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13120156CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 13120156 19429 STEVENS CREEK BLVD (316 20 115) S B C C INC CAMPBELL, CA 95008 OWNER'S NAME: ( MAIN STREET CUPERTINO AGGREGATOR LLC) DATE ISSUED: 07/17/2015 OWNER'S PHONE: 650-344-1500 PHONE NO: (408) 379-5500 1 -lCENSFD CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 13 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. z. 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 k permit is issued. X 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 said City in consequence of the granting of this permit. Additionally, the ap scant understands and will comply with all non -point source regplations p4L the Cupertino Municipal Code, Section 9.18. Date 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) z. 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. 1 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. 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 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, Sec io 9.18. Signatur Date BLDG —ELECT —PLUMB MECH _ RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: MARRIOT-(RESIDENCE INN) CONSTRUCT SUPERSTRUCTURE (5) STORY HOTEL, 142,487 SQ FT TO INCLUDE 180 GUESTROOMS 8-23-17- RFI (417) - GENERATOR INSTALL/SEISMIC ANCHORING -ISSUED 8/30/2017 06-2-17- RFI (381) - RETAINING WALL BETWEEN RETAIL 1 AND MARRIOTT - ISSUED 6/22/2017 REV #2 - CHANGES TO INTERIOR & EXTERIOR ELEMENTS, INCLUDING ELEVATOR SHAFT - ISSUED 4/10/17 DEF #3 - CERTAIN WALLS, TOWERS 1,2 & 3 - ISSUED 1/9/17 DEF #2 - STAIRS 1, 2, AND 3 - ISSUED 12/2/16 DEF # 1 - STRUCTURAL DETAILS, METAL STUDS IN EXTERIOR/INTERIOR WALLS & FRAMING MEMBERS - ISSUED 4/5/16 REV # 1 - RFI'S ""FRONT COUNTER - A Sq. Ft Floor Area: Valuation: $16500000.00 APN Number: Occupancy Type: 316 20 115 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ABBY AYENDE Date: 07/17/2015 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining inspection, I agree to remove new in erials for inspection. Signature of Applicant: Date: ALL ROOF COVERIN 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: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance CCUPERTINO I I wrc 11-w10�Dr CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 950143255 (408) 777-3228 •FAX (408) 777-3333 • building ( a)cupertino.org CAT M AnnrTlnN F� AITPRATInN/Tl RPlI FVt.CIO /DFFFRRFD ORIGINALPERMIT# 13120156 PROJECT ADDRESS 19429 Stevens Creek Blvd, Cupertino, CA _t� -7 OWNERNAME Sand Hill Const Management PHONE E-MAIL nkumar@Shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX CONTACT NAME Nandy Kumar PHONE 650.344.1500 E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX IXOWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Bob Blaska LICENSE NUMBER 336974 LICENSE TYPE B BUS. LIC # 5655 COMPANY NAME South Bay Construction E-MAIL bblaska@sbci.com FAX STREET ADDRESS 1711 Dell Ave CITY, STATE, ZIP Campbell, CA 95008 PHONE 408.621.5228 ARCHITECT/ENGINEERNAME Ninad Chaukkar LICENSE NUMBER BUS. LIC# COMPANY NAME ARCHITECTS ORANGE E-MAIL NinadC@Architectsorange.com FAX STREET ADDRESS 144 North Orange Street CITY, STATE, ZIP Orange, CA 92866 PHONE 714.639.9860 DESCRIPTION OF WORK F YZ EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH LJ ATTACH # DWELLING UMTS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑ NO ADD ION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ N By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on roperty owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local authorizerepresentatives of Cupertino to enter the a�j��t ordinances and state laws relating to9!_!