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12060102 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS•: 10800 TORRE,,VE CONTRACTOR::- " PERMIT-NO: 12060102 OWNER'S NAME-. CITY,,OF CUPERTINO: (T DATE ISSUED:07%24%2012 OWNER,S`PHONE: 6568066039 PHONE NO.; D .LICENSED CONTRACTOR'S.DECLARATION ! BUILDING PERMIT INFO: BLDG ELECT PLUMB' f License Class Lic:#'• � 3 � � _ L MECH RESIDENTIALCOMMERCIAL' I , 1 here6 'allirin that I4am licensed,und��f Contractor � � 2FfL er the rovisions of Cha ter 9 JOB DESCRIPTION:STE 100-COFFEE:SOCIETY-C©MM_T.I,UPDATECOFFEE Y P _ P_ (commencing with Section 7000)of_Divisioa 3 of the_Bus iness&Professions TO ADD,NEW FIXTURES;CONVECTION OVEN,PREP SINK �Code•and,that:mylicense is iwfull',force-and,effect. SANDWICH STATION AND,'FREEZER 510`,SQFT I,herebyaffrm under.penalty of perjury one of the--,following two.declarations: I;have ana'will maintain a ceriificate;of consent to self-,insure for:'Worker's' Compensatjon,,,M provided-for by Sect on'3700 of the.Labor Code,for the performance of'the Mork,for which this permit is issued: .1 have and-will,main_tain Worker's Compensation Insurance,as;provi'ded1or by Section,3700 of"the Labor_Code,for the.performance�uofihe'workJonwhiclYthis permit:is,issmd. Sq.._Et::FloorArea: Valuation:..$11000 APPLICANT CERTIFICATION I ceriifyihatl;have read this applicafion,and,-state,thafthe Above,lhfarhi ation:is AP,N;Number 36931033;00• Occupancy-Type: correct:I agree,to comply,with all citypand;county.ordinances,,and,state laws,relating to building consfruction;and".h by authorize'represeniaiives�of.this,city to enter upon"therabove mentioned property for inspection purposes: (We)lagree to save indemnify and keep harmless the City of Cupertino;against,liabilities,judgments, costs,and expenses'which may accrue agamstzsaid City in consequence,of'the PERMIT EXPIRES IF'WORK IS NOT STARTED granting of`thi%permit, Ad`diiionally,,the applicant understands and will comply VITIHI'N 1.80 DAYS OF-PERMIT ISSUANCE.OR with,all'°non-point source regulations per'the Cupertino;Ivlunicipal Code,Section '1$O DAYF- OM LAST CAL INSPECTION. 9;I8. - SignatureDate Issu -by:: .1 C Date: ❑ OWNER-BUILDER DECLARATION hereby aflirm-.that:hain exempt from the,Contractor',s.License Law for one;of' RE-ROOFS: i - ,the followm�Ufwo reasons: y g � AIFr_oofs shall.lie3jnspected pnordo"any roofing material berg installed.If a roof is I,.as.ownerof tbei ro ert ;or m employees with,wa es as their coin nsation„ installed-without first-obtaining an inspection,1 agree to removeall:new,materials for p p Y. _ . will do the,work;and the structure isnot intended ur ciffered for sale(Sec.7044, inspection. Business&Professions Code) L as•ownerof the,property,'am:exc lusiyelycontracting with licensed;contractors to Signature of Applicant: Date: constructthe pr6ect'(Sec.7044,Business&Professions Code): herebyaflirm underpenalty of;perjury one.of` w the following three ALL ROOF COVERINGS TO BE CLASS'''A'"OR.BETTER declarations: I have and will,maintain a,Certificate ofConsefifto self:insure for W'orker's HAZARDOUS MATERIALS DISCLOSURE .Compensation,.asrprovided.for bySection'3x7.0,0 of the'Labor•Code;�forthe performance of theswork for which d4s—.perinwis issued. Fliave read the"haiardous,materials requirements under Chapter"6:95 of the California Health 1 have and,will maintain Worker's Compensation Insurance;.as provided for`,by &csSafety Code,,Sections 25505,25533,and:25534. I will,maintain compliance with the--Cupertino Municipal Code'Chapter 932 and,thc Health'&• Sectio n,3700•of the1&or'Code,for the,perfoimance;of the work.for which this Safety Code,;Sechonf25532(a)should