07080024F
F.
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
11�4�drl1�L'1
BUILDIN ADDRESS:
PERMIT NO.
2�955 STEVENS CREEK BLVD
TURNER CONSTRUCTION CO
07080024
OWNER'S NAME:
PERMIT ISSUE DATE
WHOLE FOODS INC
60 S MARKET ST STE 1100
08 29 2007
PHONE:
SANITARY NO. CONTROL NO.
(408)295-7598
A RC H ITEt'T/ENG WEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 700U) ol"Division 3 o(the Business and Profession$ Code, and my license is
REVISION - ADDITION OF 2ND EXIT AT (E) OUTDOOR
in full force and effeCL
License Class Lic. a
PATIO
Date Contractor
ARCHITECTS DECLARATION
I understand my plans shall he used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
following mason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit (a construct, alter, improve, demolLO, or repair any structure
prior to its issuance. also requires the applicant for such permit to rile a signed statement
is licensed of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he pursuant to the provisions
(commencing with Section 7000) of Division 3 of the Business and Profmsions Code) or
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that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Number
Occupancy Type
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (S500).
32619020
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work, and the structure isnot intended oroffered for sale (Sec.7044.Business
and Professions Code.. The Contractors License Law does not apply to an owner of
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property who builds or improves thereon, and who does such word himself or though 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),
as owner of the property. am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contraaoes Li-
cense Law does not apply to an owner of property who builds or improves thercon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Co wactoes
License Law.
-❑ I am exempt under Sec _ , B & for this reason
Owner Qq�/o7-7
WORKER'S COMP TTON DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Conseri(to self -insure for workees Compen.
sation, as provided for by Section 3700 of the Labor Code. for. the performance of the
work for which this permit is issued
❑ 1 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 Workers Compensation Insurance artier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXFJ M014 FROM WORKERS'
COMPENSATION INSURANCE
(Phis section rtxd not be compicted ![the permit Is forone hundred dollars (f l00)
or less.)
I certify that in the performance of the work for which this permit is issued I shag not
employ any person in any manner so ca b orkeri Compensation
Laws of California Dat
Applitan(
NOTICE TO APPLI , alter 'ng this Certificate of Exemption, you should
become subject to the Workers Compc 'on provisions of the Labor Code, you mast
forthwith comply with such prons or this permit shall be deemed revoked -
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. CJ
'
Lender's Name
,
Lenders Address
I certify that I have read this application and state that the above information is
cortecL I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorim representatives of this city to enter upon the
above-mcmiuned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, coats and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date +2,5/'Fa5%
SOURCE REGULATIONS.
Re -roofs r
Type of Roof
0
Signature of Applicant/ContractorContractor
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store orhandle har'ardons material
as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code. Section25532(a)?
❑ Yes
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 -
Will the applicant or future building occupant use equipment or devices whicb
emit ha7Ardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes ❑Ngl
I have mad the hazardous maLerialsrequircrtxnLs under Chapter 6.95 of the Califor-
nia Health & safety Code, Sections 25505.25533 and 25534.1 understand that if the building
does not en currtly have a nertant, that it is my responsibility to notify the occupant of the
requircmcnu which in be et pear ssuancc of a cer;ficale or Occupancy.
Signature of Applicant Date
&�a'q % r-7
All roof coverings to be Class „a„ or better
'
Owner or authorized agent Date