06010119-STRBKS .CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORiINFORMA- ION
BUILDING ADDRESS: KEYKENDALL ELECTRIC PERMIT NO.06010119
21000 STEVENS CREEK
OWNER'S NAME: PERMIT ISSUE DATE
STARBUCKS COFFEE 1795 CHENEY DR 01Z23/2006
NE: SANITARY NO. CONTROL NO.
(408) 275-8038
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
in LICENSED CONTRACTOR'S DECLARATION `
1 hereby affirm Ndemand I am under provisions of Chapter Y(commencing Job Description
withSection 70M)of Division 3 of NC Business amt ( oro dc, dmyliccveis
in full rode and aCalt. -/ 4
'°i LieenWCl a L 'Ii Lie.« ADD 30A CIRCUIT FOR MICROWAVEpa
,rte Dale OI.ZS,.6� Cont - - I9 WALED ED
qq ARCNfI'crS ITEM tl IJ it 9 U9tSS area LLL��999"'
�n+U I understand my plans shallbc used aspub' ii 9e
Stu
s o H
Licensed Professional A, /7; 1-1- 2006
3 OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Convector's License law for the
pe O following mason.(Section 703 I.S.Business and'Profcstluns Calc:Any city or county I?7`14 I✓F\ .rlD?\
m which require a permit to consumer,elms,improve,demolish,or repair any swctum Y
or hs its issuance,also m uims theapplicant for such resiuo file a signed statement 2�5"�'�' rte"
x r P^ 9pc gnc
< Nat he is licensed pursuant to the provisions of the Cammcmr's License law(Chapmr 9 Sq.Ft.Floor Area NAaluatibiiU Vim`-%
.Fn (commencing with Section 70MB of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.3 by any applicant for a permit subjects the applicant to a civil penally of
not more than fixe hundred dollars ISSUE. r Occupancy Type
❑1,u owner of du property,or my cmploycu with wages u their sole compcnsauon,
will do thework.endue heComis not in Lt oroRct Tonle(See.to x4,Business
ane property
whProfessions Cod,:The Co lamont License law Coes tar apply lf an owner of Required Inspections
progenywhobuildsarireprovesch improvements
anissec twork oroffredHuuugh his
ownver,ft building
met such improvementsarcnot intendedmpleered for sale.If,
however,tie building or Improvement is salt within one year of completion,the owner-
builder will have tic burden of proving than h<did not build or improv for purpose of
sale.).
❑1,as owner of the property,am=elusively contracting with licensed convectors W
construct the project(Sec.70aL Business and Professions Cote:)The Contractor's U.
cense law tots not apply to in owner of pmpcny who builds or improve daemon,and.
who contracts for such projects with a contractor(s)licensed pursuanuo the Contractor's
License law.
❑1 am exempt under sec. ,B&P C for this mason
wrier Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following decimations:
1 hew and will maintain a Cenifam of Consent maelf-insure far Worker's Compere
von.as provided for by Section 37W of the labor Code,for the performance of the
work for which this permit is issued.
JI have and will maintain Worker's Compensation Iruurana,u required by Section
7 ofthc labor Code,for tie performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier. 5rI6h_t- Policy No.: '2 7+3eJ5i-_1__&
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This vection need not Wcomplemd lithe permit is foronc hundred dollars(SIM)
or less.)
I cenHy tial in tic performance of tic work for which this Permit is issued,l dull not
employ any person ie any manner so as an become subject to IM Worked Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cenifcam of Exemption.You should
become subject W the Worker's Compensation provisions or the labor Code,you must
.J z forthwith comply with such provisions or this permit shat]he deemed revoked.
zO` CONSTRUCTION LENDING AGENCY
I hembyalBnn that them its construction lending agency for the performance of
nY i the work for which this permit is issued(Sec 3097.Civ.C.)
f31 0 Lender's Name
p' Lenderi Addmirs
az
J C) I certify that 1 have read this application and sum thn the above information is
U. (-' correct.l kine to comply wit all city and county on inarcxs and sum laws relating W
0U building construction,and herby orhorim mpm,miativev or this city to enter upon tic
rLahnvrmcmioncd progeny for inspection purposes.