Lstore or handle Hazardous material. permit isi'ssued. Additionally;'should I use•equipment or devices which emit hazardous air I certify that-irttne performance of the'work'for which"thispermit is issued,'I shall contaminants{as defined byAb Bay Area Air Quality-Management District,I will not-employ,anyperson m,anymanner so as to becomesubject'to;the'Worker°s; maintain compliance with the Cupertino MunicipaWode,Chapter 9.1.2 and the Compensation laws:.of California. ]f,a fter'making'thiscertificat_e of exemption,I Health&Safety Code,Sections 25565,:25533,�and.25534, become subjectto the W&keC's Compensation-provisions'ofthe Labor Code,.I must forthwith comply with,such,provisions:or this:permitshall be deemed revoked, Owner'or'autho_rized3agent:, "? Date• APPLICANTCERTIFICATION. CONSTRUCTION LENDING AGENCY c. I:'certifylhat 1 have read this,application and state't1i4the above information is correct.I agree to coin I with all crY and:count"ordinances,and;state laws relating 'l;hereby_af firm thatthere•is a construction1ending agency,for the performance of work's; ,p.Y . Y y _ _ tabmldin g,construction,`and.fie r6hy,authonze representa' for whjch,this ermit`is.issued,.Sec.3097.,.Civ C: fives of-this to"enter, __ :p ( �) upon°the above=mentioned' ro ert -for'i'nspection,purposes;.(We)agree to save Lender=s Name p P Y fy p p armlessthe Crty of Cupertino against liabilities;judgments, ihrl mm `and kee i;h costs and 6 enses which may accrue=against said City.iniconsequence,of,the, Lender's Address granting,of this permit:Additionally,the applicant,understandsfand.will comply 'with all non-:point:source�regulati'bns,perthe:Cupertino Municipal Code;Section ARCHITECT'SiDECLARATION 9:18.- 1 understand my,plans;shall be^used`as public records, ;Signature 1)962> Licensed°Professional CITY OF CUPERTINO FEE ESTIMATOR-.BUILDING DIVISION ADDRESS: 10800'Torre Ave, Suite 100 DATE 06118/2.012 REVIEWED BY: Sean APN: Bp#: �'Obv', . ; -P' *VALUATION: 1$10,,000 - tPERMIT TYPE: Building Per nif P-LA^N CHECICTY;P.E': Tenant Improvement 'PRIMARY Commercial Building P.E_NTAMATION 16 TI USE, PERMIT TYPE: wORK Tenant,improvement to u•date,coffee.,shop to,add new fixtures: convection oven prep sink sandwich SCOPE; station, freezer. OCCUPANCY TYPE: TYRE.OF FLRAREA CONSTR. . s:f: PC FEES . PC FEE ID BP FEES BP FEE,ID B (Tenant Improvements) II-B,III'B.,IV,V-'B 51'0 $,1,,926.40 1BTIPLNCK $722.96 1BTHNSP TOTALS. 1 5"10 12 $1„926:40 $.722y96 .4 - 1VIECH HOURLY T Yes No,°PLUMB,HOUrRLi' „_Q Yes � No EIEC;HOURI�'� ® Yes QPNo ~ �aelerar "rrrr�Chick !'iuirt f'l rJ;'.(_7r "t:4 clot :Yttecla I' rrrru �LJ7C/ Llereh. l : cr.Perm ! /nsp• 'riv); C1rr.:7-- El `/' 47SP.1"C.(?., NOTE:This"estimate.does=not include fees,due,to.other Departments(i e..LPlanning;Public Works, Fire,Sanitary Sewer°District,School .Dis"triet,etc. . These ees,are based on:the )Wiinina y ih orination;available:an'd'are;onl,an estimate:, Contaet�the_De tf orwddn'7-info. ''FEE ITEMS jEee,Reso/ution l%-053:Gf;'7,'1 1.1} FEE QTY/FEE MISC ITEMS PlanCheck Fee: $1,926.4.0: Select diMisc,Bldg/Structure Suppl.PC F.ee. E) Reg. 0 OT Q,0 hr's $0.:00 or Element of a,Building PME.Plan Check: $0:00 Perrnit,Fee $.722.96 Suppl, Insp.'Fee:Q Reg. Q OT FO 07 hrs $0.00 PME-Unit.Fee: PME P-..ermi't:Fee: $0.00 Cr�tzslrictiUn 7 T-T rl G1�0lP10'71St1'L71lL'8 1'e(:'.: 4 Work WithoutPerinit? 'Yes No' Adyanced'Planning'Fee: $0:00 Select a,Non-Residential I�ru'�el l)c)1uv�eri8tutor .1�.'ces: Building,or Structure ® . Strong Mot'i'on:Fee: -IBSEISi&76 $2:10 Select an.Administrative Item BIdg,Stds.Cominissibn Fee:- IBCBSC. $1.00 ¢ � SUBT®1��LS $2.652,46 $0.00 $2,652:46 Revised: 06/30/2012