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11030146 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20560 TOWN CENTER LN CONTRACTOR:TEAMWRKX PERMIT NO: 11030146 OWNER'S NAME: CIVIC PARK CUPERTINO LLC 1691 OLD BAYSHORE HWY DATE ISSUED:05/25/2011 OWNER'S PHONE: 4082100025 SAN JOSE,CA 95112 PHONE NO:(408)287-2700 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class 4 Lic.N ?L( 1 y 4 MECH r RESIDENTIAL r COMMERCIAL r Contractor _r7=Avh1J ttK_C Date S-Z T—t 1 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BITTER SWEET -COMM'L TI MINOR TENANT (commencing with Section 7000)of Division 3 of the Business&Professions IMPROVEMENT Code and that my license is in full force and effect. TO EXISTING RETAIL SHOP IN SHELL BUILDING,NEW FIXTURES&EQUIPMENT FOR WAREWASMNG&COFFEE& I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,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 provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$75000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:36955082.20560 Occupancy Type: correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 D S FROM L T CALLED INSPECTION. 9.18. ` l_ ) Signature � Date -ZT—�� Issued by: �� vr- LJ �I )Date: ❑ OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(x)should 1 store or handle hazardous material. permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Own uthorized agent: Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTIN� (4 8)777-3228•FAX(408)777-3333•building(cDcuoertino.org D ❑NEW CONSTRU = ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 3W60 TOWN CENTER LANE CUPERTINO CA ApN# 369-55-082 OWNER NAME CIVIC PARK CUPERTINO,LLC - PHONE 49@2't'C:Od'1r E-MAIL ttsai@ctbt.com _ a s-s STREET ADDRESS 2nfif=^ ^�•'•,^�'TT.�LNF CI Y, TATE, FAX -P ze�e- e/D/ CONTACT NAME ED VISER PHOS 925.216.1782 ED@CAFE-DESIGN.NET STREET ADDRESS 409 PINERIDGE CITY,STATE,ZIP SAN RAMON,CA 94583 FAX 707.361.0953 ❑OWNER ❑ OWNER-BUILDER XOWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME CHRIS HILL/ERIC VENZON LICENSE NUMBER LICENSE TYPE BUS.LIC# Lic 841440/908699 COMPANY NAME TEAMWRKX E-MAIL chill@teamwrkx.com FAX 408-287-2800 STREET ADDRESS 1691 Old Bayshore Highway CITY STATE ZIP San Jose,CA 95112 PHONE 408-287-2700 ARCHITECTIENGINEER NAME THOMAS A ZIV LICENSE NUMBER 18897 BUS.LIC# COMPANY NAME CAFE DESIGN&ARCHITECTURE E-MAIL TOM@CAFE-DESIGN.NET PAX 707.361.0953 STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK MINOR TENANT IMPROVEMENTS TO EXISTING RETAIL YOGURT SHOP IN SHELL BUILDING;NEW FIXTURES 1£ EQUIPMENT FOR WAREWASHING AND COFFEE 8 ESPRESSO BAR OPERATIONS;REMODEL OF EXISTING ELECTRICAL;PLUMBING AND LIMITED HVAC DISTRIBUTION MODIFICATIONS EXISTING US PROPUSE CONST;_ #STORIES OFFICE USE ONLY OCC, TYPE DESCRIPTION S__ EXISTG NEW FLOOR DEMO TOTAL - p AREA AREA AREA NET AREA E�"-� .+■L BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKNORCH AREA I GARAGE AREA:❑ DETACH ❑ ATTACH p DWELLING UNUS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES; BEINGADDED? ❑NO ADDMON? ❑NO PR&APPUCATION ❑ YES IF YES,PROVIDE COPY OP PLANNERS N— RECEIVED BY: /� TOTAL VALUATION: PLANNING APPL N ❑ NO PLANNING APPROVAL LBTTER J 600 By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I h e read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building ction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 3) 30111 SUPPLEMENTAL TION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellin : Ap ly for demolition permit for © OVER-Tri&COUNTER '�'B'IHLDING PLAN REVIEW existing building(s). Demolition permi is quired prior to issuance of building �� permit for new building. I-] EXPREss LT PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1 --s A_ND'ARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGEn PT _Copy of Planning Approval Letter or Meeting with Planning prior to 11 MAJOR A' sERBRDISTRICT submittal of Building Permit application. ❑ ENYDtONINENTAL HEALTH BldgApp_201 1.doc revised 03/16/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 C O P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 2 OS?'GZ� ��,r/G�/fL. PERMIT# D y OWNER'S NAME: PHONE# z4 0 �4g55_ GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: /�p-�/ zPGp CITY/ZIPCODE: -t5 12 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 3130`11 Owner/Co tractor Signature Date CIVIC PARK CUPERTINO LLC P.O. Box 1325 Menlo Park, CA 94026-1325 408-436-3671 or 408-938-2552 Fax: 408-436-0101 March 30, 2011 City of Cupertino Community Development Department 10300 Torre Avenue Cupertino, CA 95014 Re: Improvement Plans by Bitter and Sweet, 20560 Town Center Lane, Cupertino Ladies and Gentlemen: This letter is to confirm that Bitter + Sweet, LLC has signed a lease as tenant to use the above space for a specialty coffee shop. Civic Park Cupertino LLC, as the owner of the space, has approved the improvement plans dated and submitted today to the city by Bitter + Sweet. Thank you. Please do not hesitate to call if you have any questions or concerns. Very truly yours, Civic Park Cupertino LLC l . By Tenny Tsai, Manager kk.oc 033011-