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15050106 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10741 N WOLFE RD CONTRACTOR:THERMA CORP PERMIT NO: 15050106 OWNER'S NAME: QUITO HOSPITALITY ASSCS LLC ETAL 1601 LAS PLUMAS AVE DATE ISSUED:05/19/2015 OWNER'S PHONE: 4088612555 SAN JOSE,CA 95133 PHONE NO:(408)347-3400 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E] HILTON GARDEN INN-MODIFY(E)2-PIPE FAN COIL LicenseClljgJu0,27-0�� .# 2-76&!f 8 SYSTEM SERVED BY (E)CHILLER/BOILER THAT SERVE t � erm � Date Jr /S A Contractor COMMON DISTRIBUTION MAIN(CHW/HHW MAIN) I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I 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 of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$700000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for die performance of the work for which this APN Number:31645015 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued b Date: granting of this ermit. Additionally,the applicant understands and will comply Y' with all non-p t source regulations per the Cupertino Municipal Code,Section 9 18. RE-ROOFS: Signature Date G f 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as,defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance wit Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S cti ns 25 05, ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this 4 (j permit is issued. Owner or authorized agen —Date: 1 certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9 18. Signature Date GENERAL PERMIT APPLICATION h�6 MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIONrctc " 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 6 b misc CUPERTINO (408)777-3228• FAX(408)777-3333•buildinauueltino.orq PLUMBING RIVIECHANICAL NELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 1 007 4 �T APN N OWNER NAME tJ-1 'Nj� n„�,,L p C.UCI, P q �-1 ck n V�k\ k)Obdam- E-MAIL LI 1:�bcc'-r�.- - C( - STREET -STREET ADDRF..SS I © W c7'�. CITYg 42kTE,ZIP -7 ^ t� FAX CONTACT NAM PHON l�1 E-N AIL STREET ADDRESS TY,STAT ZI FAX 1 t P l Urn - j p, ti3�T°5 i9 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT [�❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRAC OR NAME \ 1^1 �� LIf:ENSE NUMBER LICENSE TYPE.Q�C j BUS.LIC N j 9 l7�I J 1�J�_ '��� 2 U�D /C� y�j (! I veO�v COMPANY NAMF, FAS q_7, :�q STREET ADDRESS I%_ if • `v^\` J CJ�Y,STATE ZIPS � 9 �r 1 PHONE (-)e_ 00 ARCHITECTIENGINEERDNAME rl. LICENSE NUMBER s BUS.LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS., CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YEs BUILDING: OMMERCIAL URBAN INTERFACE AREA O FLOOD ZONE O EICHLER HOME? NO DESCRIPTION OF WORK ' r�vyCkQIr\,Q- J V\pin v r\ ro6 mac) cA nem ,-flLIQ-i- c U 1C2. o S4e S c--- S a t�. rv-,w C u�CLC IJ T'O'TAL-VALUATION: ^1RECENEDBY- r By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I hav provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t uildin�cons ction, I a representatives of Cupertino to enter the above-i entified property for inspection purposes. Signature of Applicant/Agent: Date: 1 SUPPLEMENTAL FORMATION REQUIRED '` b�twrGEvsbNty � J4 Wr F VER THE-COUNTER u 0,EXPR!~rS5 t 4n y LAIkGE r ti'Irwf' "�z"«r 4,y 3 -rr g x tA4 A1EPX1ise,4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10741 N WOLFE RD DATE: 05/19/2015 REVIEWED BY: MELISSA APN: 316 45 015 BP#: 'VALUATION: 1$700,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 GENRE WORK HILTON GARDEN INN - MODIFY E 2-PIPE FAN COIL SYSTEM SERVED BYE CHILLER/BOILER SCOPE THAT SERVE A COMMON DISTRIBUTION MAIN (CHW/HHW MAIN) - .�¢rA1� xR uyh¢g;Ra125" �f 1�i- 'tiu _i' n"k''h16 Y4VAy1 7y „ild *eF `t'� � r,}e efhy7"R $a r�Fr}Ypi:a i 'til! y S' Rw "5 t'' Mech.Plan Check "00 $0.00 :P?rrr,tt3. ?'/4,;,t'htrcF Elec.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: 1MPERMIT Phenrh, Pcrn,il I»'G-c:: Elec.Permit.Fee: IEPERMIT Other Mech.Insp. 0.0 hrs $48.00 Ojher 1'?ares . LJ I Other Elea Insp. 0.0 hrs $48.00 11"b./„sp- Phwil" h1q). Fee: tiler.b4Sp. NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff.' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Yes Q No $0.00 1 hours Plan Check,Hourly Suppl..PC Fee: (F) Reg. 0 OT 0.0 1 hrs $0.00 $143.00 ISTPLNCK PME Plan Check: $0.00 1 # Mechanical Permit Fee: Hourly Only? Q Yes Q No $0.00 $72.00 1 IBAPPLOT Other Appliance/Equip Suppl. Insp. Fee.-(j) Reg. Q OT0 0 hrs $0.00 0 Electrical PME Unit Fee: $0.00 $179.00 /BREMPOWER Other Power Devices PME Permit Fee: $96.00 C'r n.7rir. lima 0A.- _T_T Administrative Fee: (ADMIN $45.00 O Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning.Fee: $0.00 Select a Non-Residential E) or Structure Travel Documentation Fee: ITRA VDOC $48.00 Building � Strong Motion Fee: IBSEISMICR $91.00 2.0 hrs Inspections Bld.9 Stds Commission Fee: IBCBSC $28-001 $286.00 ISTINSP Inspection,Hourly y1b;��,.'pya SUBTOTALS $308.00 $680.00 �" !' 