� property for inspection purposes.Signature ofApplicant/Agent: Date' 01-z �� SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER -THF COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT -_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR 11 SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 Ldoc revised 06/21/11 f V1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 13120156 19429 STEVENS CREEK BLVD (316 20 115) S B C C INC CAMPBELL, CA 95008 OWNER'S NAME: ( MAIN STREET CUPERTINO AGGREGATOR LLC) DATE ISSUED: 07/17/2015 OWNER'S PHONE: 650-344-1500 PHONE NO: (408) 379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 1i Lic. #336974 Contractor S B C C INC Date 03/31/2018 —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: MARRIOT- CONSTRUCT SUPERSTRUCTURE (5) STORY HOTEL, I hereby affirm under penalty of perjury one of the following two declarations: 142,487 SQ FT TO INCLUDE 180 GUESTROOMS 1. I have and will maintain a certificate of consent to self -insure for Worker's REV #2 - CHANGES TO INTERIOR & EXTERIOR ELEMENTS, Compensation, as provided for by Section 3700 of the Labor Code, for the INCLUDING ELEVATOR SHAFT - ISSUED 4/10/17 performance of the work for which this permit is issued. DEF #3 - CERTAIN WALLS, TOWERS 1,2 & 3 - ISSUED 1/9/17 2. I have and will maintain Worker's Compensation Insurance, as provided for by DEF #2 - STAIRS 1, 2, AND 3 - ISSUED 12/2/16 Section 3700 of the Labor Code, for the performance of the work for which this DEF # 1 - STRUCTURAL DETAILS, METAL STUDS IN permit is issued. EXTERIORANTERIOR WALLS & FRAMING MEMBERS - ISSUED APPLICANT CERTIFICATION 4/5/16 1 certify that I have read this application and state that the above REV # 1 - RFI'S **BIN A-3** 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 Sq. Ft Floor Area: Valuation: $16500000.00 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 APN Number: Occupancy Type: source regulatiorttt per the Cupertino Municipal Code, Section 9.18. l 316 20115 Signature Date 04/10/2017 ATION PERMIT EXPIRES IF WORK IS NOT STARTED OWNER-BLiH.DEECL.AR WITHIN 180 DAYS OF PERMIT ISSUANCE OR I hereby affirm that I am exempt from the Contractor's License Law for one of the 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by ME ISSAE sale (Sec.7044, Business & Professions Code) Date' +W+W220+5 11[,(!A z. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). RE -ROOFS: I hereby affirm under penalty of perjury one of the following three declarations: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I have and will maintain a Certificate of Consent to self -insure for Worker's installed without first obtaining an inspection, I agree to remove all new materials for Compensation, as provided for by Section 3700 of the Labor Code, for the inspection. performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Signature of Applicant: Section 3700 of the Labor Code, for the performance of the work for which this Date: 04/10/2017 permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE Labor Code, I must forthwith comply with such provisions or this permit shall I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will be deemed revoked. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the APPLICANT CERTIFICATION Health & Safety Code, Section 25532(a) should I store or handle hazardous certify that I have read this application and state that the above information is material. Additionally, should I use equipment or devices which emit hazardous correct. I agree to comply with all city and county ordinances and state laws air contaminants as defined by the Bay Area Air Quality Management District I relating to building construction, and hereby authorize representatives of this city will maintain compliance with t e Cupertino Municipal Code, Chapter 9.12 and to enter upon the above mentioned property for inspection purposes. (We) agree the Health & Safety C e, Sections 5505, 25533, and 25534. to save indemnify and keep harmless the City of Cupertino against liabilities, \ judgments, costs, and expenses which may accrue against said City in Owner or authorized agent: consequence of the granting of this permit. Additionally, the applicant understands Date: 04/10/2017 and will comply with all non -point source regulations per the Cupertino Municipal CONSTRUCTION LJ�DING AGENCY Code, Section 9.18. 