10010162 CITY OF
CUPERTINO BUILDING PERMIT
PERMIT NO:10010162
CONTRACTOR:COURTYARD BY
BUILDING ADDRESS: 10605 N WOLFE RD MARRIOTT
DATE ISSUED:01/28/2010
r''-'BIER'S NAME: COURTYARD BY MARRIOTT 10605 N W OLFE RD PHONE NO:
CUPERTINO,CA 95014
o vv NER'S PHONE: 4082529100
• BLDG ELECT r PLUMB
rhereby
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO.
ass Lic.#
MECH RESIDENTIAL COMMERCIAL
Date B DESCRIPTION:PATCH UP FIREWALL IN ATTIC&REPAIR SHEETROCK&
r JO
affirm that I am licensed f Division3 of the Busness&under the provisions of tProfessions
RMV DUCT
00)
cing withlSC nsens on full force and effect.
that my
I hereby affirm under penalty of perjury one of the following
for two deeclarations:
I have and will maintain a certificate of consent to self-insure
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Valuation:$100rovided for by Sq.Ft Floor Area:
I have and will maintain Worker's oCompensation
erformance of theInsurance,
work for which this
Section 3700 of the Labor Code,f p Occupancy Type:
permit is issued. APN Number:31647019.00
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is NOT STARTED
correct.I agree to comply with all city and county ordinances ves ofthistc city t lawsrelating
pERn/jIT EXPIRES IF WORK IS
to building construction,and hereby authorize represent agree to save
inspection purposes. (we)ag IN 180 DAYS OF PERMIT ISSUANCE O
upon the above mentioned property forP WITH
and keep harmless the City of Cupertino against liabilities,judgments,
of tmhets, YS FROM LAST CALLED INSPECTION.
indemnify P 1$0 DA
costs,and expenses which may accrue against said unde understands and will comply -4
f this permit. Additionally,the app de Section Date:��
granting o P �---�
with all non-point urce LL2.s per trtino Municipal o ,
Issued b '
9.18.
! l 2 —z o/
Date
S---mature
RE-ROOFS:
of
OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material emove all nlew matenalsifor
from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to
I hereby affirm that I am exempt f inspection.
the following two reasons: Date:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETT
1,as owner of the property,am E
construct the project(Sec.7044,Business&Professions Code). IALS DISCLOSURE
HAZARDOUS MATER
I hereby affirm under penalty of perjury one of the following three hazardous in requirements under Chapter 6.95 of the
declarations: Code,Sections 25505,25533,and 25534. I will maintain
I have and
will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Chapter 9.12 and the Health&
provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code, P
Compensation,asp should I store or handle hazardous material.
Safety Code,Section 25532(a)
performance of the work for which this permit is issued. provided for by Additionally,should I use equipment or devices which emit hazardous air
I have and will maintain Worker's Compensation Insu fanticie�w rk for which this ode Chapter Dist and the
contaminants as defined by the Bay Area Air Quality Management District I will
c P
Section 3700 of the Labor Code,for the performance o maintain compliance with the Cupertino Mun►c►pal C
permit is issued. which this permit is issued,I shall Health&Safety Code,Secti s 25505,25533,and 25534.
I certify that in the performance of the work for
manner so as to become subject to the Worker's Ow
r aut orized gen 1
not employ any person in any _ Date: "-
Compensation laws of California. If,after making this certificate of exemption,I j
me subject to the Worker's Compensation provisions of the Labor Code,I m
becoJ �st
forthwith comply
with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
herebyaffirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION I
for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information a Lender's Name
with all city and county ordinances and state laws relating
correct.I agree to comply Lender's Address
to building construction,and hereby authorize representatives of this city to enter
for inspection purposes.(We)agree to save
the above mentioned property P ud
.inify and keep harmless the City of Cupertino against liabilities,judgments,f the ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said understands and will ity in consequence�omply be used as public records.
granting of this permit.Additionally,the applicant plans shall
on- oin source regulations per?the Cupertino Municipal Code,Section I understand my
with all n p
9.18. t`; ` Licensed Professional
�f Date—1
ignature �'
CITY OF CUPERTINO
ERMIT RECEIPT OPERATOR: Patg
3 ITEMS OF 3
P COPY # � 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31647019.00
DATE ISSUED. • • • • " 01/28/2010BS000009636
RECEIPT # . " ' 10010162
REFERENCE ID # • • •
SITE ADDRESS 10605 N WOLFE RD
SUBDIVISION : : : : : : : CUPERTINO
CITY . •
IMPACT AREA . . . . . . •
ER COURTYARD BY MARRIOTT
OWN ; 10605 N WOLFE R
ADDRESS • • • • • • . . . . CUPERTINO, CA 95014
CITY/STATE/ZIP . • • :
RECEIVED FROM . . . . : JULIO T CORRAL
LIC # *OWNER*
CONTRACTOR • " ' COURTYARD BY MARRIOTT
COMPANY • " " " 10605 N WOLFE RD
ADDRESS • • • • • • . . . CUPERTINO, CA 95014
CITY/STATE/ZIP . • •
TELEPHONE . . . . . . . . •
THIS REC NEW BAL
AMOUNT PD-TO-DT __
UNIT QUANTITY ------ ---------- ---------
FEE ID -------- ---------- ---- 1 . 00
___ _ ------- ----- -- 1. 00 0 .00 0 . 00
VALUATION 100 .00 0 .00 0 .63
1BCBSC 100 . 00 0 . 63 506 .00 0 . 00
1BSEISMICO VALUATION 506 . 00 0 -- -- ---_____-_
1 . 00 __ --------
JINSPCRT HOURS ---------- ----- 507 . 63 0 . 00
507 . 63 0 . 00
TOTAL PERMIT
AMOUNT REFERENCE NUMBER
METHOD OF PAYMENT _______________ --------------------
___ _ __
----------------- 507 . 63 VISA
CREDIT CARD _______________
TOTAL RECEIPT :
507 . 63
c) C)
CITY OF
CUPERTINO
CITY OF BUILDING
CU PE TINO GENERAL
PERMIT APPLICATION FORM
Date:
APN# , w� � 2 -- rte
Building Address:
10 ( �
Mailing Address (if different from building address):
• used as art of this project? Yes No,E .