1 �' TOAL`FE� $988.00 .7� y.v.rs•c a' Revised: 05/07/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10658 LA RODA DR CONTRACTOR:HIGHLIGHT SOLAR PERMIT NO: 15050108 OWNER'S NAME: STEIN R TIMOTHY AND VISHAKHA M 3554 PARKLAND AVE DATE ISSUED:05/19/2015 OWNER'S PHONE: 4087687538 SAN JOSE,CA 95117 PHONE NO:(408)489-9273 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL F]�y INSTALL 19 ROOF TOP,FLUSH MOUNTED PV MODULES License Class C Lic.# 1(_p (4.845KW) Contractor Date U J�141 1 hereby affirrivinat I am licensed under the provisions of Chapter 9 (commencing;with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. hereby affirm under penalty of perjury one of the following two declarations: I 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 of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$18600 C I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36933014 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAY ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS VI ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the S� granting of this permit. Additionally,the applicant understands and will comp) ed e• with all non-point source regulations per the Cupertino Municipal Code, t 9 18. RE-ROOFS: Signature DateC� I Z— All roofs shall be inspec a 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 255 ,25533,a d 25534. Section 3700 of the Labor Code,for the performance of the work for which this 5 Owner or authorized agent: Date: " permit is issued. I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Leader's Address I certify that 1 have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply wick all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9 18. Signature Date ALTERNATIVE ENERGY PERMIT APPLICATION is COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 AE CUPERTINO (408)777-3228• FAX(408)777-3333•building(cDcupertino.org �O PROJECT ADDRESS 1 APN N � i 3 3 i G 1 OWNERNAMEPHONE -M IL _[; � cv dl C t,. .Cn STREET ADDRESS I CITY, STATE,ZIPL� FAX C CONTACT NAME PHONE / E-MAIL 11A qo%_ - ` ;�-4 >� �L e 'ole t� c..�,, STREET ADDRESS 0 CITY,STATE_, ZIP FAX S ` U ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC N l.c, jl I i✓ FAX COMPANY NAME � � E-MAIL 0, i"+ I STREET ADDRESS CITY,STATE,ZIP PHONE L<t, l�_ ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ No u/SOLAR PANELS 1:1 ELECTRIC VEHICLE CHARGING STATION 1-1SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY):�� O(-i L, TOTAL VALUATION J U DESCRIPTION OF WORK .h ci By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pr er's behal haver is application and the information I have provided is correct. I have read the Description of Work and verify it is ac . agree to co with pplicable local ordinances and state laws relating to build' construe ion. I authorize representatives of Cupertino to enter the a ove-identified pr a nspection purposes. Signature of Applicant/Agent: Date: D ci2 io) S LEMENTAL INFORMATION REQUIRED �1i r Ttd � IS�4, �uNrJ1 "4'V�j Rat+a Ni "��ii�4��rr� >�S��yag•4�Iw �r a� i k' sal irlrT 1di��pam2�.xs.� �,"r s +abs �Yk Q J,vt�r�u?.�.�.������M!►JOI�I����y� .��1�4���rathli.' x-t,r, PVApp2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10658 LA RODA DR DATE: 05/19/2015 REVIEWED BY: MELISSA APN: 369 33 014 BP#: ''VALUATION: 1$18,600 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: SOLAR-RE i WORK I INSTALL 19 ROOF TOP FLUSH MOUNTED PV MODULES 4.845k SCOPE l� "21,051", x}", �" "(t . Ru uy�F el,.,.p1 ,r�� a �fi? r.� ,�.!7 9a +�.iid-it,�r1^t�✓P W��'tf� 1 � q;a� k cd� ; H hMt.�t a4 "i;r L ask ah � al n - U u<$..»;fir. �"_�,"i rliech. 11"o,C`hrxk Pbunh. I'hw(:'heed; I'Je, i'Ian(:'heat .1>irh. 11p7b. Pvrrrril I've T h c. P amir T e : (.)rh�w �1lt:c'ir. Tivsi;. llrher T'`iarnnb 7risn. ofh(,r 1:Jer..Insp. ,,r/ech. h2q). 1;,ee.: l'hun(,r, Insp. Fee. Z"'Icc.Insp,I hts: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS(Fee Resolution 11-053 Uf. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # Alternative Energy System Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $236.00 IPHOTOVRES Photovoltaic System PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 f.,of?:S1 Fl,ICll!1r9 :I'c'x: Ic/rr�ini.�lrrrt.rv� FCC: 0 Work Without Permit? Yes (j) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential 0 T'ra cel Doc ulnewaciorl Fees: Building or Structure 0 i Strong Motion Fee: IBSEISMICR $2.42 Select an Administrative Item ,Bldg Stds Commission.Fee: IBCBSC $1.00 � g y.,(lad tl�41 j,'sx�"=' r`� '+v 'S:� r, St7BT0�`ALS' $3.42 $236.002 " a �TOT��.FEE 4 $239.42 S2rt `��s. Revised: 05/07/2015