1 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.) Signature Date 04/10/2017 Lender's Name Lender's Address NO A CUPERTINO 71 1�Vw CONSTRuc CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELCPIVENT DEPARTMENT - BUILDING DIVISION 10300 i ORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildina(a-CUDertinO.org CION ❑ ADiDIT:0Nt ❑ ALTERATION / TI ES REVISION / DEFERI D ORIL PI iT = I �� 0 15 A PROTECT.4DDRESS� 4'-- 1�fE �1✓� 4PN� O';WNERNAME \. I`/\rii1�G� PHONE I E-1.LAILhkUmOt4`j� Cyv\I\C �Dr STREETADDRESS.2g,22 t ', \ 9, Ste- , ;4 CITY, STATE, ZIP �4 1) 9-51 FA3; CONTACT NAME k` _ � \ ����,,,� �r PHO �c c f 3 �. SOS KA c� I E-I`2?iL VN Z(AM(ll e S�CYvti��C CGv►� 1 S�8T2a SSy,�I S�e.: a --I CITY, STATE, ZIPKQh\o �1if �,C{� C���j FAX V\� \\ ,\d. xo"A NER ❑ OWNER -31 -7 -I1 -DER ❑ O"WNTRAGEN'T ❑ CONTRACTOR ❑ CON7R4CTORAGENT ❑ A.RCHITFCT ❑=NGL.tER ❑ DE\iLOPER ❑ TENANT CONTRACTOR N.kbfE p _ �1 �S 1 _ LICENSE NUI MER ��C,.7.f LICENSE TYPE BUS. LIC R r' / CONIYPNYNA'SSGC P,0 Co E -I AIL O,S420. CGW\ Fax A�� N,\sA (`C ,(�h� . STREET.4DDRESS1-7 (I W k Ave_ q C ob CIN, STATE: Z1P�a V+ 1 _r\ 1 t CA PHONE ARCHITECT,ENGLNtER NAS;E�,\,` V\A l C u l_ �qY LICENSE NTUMBER d f� BUS. LIC = COM.PANYNAMB {�rcf,; fiecrts D `r-ay.r F -M IL L� FAX �, ---- - N: ra�. C.�+–c�n:l E'c SC�r-a"I •C41— --- STREET ADDRESS ( t d �\ O,Y /� ' j / / CITY, STATE. ZIP ©fir h �q G �j OQ'� PHONE 7 /4- �(j . 9 g b� 1 DESCRIPTION OFWOP: 4 �: "70S A %a...d 000`L EXISTrf.G USE ��ROPOSED L'SE CONSTR. T1 PE I = S; CRIES USE I TY?E OCC. I SQ.FT. 'VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA ARI=4 NET AREA BAT1HROOM KITCHEN OTHER RE\401DELAREA RE)OODELAREA REMOD-eLARE.A PORCH AREA DECK AREA TOT?? DECKTORCH ARE4 G.=3 SG=- AREA: DETACH ❑ ATTACH DVVE[LUNG UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BELNGA-DDED" NO ADDITION? ❑NO PP.E-.=-P LCA,1ON 7Y5S IF1aS,P?O\"IDE COPY OF IS THE BLDGAN1 `'0 TOT." -.L N:--LUA=1(:)N: PLA NI\G.:?PL= ❑NO ?LA\N NGAPPP.O\'gLLETTER EICHLERHO?TE^ ( By my signature below, I certify to each of Lhe follo•,ving: I am the property owner or authorize gent to act o ropert): owner's behalf. I have read :h s application and the infom;ation I have rovided is correct. I have rend the Description of Work, and verify ' ccurzte. I agree to co*. ply \3`ith z1_] applicab'-e local o!'dinances and state Izv, s relzti Q to bu ldiug construction. I authorize representatives of Cupel Lino to enter the above -identified proper -Ly for inspection purposes. 7 t t Signavure of Applicant/Agent: CO �� '^�� hQ ; Date: Slirr''LE 1ENTAL II GR1vLa 1 IGN REQUIRED PLAN CHECK TYPE I ROUTING SLIP ❑ 0yTTZ TuE-CO LITER a ❑ FLILDI\G PLAN RE\ IER — New SFD or Multi tinily dwellings: Apply for demolition permit for existing building(s). Demolition I7eI-i!it is requird prior to issuance of building permit for nes' bulldi:.LT. ElE\YR£SS ❑ Pr\\L\G PLA\ RET IE\3 1 z} M _ Co,mmercial Bldgs: Provide a com-pleied Hazardous laterials Disclosure L .l ST.L\-D ARD - LJ PLELIC\ ORIS fo _n if a:.y H2zardous Materials are being >_sed as Da: of his project. - ❑ LARGE � ❑ FIP.EDEPT �. - Copy of PlamniaQ Approval Letter or Meeting arth Planning prior to � LJ t �. g a 4 ❑ SubIi7lital OfBuIIOinQ Permit application. i4JOR - ;,:• ,�. 