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15020069CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15020069 10380 PERIMETER RD cuPF,'RTINO CA 95014 (316 20 092) S B C C INC CAMPBELL, CA 95008 OWNER'S NAME: (CUPERTINO PROPERTY DEVELOP LLC) DATE ISSUED: 05/12/2016 - — - - ----_-_ OWNER'S PHONE: ( PHONE NO: ( ........ .... ------------- ---- --- _ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #336974 Contractor S B C C INC Date 03/31/2020 —BLDG — ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH — RESIDENTIAL — COMMERCIAL with Section 7000) ot'Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: HYXIT HOUSE - SITE WORK FOR FUTURE BUILDING, INCLUDING I hereby affirm under penalty of perjury one of the following two declarations: OUTSIDE LIGHTING, RETAINING WALLS & TRASH ENCLOSURES. 1, 1 have and will maintain a certificate of consent to self -insure for Worker's RFI # 194 FDC AND PIV - ISSUED 10/3/2018 Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2, 1 have and will maintain Worker's Compensation Insurance, as provided for by REV #1 - BULLETIN 2 REVISIONS TO CIVILAND UTILITY PLANS Section 3700 of the Labor Code, for the performance of the work for which this (SEE ATTACHED DETAILED LIST OF REVISIONS) - ISSUED permit is issued. 02/21/2018 APPLICANT CERTIFICATION **B** 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 Sq. Ft Floor Area: Valuation: $0.00 and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for APN Number: Occupancy Type: inspection purposes. (We) agree to save indemnify and keep harmless the 316 20 092 City of Cupertino agd''ins liabilities, judgments, costs, and expenses which may accrue aqaipst saidity in consequence of the granting of this permit. Additionally, thq'applican understands and will comply with all non -point source re ul tiops per It Cupertino Municipal Code, Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED 7 / WITHIN 180 DAYS OF PERMIT ISSUANCE OR Signatur Date 10/03/2018 180 DAYS FROM LAST CALLED INSPECTION. OWNER-HDER' DECLARATION Issued by: PAUL O'SULLIVAN I hereby affirm that I am exempt from the Conti -actor's License Law for one of the Date: 05/12/2016 following two reasons: 1 1, as owner of the property, or my employees with wages as their sole RE -ROOFS: compensation, will do the work, and the structure is not intended or offered for All roofs shall be inspected prior to any roofing material being installed, If roof is sale (Sec.7044, Business & Professions Code) installed without first obtaining an inspection, I agree to remove all new materials for 2 1, as owner of the property, am exclusively contracting with licensed inspection. contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: Signature ofApplicant: ....... 1 1 have and will maintain a Certificate of Consent to self -insure for Worker's Date: 10/03/2018 Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 2. 1 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 HAZARDOUS MATERIALS DISCLOSURE permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of' the 3. 1 certify that in the performance of the work for which this permit is issued, I California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will shall not employ any person in any manner so as to become subject to the I maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Worker's Compensation laws of'California. If, after making this certificate of Health & Safety Code, Section 25532(a) should I store or handle hazardous exemption, I become subject to the Worker's Compensation provisions of the material. Additionally, should I use equipment or devices which emit hazardous Labor Code, I must forthwith comply with such provisions or this permit shall air contaminants as defined by the Bay Area Ali- Quality Management District I be deemed revoked. will maintain compliance with the Cupertino, Municipal Code, Chapter 9.12 and the Health & Safety Co4o,,'5ecti 25505, 25533, and 25534. 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 and state laws Owner or authorized age relating to building construction, and hereby authorize representatives of this city Date: 10/0312018 to enter upon the above mentioned property for inspection purposes. (We) agree CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is issued (Sec. 3097, Civ C.) judgments, costs, and expenses which may accrue against said City in Lender's Name consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Lender's Address Code, Section 9.18. ARCHITECT'S DECLAJt4TION Signature Date 10/03/2018 1 understand my plans shall be used as public records. -,Licensed Professional .. ..... - ----- - ----- — - --__ ---------- ------ CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15020069 10380 PERIMETER RD CUPERTINO CA 95014 (316 20 092) S B C C INC CAMPBELL, CA 95008 OWNER'S NAME: (CUPERTINO PROPERTY DEVELOP LLC) I I DATE ISSUED: 05/12/2016 OWNER'S PHONE: ( 1 I PHONE NO: ( LICENSED CONTRACTOR'S DECLARATION License Class II Lic. #336974 Contractor S B C C INC Date 03/31/2018 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: 1. 