(We)a ree to mveY ndcpm fy and keep harmless the City of Cupertino against
H r/l Iiabilidu,jud cns.fOsts and expense which mer'in any stray sceruc agaiul Mid City
Vz mconseque cofDIgrantingofthispermit. / Z0-
SOURCA UNDERSTANDS AND-WILL-COMPLY WITH ALL NON-POINT Issued by: Date C �—
SOURC E DNS..,---
I
NS:,"'--I / U/ 7-3_
'snBn we of Applin vacmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
W BNe applianl or fuwre building oce.pamamm or handle lm miuu material
az ere b/the Cupertino Municipal Co@,Chapter 9.11,and the Health and Safety
od 255J3(a)? ®N
❑YApeo All roofs shall be inspected prior to any roofing material being installed.
/ If a roof is installed without first obtaining an inspection,I
Will the epplicam or future building axupam use cyuipmcnt or devices which g agree to remove P
it he'smi ,air contaminants as defncd by the Bay Area Air Quality Management all new materials for inspection.
❑ive /Il4'N .
Ihave rtaaaxxxssstttttt,, ebuarM/v0O'' a¢rialsecquirtme5534.l rGhaped6 atiflh W;Idiing
nixs noth&r y.h" cu deal
itis
my re onschi4.1 to portlyt a the ,of dic
dos not curtc y,hiwa et it stay es,of a hility W nadfY cc acupant of the
-ul
Me
nmuRb ntporniaanecoracerfeaeoraeupnY. Signature of Applicant Date
n -�l•ob
Owner r inborixpd agent ❑,m All roof coverings to be Class"B"or better
(
Community Development
J 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
ZI 000 S7 i/cruS 4.. 3Z. 950/ o/O//
OWNER'S NAME: `T& L 7K,,a PHONE # , ,rz.,90W.%7-5u
GENERAL CONTRACTOR: FAX # if,,o Z,95"7 65
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical VYKr�nRu F vL,.� Z 75
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
heet B.o k
ol•Z�a6
/Owner/Contractor Signature Date
C1
CITY OF CUPERTINO
CUPE(ZF PERMIT APPLICATION FORM D �' l L J
N # 3C c� �•�� Date:
.l l 7 �
uilding Address: Mailing Address (if different from building address):
Zi ocv s`rort -
Owner's Name: Phone#:
Contractor: License#:
ontact: Phone: 4u5 2-7S 5"3,P Cupertino Business License#:
Fax: Z
Building Permit Info:
Bldg ❑ Elect E7 Plumb ❑ Mech ❑
Job Description:
Residential ❑ Commercial Ab 6, t, DGsJ ui t-nSQA cc ;
Sq.Ft. Floor Area: q.Ft.: C
Cost of Proi ect: Occupancy Grouu:
Type of Construction: Please check this box if the project is a
second-story addition: ❑
91�roiect Size: Standard ❑ Large ❑ Major ❑
uant ity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BB.OILER3. Boiler> 500K to IM Btu MECHANICAL
BBOILER4 Boiler> 1M to 1,75 M Btu MECHANICAL
BBOILERS Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—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
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�� . P,�D
g al CITY OF CUPERTINO
CUPEf�IM
F PERMIT APPLICATION FORM
% Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMIIIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum . PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERA1FEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan 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 Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BRFhIFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREAMTHOOD Installation of Hood AlECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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'i CITY OF CUPERTINO
CUP 7Y0 PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMYENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL S ecial ectinCHANICA
BUILDING
BSWIM' Swimming PoBUILDING
BTEMP TemporaPoELECTRICAL
BTEMPPERAI Tem ora Bld PBUILDING
BTEMPSVCS Tem Dist SvELECTRICAL
BUSLIC Business LiceBUILDING
ELECTRIC Electricals foELECTRICAL
EPERMPITEE Elec Permit IssuELECTRICAL
MPERMFEE Mechanicals . MECHANICAL
MPERMITFEE Mech Permit IssMECHANICALPPERMITFEE Plumbin PermitPLUMBINGPPLBG Plumbin Fee sPLUMBINGPLLONGRNGC Plannin LR Commel PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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