54\IT4R1 �F�x ER DI�TRIC? _ ` ❑ E\t IRO\1iE T4L HEALTH Bldg-=pp_2011.doc revised 0642 1/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19429 STEVENS CREEK BLVD CONTRACTOR: SOUTH BAY PERMIT NO: 13120156 CONSTRUCTION, INC OWNER'$ NAME: MAIN STREET CUPERTINO AGGREGATOR 1711 DELL AVE DATE ISSUED: 07/17/2015 OWNER'S PHONE: 4087251955 CAMPBELL, CA 95008 PHONE NO: (408)379-5500 LICENSED CONTRACTOR'S DECLLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ License Class Lic. #If) � jl� MARRIOT- CONSTRUCT SUPERSTRUCTURE (5) STORY HOTEL, 142,487 SQ FT TO INCLUDE 180 GUESTROOMS p _ Contractorte I hereby affirm that I aro licensedunder 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 Sq. Ft Floor Area: Valuation: $16500000 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 APN Number: 31620109.19429 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 save4by: LED 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 granting of this permit. Additionally, the applicant understands and will comp with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. �j ' Signature t ► —� Date % 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 I, as owner of the property, ormy'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). I 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 ander 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 with the Cupertino Municipal Code, Chapter 9.12 and I have and,will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this y— i rj Owner or authorized agent: Date: �! permit is issued. 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 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 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 19429 STEVENS CREEK BLVD PERMIT NO: 13120156 OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LL I I DATE ISSUED: 07/17/2015 1 OWNER'S PHONE: 4087251955 1 , I PHONE NO: W LICENSED CONTRACTOR'S DECLARATION License Cl ss C. # 82- Cont�j � c/tiTT►xlt�'"" Date -S /�/� I hereoymtrrm 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. 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 against said City in consequence of the granting of this it. Additionally, the applic t understands and will comply with all no mt s urce regulations per pertm Municipal Code, Section 9.18. Signa ate S --j7 — f S ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 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) 1, 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: 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. 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. JOB DESCRIPTION: RESIDENTIAL EJ COMMERCIAL E] MARRIOT- CONSTRUCT SUPERSTRUCTURE (5) STORY HOTEL, 142,487 SQ FT TO INCLUDE 180 GUESTROOMS Sq. Ft Floor Area: I Valuation: $16500000 APN Number: 31620109.19429 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERM ISSUANCE OR 180 Dom'£ FRO ED INSPECTION. 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: 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 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quanagement District I will maintain compliance with upertino icilpae, Chapter 9.12 and the Health & Safety Code, goons 5505, 33, and 2'J314'. Owner or authorized ai!AjVJ'23, C te: e3 —/7—/ 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 DESIGN ENGI NEE R I NG GROUP, LLC GENERAL CONTRACTORS CHANGE OF CONTRACTOR LETTER October 9, 2015 Cupertino Community Development Building Division 10300 Torre Avenue Cupertino, CA. 95014 RE: Marriott Residence Inn 19429 Stevens Creek Blvd. I Joseph E Petrillo am requesting a change of contractor at the project listed above, for permit number 13120156 issued on 07/17/2015 from Joseph E. Petrillo dba Design Contractors inc. to South Bay General Contractors 1711 Dell Avenue, Campbell, CA. License Holder: Jason E Petrillo License Number: 823163 Company Name: Jason E. Petrillo dba Design Contractors Company Address: 12300 Wiles Ro d Coral Springs, F . 