Are Hazardous Materials being P
work only) Yes ❑ No If es,provide letter from HOA
HOA: (Exterior Phone#:
Owner's Name: tX V V,1
Phone:
Contracto
j
Fax:
Contractor License#:
Cupertino Business License#: Phone: �T e ' �
Contact: Fax:
0111,!C�L 1
Residential Commercial
Job Description: _ j6r�r -5 ray.k
-Ike- 4 -c q,/Ij
0 ff _
remove- d
Building Permit Info:
Plumb ❑ Mech ❑
Bldg C�"� Elect ❑ Occu ancy Type:
Type of Construction(Usage Class). p
YP
1-A, 1-B ❑ II/III/V-A Square Footage:
II/III B, IV-HT,V-B ❑
Valuation: 1451d
❑ Major
tadard
ProJect Size: x press n ❑
portion
of the Green Building/LEED Checklist & attach it
Green Building: Please complete relevant po• elude in plan set& the sheet index.
to the application or if applicable, in P
Points Achieved:
For hel , contact Build it Green at www.buildit reen.or
p.
Revised 07/14/09
i
r 4 CITY OF CUPERTINO
TY GENE RAL BUILDING APPLICATION
CUPEf�TINO
FEE SCHEDULE
• ID Fee Description Fee Permit Type
Quantity/Sf Fee Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 s fl B
additional stucco application
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1WINMEWSTR New Window-structural shear B
wall/masonry(includes plan ck fee)
l EPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1 PPERM
ITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1MECPLN
CK Stand Alone Mechanical Pln Ck(hrly) M
1 PLMB
LNCK Stand Alone Plumbing Pln Ck(hrly) P
1 STPLN
CK- 3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter hourly-stand alone
Cal Bldg Standards Commission Fee B ALL PERMIT
1
SC TYPES
1BSEISMICR Seismic Residential B
1
BSEISMICO Seismic Commercial B
1 TRAVDOC Travel &Documentation B
1 BUSLIC Business License B
5 of 5
M.Indoor Air Quality and Fmr,shes p
1, tah
oo"*-V{ � 1 IAQ/Health pts y=yes U900
21AOJHeay—y
lth pts eS
2.Use Low VOC,Water-Based Wood Finishes p= es
31AQ/Health pis YY
3.Use Lew�� N0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes
5.Use Engineered Sheet Goods with no added Urea 0
Formaldehyde 61A(yHealth pts y=yeS 0
1 IAQ/Health pts y=yes
6.Use Exterior Grade Plywood for Interior Uses 4 IAQ/Health.pts y=yes 0
Seed t 0
Use FSC Certified Materials for Interior Finish 4 Resource pts y=yesis es p
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource p Y=Y 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes
N.Flooring p
8 Resource pts y=yes
1.Select FSC Certified Wood Flooring 4 Resource pts y—yeS 0
2.Use Rapi*Renewable flooring Materials 0
4 Resource pts y=yeS 0
3.Use Recycled Content Ceramic Tiles 5 IAQ/Health pts y=yes
4.Install Natural Linoleum in Place of Vinyl 0
4 Resource pts y=yes
5.Use Exposed Concrete as Finished Floor 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes
• le: 140 130 57
Total Points Availab
0
Total Points Project Received:
p 0
1 — 1 L, 2 0
G:datalprogs/greenbuiidingguidelines/remodelers/greenpc intsfina12.12.04protected.xis
owN
ER-BUILDER VERIFICATION
immediate family (parent,spouse or child) will perform:
1, (Check one) I or my i� y
A. All the work authorized by this permit
—
B A portion of the work
C None of the work
If B or C is checked,com Tete 2 or 3 below.
2.
A state licensed contractor will be hired to do:
A. _ All of the work
A portion of the work (complete section below)
B. p
Phone # State License # Type of work to
Contractor Address/City be erformed
. other than m immediate family to perform all or
3.
I will utilize unlicensed person(s) o y to an employer (see reverse side). A
e authorized work. I understand that I may be pile at the Ci of
portions of the workers' compensation must be on f City
Certificate of Insurance covering
Cupertino Building Department office.
• Number Type of work to be
Person/Firm
Address/City Phone erf ormed
...........................................................
e under enalty of perjury that the above s true
and correct.'I have read and understand the
I declar p i
Owner-Builder Information(reverse ide). o / 0
'�a
!r
Property Owner's Signature: Date:f
� 6
Permit#1
Job Address:
be submitted to the Ci of Cupertino Build
An chan es to the information rovided on this form shall
Department.