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. 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 permit is issued. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. �Signature to 10/11/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. 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. 2. 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 permit is issued. 3. I 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 certificaof exemption, I become subject to the Worker's Compensation provisions ofe Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 10/11/2016 BUILDING PERMIT INFO: —BLDG —ELECT —PLUMB _ MECH _ RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: HYATT HOUSE - SITE WORK FOR FUTURE BUILDING, INCLUDING OUTSIDE LIGHTING, RETAINING WALLS TRASH ENCLOSURES Sq. Ft Floor Area: I Valuation: $0.00 APN Number: Occupancy Type: 316 20 092 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: MELISSA NAMES Date ^".arm t O 1 /1 1 (t; RE -ROOFS: 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: 10/11/2016 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Sections 25505, 25533, and 25534. Owner or authorized agen . Date: 10/11/2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. Licensed Professiona CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15020069 10380 PERIMETER RD CUPERTINO CA 95014 (316 20 092) S B C C INC CAMPBELL, CA 95008 J OWNER'S NAME: (CUPERTINO PROPERTY DEVELOP LLC) I I DATE ISSUED: 05/12/2016 OWNER'S PHONE: ( 1 I PHONE NO: ( License Class GENERAL BUILDING CONTRACTOR Lic. #336974 Contractor S B C C INC Date 03/31/2018 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: t. 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. 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 permit is issued. 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 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue agains id City in consequence of the granting of this permit. Additionally, the plitlant understaros and will comply with all non -point source regulalj6ns pef tpe CuperlOo Municipal Code, Section 9.18. Date 02/21/2018 I hereby afhXRfthat I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) z. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). BUILDING PERMIT INFO: —BLDG —ELECT —PLUMB _ MECH _ RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: HYATT HOUSE - SITE WORK FOR FUTURE BUILDING, INCLUDING OUTSIDE LIGHTING, RETAINING WALLS & TRASH ENCLOSURES. REV #1 - BULLETIN 2 REVISIONS TO CIVIL AND UTILITY PLANS (SEE ATTACHED DETAILED LIST OF REVISIONS) - ISSUED 02/21/2018 **B** Ft Floor Area: I Valuation: $0.00 APN Number: Occupancy Type: 31620 092 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: PAUL O'SULLIVAN Date: 05/12/2016 RE -ROOFS: 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 Appl Date: 02/21/2018 I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. 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 permit is issued. 3. I 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 02/21/2018 HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cu Municipal Code, Chapter 9.12 and the Health & Safety Cod , ectio s 25505, 25533, and 25534. Owner or authorized agen 18 Date: 02/21/20 ON LENDING I hereby affirm that there ikar6onstruction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCIIITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10380 PERIMETER RD CUPERTINO CA 95014 (316 20 092) OWNER'S NAME: ( OWNER'S PHONE: LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor (CUPERTINO PROPERTY DEVELOP LLC ) Date hereby affirm that I am licensed under the provisions of Chapter 9 (commencing ith Section 7000) of Division 3 of the Business & Professions Code and that my cense is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1. 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. 2. 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 permit is issued.' APPLICANT CERTIFICATION I certify that] 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 05/12/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. 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. 2. 