33076 License Holder Signature STATE OF FLORIDA COUNTY OF BROWARD This instrument was acknowledged before me this gth day of October 2015 by the above referenced individual, who acknowledged that he is the duly licensed contractor with Jason E. Petrillo dba Design Contractors, and who acknowledged that he is authorized to execute this document. He is personally known to me. WITNESS my hand and official seal this 91h day of October 2015 Notary Public Signature KATHERINEZUGBI cr t aty FUD11C - State of Florida Printed Name: �i-i 2Cl '-' '= Commission +1 ff 190247 I My Comm Aires May 10, 2019 Bonded through National Notary Asan. My Commission Expires 12300 Wiles Road - Coral Springs, FL 33076 OFFICE: 954.344.7717 - FAX: 954.323.5603 www.deggc.com 04 0 er1 N 0 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building0cuperfino.oLq nnv-ykv,ky nuD&Avr4l RldgApp_201 ],doe revised 06121/11 A PROJECT ADDRESS at�rTAPN 4 01171ER NAME Main Street Cupertino Aggregator, LLC PHONE 08-725-1955 IAII nkumar@shcmllc.com -TT;�� STREET ADDRESS, 12930 Saratoga Avenue Suite B-5 I CITY STATE. ZIP Saratoga, CA 9507 (408) 725-9866 CONTACT NAME Nandy Kumar I PHONE 408-725-1955 I E -MA` nkumar@shcm[ic.com STREET ADDRESS 12930 Saratoga Avenue Suite B-51 CrrY,STATr, ZIP Saratoga, CA 95070 1 FAX (408) 725-9866 13 OWNER [I OWNER -BUILDER 13 OWNER AGENT El CONTRACTOR 000NTRACTORAGENT 13 ARC19TLCT 0 ENGINEER El DEVELOPER 11 TENANT CONTRACTOR NAME To Be Determined LICENSE NUMBER LICENSETYPE BUS LIC# COMPANY NAME FMAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENCINEER NAME Henry Wong LICENSE NUMBER C-10250 BUS. LIC # COMPANY NAME D. M. Bergerson, Inc. F.-MAILhenry.woong@,ldmbarchitects.com FAX 949-272-0201 STREET ADDRESS 8911 Research Drive, 1st Floor CITY- 11z" Irvine, CA 92618 PHONE 949-272-0171 DESCRIPTION OF WORK New 180 guestroorn extended stay hotel, with meeting space, public areas, and supporting ancillary back of the house area. EXISTING USE n/a I PROPOSED USE CONSTR. hotel i-Auim l TYPE I #STORIES 5 USE TYPE occ. SQ,FT. VALUATION (S) EXISTG AREA n/a NEW FLOOR AREA DEMO I AREA n/a TOTAL I NET AREA BAUEROOM REMODEL AREA n/a KITCHEN REMODEL AREA n/a OTHER REMODEL AREA PORCH AREA DECK AREA TOTALDECK/PORCHAREA GARAGE AREA DETACH : n/a n1a n/a I I HATTACH it DWELLING UNITS! IS A SECOND UNIT [] YES SECOND STORY []YES n/a I BEING ADDED? ENO ADDITION? ENO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF ISTHEDLDGAN ©YES PECEIV Y ALUATION: PLANNINGAPPL# []NO PLANNING APPROVAL LETTER EICHLERHOIJE? ENO I By my signature below, I certify to each of the following: I am the property owner or authorized 'agqto act on the property owner's behalf. I have read this application and the information I ha -Rrovided is corr!ct, v read the Description of Work and vitify it is accurate. I agree to comply with all applicable local Imano V �14-htehorize representatives ordinances and state lays lel.im i7:ooBsWxJWn& I �u ofCupertino to enter the aboveltdcritAffied property for inspection purposes. Date: Signature of Appliftnt/Ai ent, i 2- SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK 11.1t ROUTING SLIP -F+-n1ILD1NC. PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for❑OVLR-TH1rC0VNThR existing building(s). Demolition permit is required prior to issuance of'building permit for new building. ❑ EXPRESS PLAININGPLA14 REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 sTAND&RD -ErPUBLIC WORKS form if any Hazardous Materials are being used as part of this project.LARGE -9—FIVRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to El MAJOR -a-SANITARY sFwER DisTRlcr submittal ofBuilding Permit application. K:r11NVJRONrIENTAL HLALTH RldgApp_201 ],doe revised 06121/11 A CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: Main St- Hotel DATE: 12/16/2013 REVIEWED BY: Sylvia PC FEE ID APN: BP#: *VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: Commercial Building Civil / Religious activities in BQ zone? Yes Q � No PENTAMATION 1 R1 HM PERMIT TYPE: WORK Marriot -Superstructure new 5 story hotel 142,487 sq ft to include 180 questrooms SCOPE Suppl. Insp. Feer Reg. Q OT OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-1 (Hotels & Motels) II-A,111-A,V-A 142,487 $14,324.25 IRIHOTPLN, $60,428.00 IRIHOTINSP Permit Fee: $60,428.00 Suppl. Insp. Feer Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Ta Tax: IBCONSTAXH 180 # new rooms $39,439.80 G Work Without Permit? 