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08040184oc Z OO rep UU Z as im f� s� ma aO 0 a Icy '=a Fc CITY OF CUPERTINO BUILDING DIVISION PERNUT r Comer no IWi 5 BUILD N DDRESS: PERMrr NO. ���55 STEVENS CREEK BLVD AQUAMATIC FIRE PROTECTION 08040184 OWNER'S NAME: PERMIT ISSUE DATE WHOLE FOODS INC 540 GARCIA AVE #A 05/13/2008 PHONE: SANITARY NO. CONTROL NO. (925)753-0420 ARCHI7ECr/ENGINEER: BUILDING PERMrriNFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Chapter Job Description 1 hereby affirm that 1 am licensed under provisions of 9 (commencing with Section 7000) ol"Division 3 ofthc Business and Professions Code, and my license i3 REVISION -INSTALL NEW DELUGE SYSTEM 12 HEADS ORIG in full force and effecy License Class I Lie. a 570 PERMIT # 0 6 0 9 0 0 4 4, Data Contractor .EM U46me— ARCHITEC" DECLARATION 1 understand my plans shall be used as public records Licensed Professional . OWNER -BUILDER DECLARATION I hereby alTirm that I am exempt from the Contractor's License Law for the 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 prior to its issuance, also requires the applicant for such permit to file a signed statement the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of $ 5 7 5 0 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of 32619020 Number ATO' Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500). ❑ L as owner of the pmpetty, or my employers with wages as their sole compensation, Required Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thermn, and who does such wort himself or through 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.). ❑ L as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such pmjecs with a contractor(s) licensed pursuant to the Contractors License law. ' .[II am exempt under Sec , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the wort 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 Worker's C ;e{,g�ati5on Insurance carrier and Policy number are: Cartier. 5t/ •,4" Policy No.: '?- CERTIFICATE OF EXEMPTION FROM WORT: S' COMPENSATION INSURANCE (nis section need Trot be completed if the permit is forone hundred dollars ($I00) . or less) 1 certify that in the performance of the work for which this permit is issued, 1 shall not employany 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 Worker's Compensation provisions of the Labor Code, you most 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 (Sec. 3097, Civ. Q ' Lenders Name Lenders Address 1 certify that I have read this application and state that the above information is corecL 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorise representatives of this city to enter upon the ahove-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 arty way accrue against said City in consequence of the gandng of this permit APP CAM UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date S R CATION �Z/_,5A Cl Re -roofs Type of Roof Signature ofAppli Contracto Date, HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Muni 'pal Code, Chapter 9.12. and the Health and Safcty Code, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes E] No 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 which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? / C:] Yes `a No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505. 25533 and 25534.1 understand that if the building does not currently have a tenant. that it is my responsibility to notify the occupant of the 'mqpWcms V#9 must be met prior to issuance of a Certificate of Oc pan Signature of Applicant Date /� All roof coverings to be Class'n" or better Date Owner or authorized a cot '