06090044 - TICY OF CUPIERTI
BUILDING DIVISION
BUILDING ADDRESS:
PERMIT NO.
20955 STEVENS CREEK BLVD WHOLE FOODS MARKET 06090044
OWNER'S NAME: PERMIT ISSUE DATE
WHOLE FOODS MARKET
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
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I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
ith Section 70(M of Division 3 of the Business and Professions Code, and my license is
i full force and elf, vu�
icensc C1 l.ic. p
art V 0 Contractor I��I�W
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
icerrsed. Prufcssional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for the
allowing mason. (Section 7031.5, Business and Professions Code: Any city or county
rhich requires a permit to construct, alter, improve, demolish, or repair any situctum
rior to its issuance, also requires the applicant for such permit to file a signed statement
hat he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
commencing with Section 7000) of Division 3 of the Business and Professions Code) or
hat he is exempt therefrom and the basis for the alleged exemption. Any violation of
lection 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
iot more than rive hundred dollars (S500).
1, as owner of the property, or my employees with wages as their sole eompensa0cxe,
vill do the work and the structure is not intended or offered forsak (Sec.7044, Business
utd Professions Code: The Contractors License Law does not apply to an owner of
)roperty who builds or improves thereon, and who does such work himself or through his
rwn employees, provided that such improvements are not intended or offered for sale. If.
towever, the building or improvement is sold within one year of completion, the owner -
milder will have the burden of proving that he did not build or improve for purpose of
tale.).
—1 1, as owner of the property, am exclusively contracting with licensed contractors to
:onstruct the project (Sec. 7044, Business and Professions Code:) The Contractors Li -
:ease 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 See . B & P C for this moon
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintaina Centificate of Consent to self -insure for WorkersCompcn-
sation, as provided for by Section 3100 of the Labor Code, for the performance of the
work for which this permit is issued
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
3100 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation I�nsurancee carrier and Policy number are:
Cartier. L /� � A3IY Gt CN Policy No.: /I/ C V 36I b %
CERTIFfCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foranc hundred dollars (3100)
or less.)
1 certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manncrso as to became 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 Cade. you must
forthwith comply with such provisions 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 (See. 3097. Civ. C.)
Lender's Name .
Lender's Address
I certify that I have read this application and state that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws relating to
building construction. and hereby authorim rep resenstives of this city to enterupon the
above -mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accmc against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANI)S AND WILL COMPLY WITH ALL NON -POINT
of
Date
HAZARDOUS MATERIALS DISCLOSURE
WIII the applicant or future building occupantstoro or handle hazardous material
as defined by the Cupertino Municipal Code- Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes O 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?
0 Yes C5 N
1 have read the bazardous materials requirements under Chapter 6.95 of the Califon
nia Health & Safety Code, Sections 25505, 25533 and 25534. I understand that if the building
does not cuqently have a tenant that it is my rc nsihility to notify the occupant of the
rcyuircryC9tE which_mu toet prior to iss Of. Ccni(catc of Occupancy.
Job Description
TI-GROCERY STORE IN AN (E)SHELL BUILDING
INCLUDES: MECHANICAL,ELECTRICAL,PLUMBING, ETC.
vi
SEE TEMPORARY PERMIT #07020027 FOR SOME OF THE
Sq. Ft. Floor Area
32631020 . MN
Issued by:
Re -roofs
Type of Roof
$5500000
Required Inspections
Valuation
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
Ali roof coverings to be Class "B" or better
rlwnrr nr a,oh.,i> d anent
Date