0 Yes Q) No $0.00 TOTALS: 142,487 $14,324.25 $60,428.00 Strong Motion Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept_for addit7 info. FEE ITEMS (Fee Resolution 11-053 E . 711113) Xleeh. Plan Check 11bi rij3. ficin Check L'Ie . I!ml i,l,ee k /lied, P£srinit Fee, pb n h. Ye rpnii- Fet': 1,,7ee, Permit Fee: Oth r .-V 'r. In -m. ,ber Phnnb Insp. oi&;r Elec. I $0.00 PME Plan Check: yyInsp.Li NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept_for addit7 info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $14,324.25 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $60,428.00 Suppl. Insp. Feer Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Ta Tax: IBCONSTAXH 180 # new rooms $39,439.80 G Work Without Permit? 0 Yes Q) No $0.00 Advanced Planning Fee. 1PLLONGC $39,896.36 Select a Non -Residential G Building or Structure i Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS 154,088.41 $0.00 TOTAL FEE:; $154,088.41 11 Revised: 10/01/2013 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19429 STEVENS CREEK BLVD 20 115) CONTRACTOR: PERMIT NO: 13120156 (316 S B C C INC CAMPBELL, CA 95008 OWNER'S NAME: ( MAIN STREET CUPERTINO AGGREGATOR LLC) DATE ISSUED: 07/17/2015 OWNER'S PHONE: 650-344-1500 PHONE NO:,(408) 379-5500 LICENSED ONT A TOR'S DDCLARATION BUILDING PERMIT INFO: License Class QENERAL BUILDING CONTRACTOR Lic, #336974 Contractor S B C C INCDate 03/31/2018 —BLDG _ELECT PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH ^ RESIDENTIAL _ COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: MARRIOT CONSTRUCT SUPERSTRUCTURE (5) STORY HOTEL, I hereby affirm under penalty of perjury one of the following two declarations: 142,487 SQ FT TO INCLUDE 180 GUESTROOMS 1. I have and will maintain a certificate of consent to self -insure for Worker's, REV # 2 (4/13/16) - CHANGES To INTERIOR & EXTERIOR Compensation, as provided for by Section 3700 of the Labor Code, for the ELEMENTS, INCLUDING ELEVATOR SHAFT .performance of the work for which this permit is issued. DEF #3 - CERTAIN WALLS, TOWERS 1,2 & 3 - ISSUED 1/9/17 2. ,1 I have and will maintain Worker's Compensation Insurance, as provided for by DEF #2 - STAIRS 1, 2, AND 3 - ISSUED 12/2/16 Section 3700 of the Labor Code, for the performance of the work for which this * *BINA-3 * * permit is issued. DEF # 1- STRUCTURAL DETAILS, METAL STUDS IN APPLICANT CERTIFICATION EXTERIORANTERIOR WALLS & FRAMING MEMBERS - ISSUED I certify that I have read this application and state that the above 4/5/16 information is correct. I agree to comply with all city and county ordinances REV # 1 - RFI'S 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 Sq. Ft Floor Area: Valuation: $16500000.00 source regulationsiper the Cupertino Municipal Code, Section 9.18. t} 1, Fti t APN Number: 31620115 Occupancy Type; Signature ; F , n / V Date 01 /09/2017 , OWNER-BUH:DER DECLARATION PERMIT EXPIRES IF WORK IS NOT STARTED I hereby affirm that I am exempt from the Contractor's License Law for one of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR following two reasons: 1. I, as owner of the properly, or my employees with wages as their sole 180 DAYS FROM LAST CAL ECTION. compensation, will do the work, and the structure is not intended or offered for :NA sale (Sce.7044, Business & Professions Code) Issued by MELISSA z. I, as owner of the property, am exclusively contracting with licensedDate: ^ ",�rrr"rrzv rT contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: RE -ROOFS: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's All roofs shall be inspected prior to any roofing material being installed. If a roof is Compensation, as provided for by Section 3700 of the Labor Code, for the installed without first obtaining an inspection, I agree to remove all new materials for performance of the work for which this permit is issued. 