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07090117 CITE'OF CUPERTINO BUILDING DIVISION PERMIT +c� GTc� IMTI� t* PERMIT NO. BUILD,(N2$ ESHOMESTEAD RD R K ELECTRIC INC 07 09 0117 L j PERMIT ISSUE DATE OWNER'S NAME: STARBUCKS 42021 OEGOOD RD 09/18/2007 SANITARY NO. CONTROL NO. 'NE: (510) 77C -5660 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p Q LICENSED CONTRACTOR'S DECLARATION Job Description MV C I hereby affirm that I am licensed under provisions of Chaptcr 9(commencing z m with Section 7000)of Division 3 otthe Business and ofcssiuns C(odde,a(td my license is T. I . C OI1M'L; ADD OUTLET TO EXISTING C C)MM'L y in full force and efl �� BUSINESS.. u v2 z License Class ' Lic.# M U2 Date ��CL Contractor T r D ARCHITECTS DECLAR O � i a< 1 understand my plans shall be used as public records )aU O y Licensed Professional OWNER-BUILDER DECLARATION ja 1 1 hereby affirm that 1 am exempt from the Contractor's License Law for the -p O following reason.(Section 703 1.5,Business and Professions Code:Any city or county e$9 which requires a permit to construct,alter,improve,demolish,or repair any structure "rn prior to its issuance,also requires the applicant for such permit to file a signed statementc Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 �.q.Ft.Floor Area $775 Z H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of e�j�Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3260102 :l�b not more than five hundred dollars($500). ❑1,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 Contractor'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 Contractors U- 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 Contractors License Law. C3 I am exempt under Sec. B&P C for this reason Owner Date - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of pedury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I 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 Worker's Compe aeon Insu nce carrier and Policy number are: n� Cartier. t T Policy No.: l CERTIFICATE OF EXEMPTION FROM W� 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 the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Cornpensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. 7_2 CONSTRUCTION LENDING AGENCY rte. I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(See.3097,Civ.C.) W A Lenders Name Z Lenders Address 1 certify that I have read this application and state that the above information is [UL.O correct.I agree to comply with all city and county ordinances and state laws relating to rJ- U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. Wi (We)agree to save,indemnify and keep harmless the City of Cupertino against 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 �r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by _ SOURCE RE TIONS. 9- 1 7 / Re-roofs Signature o Applicant/ ontractor Dare T of R oof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store orhandle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes 624 If a roof is installed without first obtaining an inspection,.1 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 R aterials for inspection. District? ,,��11'' ❑Yes o I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not cu fly ave a tenant,that it is my responsibility to notify the occupant of the requirement' must be mel prior to 1sW21q,of a Certificate of Occup er- Signature of Applicant Date -'� All roof coverings to be Class 'B or better Owner or(uthori-rcd agent are CITY OF CUPERTINO 3 ITEMS OF 9 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 326 )1027 . 00 DATE ISSUED. . . . . . . : 09/ 18/2007 RECEIPT #. . . . . . . . . : BSO)0002680 REFERENCE ID # . . . : 070)0117 SITE ADDRESS . . . . . : 22330 HOMESTEAD RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER STARBUCKS ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : RECEIVED FROM . . . . : ROBERT L WEST CONTRACTOR . . . . . . . : ROBINSON, GARY LIC # 10239 COMPANY . . . . . . . . . . : R K ELECTRIC INC ADDRESS . . . . . . . . . . : 42021 OSGOOD RD CITY/STATE/ZIP . . . : FREMONT, CA 94539 TELEPHONE . . . . . . . . : (510) 770-5660 FEE ID UNIT QUANTITY PMOUNT 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 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- --------- 101 FOUNDATION 102 PIERS 103 UFER 104 REBAR 105 ANCHOR BOLTS 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCRATCH COAT 313 ROOF NAIL CITY OF CUPERTINO awl D �, OF PERMIT APPLICATION FORM CUPEkT(NO APN# a Oc� / ® 0 Date: Building Address: as 3q U � � p,,, ailing Address (if different from building address): Owner's Name: �f 13v L�3 Phone#: Contractor: License #: /� I (1 V Contact: nn au,-� Cupertino Business License#: P's Fax: % C Building Permit Info: „I n I �a a, ,n' A.1 Z j Mon5 Bldg ❑ Elec Plumb ❑ Mech ❑ Job Description: Residential Elm Comercial-, Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy G ou Type of Construction: Please check this box if the_ project is a second-story addition: ❑ Project Size: Standarctl 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> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Co a. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Co lstax—Resi/Mobile BUILDING BELEC1000 Elec 600V<= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING I of 3 CITY OF C UPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quinti Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP N(-,w Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPF IXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK flan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Law 1 S rinklerBackflo PLUMBING -BPSTORM - S:orm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER W iter Heater/Vent PLUMBING BPWSVCS M iin Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C-Jnits <= 10,000 cfm MECHANICAL BREMAPPLI jippliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT bighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Rek, Furnace> IOK btu MECHANICAL BREMHEAT F eater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Po e/Platform Fixture ELECTRICAL BREMPOWER Powfr Device/Apparatus ELECTRICAL BREMRECEPT Repi], Switch & Outlets ELECTRICAL BREMRELOCA R-,location of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO UPaWTYF 1 PERMIT APPLICATION FORM C R� 2uanti Fee ID Fee Description Fee Group BREMSIGNAD Rmd] Signs Add Branch ELECTRICAL BREMSIGNS Remcdel Signs,Marquee ELECTRICAL BREMTHEATR Thez trical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems. MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seip mic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM wimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elegy: Permit Issuance ELECTRICAL MPERMFEE Mi;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 Lone Range Residential PLANNING 3 of 3 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 �C(TY OF Fax(408)777-3333 -UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # r/7 OWNER'S NAME: PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: q7- Signature Signature Date Please check applicable subcontractors and o!m (ete 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