B-2018-0567 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0567
20955 STEVENS CREEK BLVD CUPERTINO,CA 95014-2107(326 31 022) KEW ENTERPRISES
WEST SACRAMENTO,
CA 95605
OWNER'S NAME: DATE ISSUED:08/20/2018
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#595999 X_BLDG_ELECT_PLUMB
Contractor KRW ENTERPRISES Date 06/30/2018
I herebyI'Brm that I am licensed under the provisions at'Chatter 9 —MECH_RESIDENTIAL X COMMERCIAL
a p a I (commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
WHOLE FOODS-11.-CHECK-STAND/CUSTOMER SERVICE/MEAT
I hereby affirm under penalty of perjury one of the following two declarations: LINE UP/PREPARED FOODS AREAS(1600 SF).
n. I have olid will maintains 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 far which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performanewof the work for which this
II is issued. Sq.Ft Floor Area: Valuation:$375000.00
APPLICANT CERTIFICATION
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 32631 022 A(Tenant Improvements),M(Tenant Improvements)
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,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City In consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature _ Date 08/20/2018 Issued by:Jasmine Archbold
Date:08/20/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed,If a roef is
t. 1,as owner of the property,or my employees with wages as their sale installed without first obtaining an inspection,l agree to remove all new materials for
compensation,will do die work,and th—tructure is not intended or offered for inspection.
sale(Sce.7044,Business&Professions Code)
z. f as owner of the property,am exclusively contracting with licensed Signature ofApplicnmt:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:08/20/2018
1 hereby affirm under penalty of perjury one of the following three declarations: ALL 1200E COVERINGS TO BE CLASS"A"OR BETTER
t. l 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 ofthe work for which this permit is issued, HAZARDOUS MATERIALS DISCLOSURE
z. 1 have and will maintain Worker's Compensation insurance,as provided faby I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9,12 and the
a. I certify that in the perrormenea of the work for which this permit is issued,I health&Safety Cade,Section 25532(x)should 1 store or handle hazardous
shall nat employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws ofC.lifanin.If,after making this certificnte of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I became subject to the Worker's Compensation provisions ofthe the Health&Safety
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec,3097,Civ C.)
to enter upon the above mentioned property for Inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
Judgments,costs,and expenses which may accrue against said City In Lender's Address
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARIshe DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 08/20!2018 Licensed
Professional