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 permit is issued. % 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any maturer so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, ^,--, CONTRACTOR: PERMIT NO: 15020069 (CUPERTINO PROPERTY DEVELOP LLC) 19620 STEVENS CREEK BLVD STE 200 CUPERTINO CA 95014 DATE ISSUED: 05/12/2016 PHONE NO: 4083431088 BUILDING PERMIT INFO: BLDG _ELECT _PLUMB _ MECH _ RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: HYATT HOUSE - SITE WORK FOR FUTURE BUILDING, INCLUDING OUTSIDE LIGHTING, RETAINING WALLS & TRASH ENCLOSURES Sq. Ft Floor Area: Valuation: $0.00 APN Number: Occupancy Type: 316 20 092 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED` INSPECTION. Issued by: PAUL O'SULLIVAN LO5LI LU I Date: 05/12/2016 RE -ROOFS: 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 ofApplicant: Date: 05/12/2016 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9,12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent Date: 05/12/2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15020069 10380 PERIMETER RD CUPERTINO CA 95014(316 20 092) SB CC INC CAMPBELL,CA 95008 OWNER'S NAME: ( DATE ISSUED:05/12/2016 OWNER'S PHONE:( PHONE NO:(408)379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic.#336974 Contractor S B C C INC Date 03/31/2020 ^BLDG _,ELECT ,PLUMB MECH_RESIDENTIAL_COMMERCIAL I hereby affirm that lam 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. JOB DESCRIPTION: HYATT HOUSE-Sri L WORK FOR FUTURE BUILDING,INCLUDING I hereby affirm under penalty of perjury one of the following two declarations: OUTSIDE LIGHTING,RETAINING WALLS&TRASH ENCLOSURES. i. 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 RFI#319 Offsite Asphalt too high to Conform to New C&G-ISSUED '\,performance of the work for which this permit is issued, 1/28/2019 ... Section 3700 of the Labor Code,for the performance of the work for which this RFI#355 South West ADA Ramp permit is issued. RFI#364 Grades at Lobby Entrance-ISSUED 1/28/2019 APPLICANT CERTIFICATION RFI#194 FDC AND PIV-ISSUED 10/3/2018 I certify that I have read this application and state that the above REV#1 -BULLETIN 2 REVISIONS TO CIVIL AND UTILITY PLANS information is correct.I agree to comply with all city and county ordinances (SEE ATTACHED DETAILED LIST OF REVISIONS)-ISSUED and state laws relating to building construction,and hereby authorize 02/21/2018 representatives of this city to enter upon the above mentioned property for **g** inspection purposes. (We)agree to save indemnify and keep harmless the REV#2-BULLETIN#7-STORM DRAIN PIPINGPIPING-CHANGES SHEET City of Cupertino against liabilities,judgments,costs,and expenses which . P-2.0 AND P3.3;DRAINS DELETED,UPSIZED OR RELOCATED ,F' may accrue against s.'•City in consequence of the granting of this permit. Additionally,the a•,ica t understands and will comply with all non-point , SHEET P=2.ID;TRENCH DRAIN CHANGES SHEET C-5.2;CURB source regulatio Municipal Code,Section 9.18. ,REMOVED AT ADA RAMP SHEET L1.2 AND L1.3;.PLANTER DETAIL ADDED • L.6.2-ISSUED 02/14'/2019 REV#3=BULLETIN#12-GRADING REVISIONS SHEET C-4.0,C-4.1, Signature _ Date 021 4/2019 C-4.2;ADA RAMPS,POOL CABANA SHADE,METAL WALL, LIGHTING LOCATIONS,DRAINS ADDED TO NORTHEAST W s t-: 1` LI ! ; :;T 1► ' PLANTER REFER TO ALL LANDSCAPE SHEETS I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Sq.Ft Floor Area: Valuation:$0.00 1 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) APN Number: Occupancy Type: 2. I,as owner of the property,am exclusively contracting with licensed 316 20 092 contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: PERMIT EXPIRES IF W ORK IS NOT STARTED i. 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR performance of the work for which this permit is issued. 180 DAYS FROM LAST CALLED INSPECTION. 2. 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 permit is issued. ' Issued by:PAUL O'SULLIVAN 3. I certify that in the performance of the work for which this permit is.issued,I Date:05/1.2/2016. 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 RE-ROOFS: exemption,I become subject to the Worker's Compensation provisions of the All roofs shall be inspected prior to any roofing material being installed.If a roof is Labor Code,I must forthwith comply with such provisions or this permit shall installed without first obtaining an inspection,I agree to remove all new materials for be deemed revoked. inspection, APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is Signature of Applicant: correct.I agree to comply with all city and county ordinances and state laws Date:02/14/2019 relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands HAZARDOUS MATERIALS DISCLOSURE and will comply with all non-point source regulations per the Cupertino Municipal I have read the hazardous materials requirements under Chapter 6.95 of the Code,Section 9.18. