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07090115-STRBKS 7777 CITY OF CUPERTINO BUILDING DIVISION PERMIT �NTICt� GTQ IN NIN ON� -- PERMIT NO. BUfLDj(-1T nTSSTEVENS CREEK BLVD R K ELECTRIC INC 07090115 G PERMIT ISSUE DATE OWNER'S NAME: STARBUCKS COFFEE 42021 CSGOOD RD 09/18/2007 SANITARY NO. CONTROL NO. NE: (510) 770-5660 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH 0 0 0 a z LICENSED CONTRACTOR'S DECLARATION Job Description UC 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing z m with Section 7000)of Division 3 of the Business an ofcssions ode.and my license is T. I . C C NMK'L ADD OUTLET TO EXISTING C OMM L h y in full force and of h z License CI Lic.# BU S I NE E S. F Date Contractor ARCHITECTS DECLAR i a< 1 understand my plans shall be used as public records )aU Oy Licensed Professional v, OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the ja O following reason.(Section 7031.5,Business and Professions Code:Any city or county ff which requires a permit to construct,alter,improve,demolish,or repair any structure ?Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area 7 7 5 e.t=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 5 9 0 7 0 C 5�1N Number Occupancy Type not more than five hundred dollars(5500). 0 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 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.), 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- ccnse 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. ❑1 am exempt under Sec. B&P C for this reason OwnerDate _ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 i have and will maintain a Certificate of Consent to self-insum for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. C]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 Compensation Insurance carrier and Policy number are: �,� y Cartier: 4A& 1-1 kle Polity No.: 60 7 1 � La —SCERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or Icss.) 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'Compensation 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 mast Qforthwith comply with such provisions or this permit shall be deemed revoked. Z, CONSTRUCTION LENDING AGENCY F~t�. 1 hereby affirm that there is a construction lending agency for the performance of a the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name Z Lender's Address (�0 1 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 rJ- V building construction,and hereby authorize representatives of this city to enter upon the W ahove-mentioned property for inspection purposes. O, (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 G U Z in consequence of the granting of this permit. APPLICANT U DERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b3: O' _ SOURCE RE ATIONS, 1-4 Re-roofs Signature of pplicant/Contractor Dare Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupantslore or handle hazardous material as defined by the Cupertino pku'ipal 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. 0 Yes Will the applicant of future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,.I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r iaterials for inspection. District? y�� 0Yes 1L6 I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 75534.1 understand that if the building docs not currentlg a tenant,that it is my responsibility to notify the occupant of the reyuiremcnts whisl be met priori ance of a Certifhcatc fOccupan Signature;of Applicant Date �►/•J All roof coverings to be Class"B"or better Owner or authori•.cd agent ae CITY OF CUPERTINO 3 ITEMS OF 9 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl{: Lot: APN . . . . . . . . . 35307005 .01 DATE ISSUED. . . . . . . : 09/18/2007 RECEIPT #. . . . . . . . . : BS)00002680 REFERENCE ID # . . . : 0790115 SITE ADDRESS . . . . . : 2100 STEVENS CREEK BLVD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER STARBUCKS COFFEE ADDRESS 11111-C N. WOLFE ROAD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ROBERT L WEST CONTRACTOR . . . . . . . : ROBINSON, GARY LIC # 10239 COMPANY . . . . . . . . . . : R K ELECTRIC INC ADDRESS 42921 OSGOOD RD CITY/STATE/ZIP . . . : FREMONT, CA 94539 TELEPHONE . . . . . . . . : (510) 770-5660 FEE ID UNIT QUANTITY '\MOUNT 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 -3.02 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 (.UPERTINO CU TWOY70 NO PERMIT APPLICATION FORM APN# 0 O C) Date: CH Building Address: )� TTng Address (if different from building address):oo ���� cue Owner's Name: , /n /L � Phone#: J —( 0 b Contractor: ,� ) (J License #: q1 , `) q ]l d Contact: Phone: )V- ' Q-;Z6--, Cupertino Business License#: V4 S� Fax: p- '(' i� - zt, Building Permit Info: ,�� %��L� "�` �'` U�►' y��`�a` a kl� �-' C0 th Bldg El Elec dumb ElMech E] Job Description: Residential ❑ CommercialC�, Sq-Ft. Floor Area: Sq.Ft.: Cost of Project: , 7 a D-7 Occupancy Group: I Type of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standar Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Bailer<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boi ler> 500K to 1M Btu MECHANICAL BBOILER4 Boil,-,r> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ir d/OfUComm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Cc nstax-Resi/Mobile BUILDING BELEC 1000 E lec 600V <= 1 OOOA ELECTRICAL BELEC1001 Elec 600V> IOOOA ELECTRICAL BELEC200 Elegy. Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING I of 3 CUPERTINO CITY OF CITY of CUPE�TiNO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME I�ew Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING _ BPCESSPOOL Cesspool PLUMBING BPERMFEE j'31dg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ina Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKA.DD Plein Check Add Multi BUILDING BPLANCKREP Plen Check Repeat Fee BUILDING BPREPIPE R e i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPS-TORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT A It of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Neater Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN AJC Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BR:EMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BR:EMHEAT Beater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pc le/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMR:EPALT R,,-pair/Alter Heating MECHANICAL BREMR:ESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF (:UPERTINO aWOFPERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rm31 Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Th,;atrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS V m ilation Systems MECHANICAL BSCBLVD 3cb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL :special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC ;3usiness License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE EIL,-c Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plambing Fee sq foot PLUMBING PLLONGRNGC Plannin LR Comme/Multi-Fam PLANNING PLLONGRNGR Plannin Long Range Residential PLANNING 3 of 3 Community Development a 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 '-UPEkTINO Building Department JOB ADDRESS: I u C ���� CQ dz g f J PERMIT #b� OWNER'S NAME: ) PHONE # ) V - -110 - 5�b O GENERAL CONTRACTOR: c FAX# I am not using any subcontractors: �17, Y r Si mature Date Please check applicable subcontractors and co :)lete 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