PHONE 11/650-701-1500
GENERAL CONTRACTOR: NOVO CONSTRUCTION
BUSINESS LICENSE # 791022
ADDRESS: 1460 O'BRIEN DRIVE
grymPCODE: MENLO PARK, CA 94025
'Our municipal code requires all businesses working in the cit) to have a City of Lupa-tino Dusmess ncense.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using an subcontractors:
Signature
Please cltecic applicable subcontractoi-s and complete the following 'information:
Date
Novi CytnS rt)6 on I/11 t t�
Ooer / Contractol' Signature Date
7
SUBCONTRACTOR
BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Mission Bell 418536 ,
Cement Finishing
Electrical
Sprig Electric 296728 `v`"
Excavation
Fencing
Flooring / Carpeting
SD Flooring 881
Linoleum / Wood
Glass / Glazing
Walters & Wolf 373392
Heating
Insulation
California Drywall ,2 148320
Landscaping
Lathing
Masonry
Painting / Wallpaper
City Painting UDZ 357621
Paving
Plastering
Plumbing
_
UMI-=-- -�— 962593
Roofing
Septic Tank
Sheet Metal
UMI 828335
Sheet Rock
California Drywall 148320
_
`file
Novi CytnS rt)6 on I/11 t t�
Ooer / Contractol' Signature Date
7