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Section 25532(a)should I store or handle hazardous Signature Date 02/14/2019 material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and orized agent: Date:02/1412019 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional • ----,.........-, CONSTRUCTION PERMIT APPLICATION VCOMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE.CUPERTINO,CA 95014-3255 (408)777-3228.FAX(408)777-3333.buildincia,cLjpertino.org CUPERTINO 0 , f --4- ,---I-ta El NEW CONSTRUCTION 0 ADDITION ..:ALTERATION I TI '.'Z'i REVISION/DEFERRED ORIGINAL PERMITS 15020069 PROJECT ADDRESS 10380 Perimeter Road APN g ' . I OWNER NAME1 E-MAIL KCR Development l PH°NE 408-343-1088 dchan©kcrdevelopment.Com .._....._ STREETADDRESS (-TN,S'rATE,ZIP 19620 Stevens Creek blvd Cupertino, CA 95014 FAX CONTACT NAMEE-MAIL Dan McCarty _ P'N' 408-680-4642 dmccarty@sbci.com STREET ADDRESS CITY,STATE,ZIP 1711 Dell Ave Campbell, CA, 95008 FAX 0 OWNER 0 OWNER-BUILDER 0 OWNER AGENT X CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAME Dan McCart LICENSE, 336974 NUMBER LICENSE TYPE B BUS.LICE 5655 . , COMPANY NAME South Bay Construction E-MAIL FAX dmccarty@sbci.com STREET ADDRF.SS CITY,STATE,ZIP PHONE 1711 Ave DellCampbell, CA 95008 408-680-4642 ARCHITECT/ENGINEER NAME Randy ltaya LICENSE NUMBER BUS.LICE COMPANY NAMEE''MAIL ritaya@axisgfa,coin FAX Gene Fong Associates STREET ADDRESS CITY,STATE.ZIP '"E 1130 Westwood blvd Los Anseies CA 90024 310-209-7520 DESCRIPTION OF WORK Site Permit Revision#2 __..7 , . EXISTING USE PROPOSED USE CONSTR.TYPE It STORIES 17 SQ. . 11111111121111111 VALUATION(S.) .._ .. EX ISTG NEW FLOOR DEMO TOTAL IIIIIIIIIIIIIIIIIIIIIIII ' AREA AREA ' AREA NET AREA BATHROOM KITCHEN , OTHER lir REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKNORCH AREA GARAGE AREA al DETACII al 0 ATTACH #DWELLING UNITS: IS/LSECOND UNIT DYES SECOND STORY OYES BEING ADDED? ONO ADDITION? 0 NO 111111111111111111111111. PRE-APPLICATION DYES IF YES,PROVIDE COPY OF IS TBE BLDG AN DYES 'RHCE p BY! ., ° , e-, • TOTAL,V.ALUATION• PLANNING APDL# 0 NO PLANNING APPROVAL LETTER EICHLER.HOME? 0 NO , ' By my signature below,I certif.},to each of the following: I am the property owner or authorized a ent to act on the pc perty owner's be all. I have read this application and the information I.have provided is correct. !have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buiidina construc,Ivi authorize representatives of Cupertino to enter the above-identified property for inspection purposes. .,..-7 12-13-18 Signature of Applicant/Agent: : ,..,,,-`f--- -'2,,-'',....-* L'c'';----- Date: • — - SUPPLEMENTAL INFORMATION REQUIRED PLAN CIIE,d(TYPE' ' '' ,, .120ITEINCIP New SFD or Multifamily dwellings: Apply for demolition permit for '0 ,OVETZ411E-COtiNiEtt , ... '0,BIAI,DING PENN REVIEW' existing building(s). Demolition permit is required prior to issuance of building • :,.• • • - ',.,,,, - permit for new building. l CI EXPRESS ',', „ 0'11..it..N,XING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 STANDARD ' '- - 0 piliftic‘vottut, , _....... form if any Hazardous Materials are being used as part of this project. 0 ....., u LARGE, ,., = , FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to D,MAJOR , 0-S&NITAR.17,SEWER DISTRICI' submittal of Building Permit application. , • CNVIR0141E 0 NTAI,11,F,AI,T11 ,. . BIdgA/?p 2811.tioc revised 0612.11/I 1 , I , CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS:I CONTRACTOR: PERMIT NO: 15020069 10380 PERIMETER RD CUPERTINO CA 95014(316 20 092) SB C C INC CAMPBELL,CA 95008 OWNER'S NAME: ( DATE ISSUED:05/12/2016 OWNER'S PHONE:( PHONE Nth(408)379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#336974 Contractor S B C C INC Date 03/31/2020 _BLDG _ELECT ,PLUMB _MECH_RESIDENTIAL_COMMERCIAL 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. JOB DESCRIPTION: HYATT HOUSE-SITE WORK FOR FUTURE BUILDING,INCLUDING I hereby affirm under penalty of perjury one of the following two declarations: OUTSIDE LIGHTING,RETAINING WALLS&TRASH ENCLOSURES. i. 