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07020027CITY OF CUPERI'iNU BUILDING DIVISION PERM BUILDING ADDRESS: PERMIT NO. 20955 STEVENS CREEK BLVD WHOLE FOODS MARKET 07020027 OWNER'S NAME: PERMIT ISSUE DATE WHOLE FOODS MARKET PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: i a a LICENSED CONTRACTOR'S DECLARATION NU 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing t Z with Section 7000) of Di on 3 of the Business and Professions Code, and my license is < in full force and effect D C j Z License CI 111 ✓✓✓✓✓ Lic. p J t Date Contractor ARCHITECTS DECL.ARATMK j < understand my plans shall be used as public records )aU e u, �a Licensed Professional 1 y .] OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the COO following reason. (Section 7031.5, Business and Professions Code: Any city or county < which requires a permit to construct, alter, improve, demolish, or repair any structure u — y prior to its issuance. also requires the applicant for such permit to file a signed statement - a that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 titY- (commencing with Section 7000) of Division 3 of the Business and Professions Code) or u 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 penalty of not more than five hundred dollars (SM. ❑ 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 and Professions Code: The Contractors 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 Imended 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.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractors Li. 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 Contractor's License Law. ❑ 1 am exempt under Sec. . B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affinh under penalty of perjury one of the following declarations: BUILDING PERMIT INFO ELECT PLUMB MECH Job Description TEMPORARY PERMIT: UNDERFLOOR PLUMBING ONLY EXPIRES: 3/6/07 Sq. Ft. Floor Area 32631020.-D-(T 4t1 have and will maintain a Certificate of Consent to self -insure for Workers Compen- on, 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 Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued My Workers Compe aeon Insurance carrier and Policy number arc: Carrier. Polity No.: / CER IC7fF nT�PTION FROM WORKERS' COMPENSATION INSURANCE / �tf? (This section need not be completed if the permit is foronc hunn /dollars ($I00) or less) I certify that in the performance of the work for which this permit is issued, 1 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 Workers Compensation provisions of the Labor Code, you must Z forthwith comply with such provisions or this permit shall be deemed revoked. z O CONSTRUCTION LENDING AGENCY E-+ � 1 hereby affirm that there is a construction lending agency for the performance of 1:4 > the work for which this permit is issued (Sec. 3097, Civ. C.) QLenders Name Z Lenders Address U C) I certify that I have read this application and state that the above information is U. '-' torten. I agree to comply with all city and county ordinances and state laws relating to 0 U building construction, and hereby authorize representatives of this city to enter upon the U above -mentioned property for inspection purposes. f"' d7w (We) agree to save, indemnify and keep harmless the City of Cupertino against r.,., W liabilities, judgments,costs and expenses which may in any way accrue againstsaid City UZ in consequence of the granting of this permit APPLICANT U DERSTANDS AND WILL COMPLY WITH A NON- INT SOUR R U TI S. Zt 49 Si gfd h re f6 f Ap scant/ ntrac or 17atc HAZARDOU ATP-RIALS DISCLOSURE Will the applicant or future tiding occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? El Yes No 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 District? ❑Yes No I have read the hazardous materials requirements under Chapter6.95 of the Califor- nia Hcalth & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently arc a tenant. that it is my responsibility to notify the occupant of the rcquiremc hi u be et p ' to issuance of a Certificate of cupan . l d�07 Owner or authorized ¢c Date Issued by: Re -roofs Type of Roof Valuation $5500000 Required Inspections Occupancy Type Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better 1 0 CUPEkTINO • CITY OF CUPERTINO MOZ04(l PERMIT APPLICATION FORM APN # 326-31-018-020 Date: 5 February 2007 Building Address:20955 Stevens Creek Blvd. Mailing Address (if different from building address): Owner's Name: Phone #: Jack Wagner, Project Manager Whole Foods Market of Northern California428-7473 Contractor: ; �e Go��fe vv License #: D 41 5$' CP91act. Phone:-W7 76Z-31.o O Cupertino Business License#: P 40 Fax: -7 2 - D 7&10 Building Permit Info: E M P O RARY PERMIT YJ ei k�� d �3 Oa✓ _ Bld Ele Plumb X Me Job Description: Tenant improvements for a grocery store in an existing shell building Residential ❑ Commercial Sq.Ft. Floor Area: Sq.Ft.: 751-634 S.F. Cost of Project: $5,500,000 Occupancy Group: M B, S-2, S-3 & H-7 Accessory to M primary, A-3, Type of Construction: V-1 H R Please check this box if the project is a second -story addition: ❑ Project Size: Standard ❑ Large)Large)< Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1 M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ uasi 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 1 of 3