06020090 CMfgITY OF CUPERTINOu
BUILDING DIVISION PERMIT =^..CONTRA�.C�0WINFORMAT
BUILDING ADDRESS , PERMIT NO.06020090
22390 HOMESTEAD RD
OWNER'S NAME: PERM MUEOATE
STARBUCKS COFFEE 06/20/2006
NE: SANITARY NO. CONTROL NO.
ARCHTIECTIENGINEER: BUILDING PERMIT INFO
BLOC ELECT PLUMB MECH
u O o LICENSED CONTRACTOR'S DECLARATION
1 Isometry affirm that I am loused under previsions of Chapter 9(commencing Job Description
Z wtdesecWn7")orDiviAon3ofthcH huxua di Prefmtua Code.andmylkemeu
mm�faeeanderr:e� 5 S TI-STARBUCKS-ELECTRICAL/MECHANICAL/PLMBG
'N4 4 Lkeeme aas
#J Dames Contractor
ARCHITECTS DECLARATION
1 undersand my plana.hall he used u public..''
eau
So Licensed Professional
a Oat I am exempt
fo DECLARATION _
i f i hereby affirm that 1 1. .umpl(rem the eonlramCm License Law for the
HI O following meson.(Suction 7071.!,Basions and Rafeesiom Cade:Any city or aunty
$ which requires a permit to construct.alter.hapmw,demolish.nr repair any aucture $80000
prior At its issuance,also mquim the applicant forsuch permit o file a signed statement
F thatWislianxedpurwanitotheprovisInusafumConuscier'sLicenseLaw(chapter9 Sq.Ft. Floor Area Valuation
Y�$
(cm
mencio&with Salon 7000)of0ivision 3 oftW Busimss and Prafruiom Codel or
Q — that be Is exempt therdm n and the basis for the alleged e..mpreore Any vielation of
Sudan 1071.3 by my Applicant(W a permit subject,the applicant te a civil PM19Y of APN Mrhber Occupancy Type
not mom than five bundmd dallan(5500}
❑I,As owner of me property.or my employees with wages as their sole compensation,
will do the wok..nd the suumure is not intended man.md Lor ask(Sm.7044.Bumnm Required Inspections
And Prefesdaus Cade:The Conusctee.Liana law does at apply m an.1 of q P
propertywW builds or improvestberean,and wed donsuch wart humad(.threaghhu
awn cmplaya;provided that such Imprevcmets are not intended a uffe ed rte ole U.
however,me Wincing or impmvemeM is said within am yea ofcomPletion.me owner- 1r1s yn,� �] fpg [��
builder will have me tarda of proving that be did at W,Id or improve fa purpose of ��HN N Ly f'I�' yam..
ssle.). Star 1i�9 {p�f+ff�,gtYs`'6p'gD
0 I,as owner of the property,ars exclusively contracting with liuned exon anon An
comwct the project(Sec.70",Bwine.and Professions Code:)The Cucuacmes U.
sera Law does not apply As an owner of property wed builds or improves thereon,and. `yr
whoanuacuforauchpmjcmu Lhsmnu *)IieasedpursusmtetheConuanora •1, Ca.- IQ6
LleemeLaw.
❑I am exempt under See ,B h P C for this mason
Owner S+ ER'Qri.7
Data j
WORKER'S MPENSATION AATION
I hereby aOQm tinder parody of perjury am of the following decluatlmhc
1 hawand will maintain•CertificateofC..[As self-Wort for Workeh
atioCompen-
sn,as provided for by section 7700 of the Labor Cade,for We performance of the
work for which this permit is hatted.
❑1 haw and will maintain Workers Compensation Insurance,as remained by Section '
7700 of the latter Code,far the performance of the work far which this permit is lured. '
My Workers Compensation Insuraae arts.and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This=arm need our he cmnpmted Irthe .It is forone hundred don.(5100)
or mesa)
I..oily Wt in the performance of the works for which this Permit is Wmd,l shell am
employ any person in ay manuso As in became subj.l to the Worlans'Compematon
Laws of Califamia.Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you ahaum
accurate abject an the Workers Compeusstian provisions of me Loh.Cade.you mus!
O forthwith comply with such provisions or this permit shall be dmmed revoked.
„Z,dM CONSTRUCTION LENDING AGENCY
F-h I hereby oM m tied mere is a construction lending agency for the performance of
E
s7
the work for which this permit 4 Wood(Sec.7097,Civ.C.)
�W Lenders Name
7.Z Lenders Address
U O I unity mat I have reed this application And state that the aWve Information is
Iy t-' carrtoL 1 agree to comply with all city and county aNinances and sum laws rotating in
0U building convection,and hereby authonre MPresednatws of this city to cmcr upon the
Lsi .hove-mentioned propray for inspection purpose.
(We)agree to ave,indemnify ad keep harmlm the City of Cupertino agumt
y liabilities.Jndgmenta,<wlsend eapenw hmaymanyw'ayaccrucagalmtutd City
UZ I. onsem qof the grating a(m
APPLI u
APUNDER ST AN LL COMPLY WITH ALL NON-POINT Issued by: Date (o
SOUR E AMO
Re-roofs �`--�
HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
Will ms applicant.future Wilding oc upatstert or handle havNon mat.ial
as defined by the Caperton Municipal Code.Chapter 9.1;and the Health and Safety
este, y. ON.zsssz(.17
0All roofs shall be inspected prior to any roofing material being installed.
Yn
1 Will uic applicant or future Wilding occupant ma cqulpmmt ar devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hazardous sir conumianu As defined by the Bay Arta Air Quality MaaSemenl all new materials for inspection.
Disuict7
❑Yes ANO
I hew mad the hazardoassuuumaterrA tequimments under Chapter 6.93 ofute Califor.
ria HcolthkSafclyCade.S 1 7yU3,E5533w1Z533C.l to muiunde Occupant
daonot a ntlyhaw ttttp th}TIL^m7w/(-t(�bu myresponsibility 3md25534.lunnotifytheai(Lhc of the
rtquirt ta ten t m rteivaatmeanCenirtateafo .paw, Signature of Applicant Date
.rat omada at Dam All roof coverings to be Class"B"or better