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 RFI'#319"Offsite Asphalt too high to Conform to New C&G-ISSUED Section 3700 of the Labor Code,for the performance of the work for which this 1-#355-South West ADA Ramp permit is issued. RF-I-#364:G%adds at Lobby Entrance-ISSUED 1/28/2019 APPLICANT CERTIFICATION RFI#194 FDC AND PIV-ISSUED 10/3/20 18 I certify that I have read this application and state that the above REV#1-BULLETIN 2 REVISIONS TO CIVIL AND UTILITY PLANS information is correct.I agree to comply with all city and county ordinances (SEE ATTACHED DETAILED LIST OF REVISIONS)-ISSUED and state laws relating to building construction,and hereby authorize 02/21/2018 representatives of this city to enter upon the above mentioned property for **B** inspection purposes. (We)agree to save indemnify and keep harmless the REV#2-BULLETIN#7-STORM DRAIN PIPING CHANGES SHEET City of Cupertino ana nst liabilities,judgments,costs,and expenses which P-2.0 AND P3.3;DRAINS DELETED,UPSIZED OR RELOCATED may accrue ag 1`st s id City in consequence of the granting of this permit. Additionally,t e applint understands and will comply with all non point SHEET P-2.1D;TRENCH DRAIN CHANGES SHEET C-5.2;CURB source PLANTER REFER TO ALL LANDSCAPE SHEETS , I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Sq.Ft Floor Area: Valuation:$0.00 1. 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) APN Number: Occupancy Type: z. I,as owner of the property,am exclusively contracting with licensed 316 20 092 contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: PERMIT EXPIRES IF WORK IS NOT STARTED 1. I have and will maintain a Certificate of Consent toself-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the WITHIN 180 DAYS OF PERMIT ISSUANCE OR performance of the work for which this permit is issued. 180 DAYS FROM LAST CALLED INSPECTION. 2. 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 permit is issued. Issued by:PAUL O'SULLIVAN 3. I certify that in the performance of the work for which this permit is issued,I. Date:05/12/2016 shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of Califomia. If,after making this certificate of RE-ROOFS. exemption,I become subject to the Worker's Compensation provisions of the All roofs shall be inspected prior to any roofing material being installed.If a roof is Labor Code,I must forthwith comply with such provisions or this permit shall installed without first obtaining an inspection,I agree to remove all new materials for be deemed revoked. inspection. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is Signature of Applicant: correct.I agree to comply with all city and county ordinances and state laws Date:01/28/2019 relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands HAZARDOUS MATERIALS DISCLOSURE and will comply with all non-point source regulations per the Cupertino Municipal I have read the hazardous materials requirements under Chapter 6.95 of the Code,Section 9.18. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Section 25532(a)should I store or handle hazardous Signature Date 01/28/2019 material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality'Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Cod•, ectio s 25505,25533,and 25534. Owner n: or authorized age r 01/28/2019 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO 99M FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10380 PERIMETER RD RD FEE DATE: 02/11/2015 REVIEWED BY: MELISSA ' APN: 316 20 092 BP#: $0.00 *VALUATION: Iso PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement - PRIMARY Commercial Building USE: hrs $0.00 PENTAMATION PERMIT TYPE: 1GENCOM WORK HYATT'HOUSE - SITE WORK FOR EXTERIOR LIGHTING, TRASH ENCLOSURES & RETAINING. SCOPE WALLS Permit Fee: Hourly Only? 0 Yes Q No i'bi£;£;r2 Pt£ 3: N?wb, /'shirt C/,,ock Fix:..f hoi. other v.h;c,h. Irzy'. C�'t'aa? I'xri �ai> Ie;ir3, tlt wr 7;i imp" iifEtck fnsp. F,tV t 'rr,r i. Ir a £ r L„c:.. tts Fee: NOTE. This estimate does not include fees due to'other Departments (Le. Planning. Public Works, Fire, Sanitary Sewer District, School )istrict, etc.). These fees are based on the Preliminar information available and are only an estimate. Contact the Det for addn'l info. FEE ITEMS (Fee Resolution 11-033 E . ZIZ13, FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (E) No $0.00 10 hours $1,430.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: (D Reg. 0 OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee.0 Reg. Q OT Q,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (.-,onst lcfi n : ni£x. iniSGI'�5.4£tive .2.-' e 0 G Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) 0 y yy �nef{��-I.�/{�c�.��fn�:.idL �Ri ion l Strong Motion Fee: $0.00 = hrs $1,430.00 Inspections 1STINSP Inspection, Hourly Bldg Stds Commission Fee: $0.00 3sI�BTOTaIS �... r_.. $0.00 $2,860.00 y k TOT,ALFEE ` �. $2,860.00 Revised: 01/06/2015