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 Signature of Applicant: permit is issued. Date: 01/09/2017 a. 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE be deemed revoked. `", I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will APPLICANT CERTIFICATION maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I certify that I have read this application and state that the above information is Health & Safety Code, Section 25532(a) should I store or handle hazardous correct. I agree to comply with all city and county ordinances and state laws material. Additionally, should Iuse equipment or devices which emit hazardous relating to building construction, and hereby authorize representatives of this city air contaminants as defined by the Bay Area Air Quality Management District I to enter upon the above mentioned property for inspection purposes. (We) agree will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in the Health & Safety Code, Section 25505, 25533, and 25534. --- consequence of the granting of this permit. Additionally, the applicant understands Owner or authorized agent:! 1 A CJ, of / p and will comply with all non -point source regulations per the Cupertino Municipal Date: 01/09/2017 V Code, Section 9.18.. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Signature Date 01/09/2017 of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 c t P E RT I N O I (408) 777-3228 • FAX (408) 777-3333 • building(Wcupertino.org F-1 NFW CONSTRI JCTION n ADDITION n ALTERATION / TI M REVISION DEFERRED ORIGINAL PERMIT # 13120156 PROJECT ADDRESS 19429 Stevens Creek Blvd, Cupertino, CA APN# — Z 0 OWNERNAME Sand Hill Const Management PHONE nkumaCrJ@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAN CONTACT NAME Nandy Kumar PHONE 650.344.1500 E-MAIL nkumar@shcmllc.com IREETADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX XOWNFR ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Bob Blaska LICENSE NUMBER 336974 LICENSE TYPE B BUS. LIC# 5655 COMPANY NAME South Bay Construction E-MAIL bblaska@sbci.com FAX STREET ADDRESS 1711 Dell Ave CITY, STATE, ZIP Campbell, CA 95008 PHONE 408.621.5228 ARCHITECT/ENGINEER NAME N i n a d C h a u kka r LICENSE NUMBER BUS. LIC # COMPANY NAME ARCHITECTS ORANGE E-MAIL NinadC@Architectsorange.com FAX STREET ADDRESS 144 North Orange Street CITY, STATE, ZIP Orange, CA 92866 PHONE 714.639.9860 DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSIR TYPE 4 STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AMRE GARAGE AREA: DETACH ❑ ATTACH I # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG ❑ YES REC Y' TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? By my signature below, I certify to each of the following: I am the property 0 r agen ct prop o er's behalf. 1 have read this application and the information I have provided is correct. I have read th ption of Work It is accurat ee to comply with all applicable local ordinances and state laws relating t ilding construction. I authorize representatives of C no to enter the a ntified property for inspection purposes. Signature of Applicant/Agent: Dat ' SUPPLEMENTAL INFORMATION REQUIRED CHECK TYPE ROIPrINGSLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ ❑ LARGE FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. MAJOR ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 13120156 19429 STEVENS CREEK BLVD (316 20 115) S B C C INC CAMPBELL, CA 95008 OWNER'S NAME: ( MAIN STREET CUPERTINO AGGREGATOR LLC) DATE ISSUED: 07/17/2015 OWNER'S PHONE: 650-344-1500 PHONE NO: (408) 379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 13 Lic. #336974 Contractor S B C C INC Date 03/31/2018 —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: MARRIOT- CONSTRUCT SUPERSTRUCTURE (5) STORY HOTEL, I hereby affirm under penalty of perjury one of the following two declarations: 142,487 SQ FT TO INCLUDE 180 GUESTROOMS t. I have and will maintain a certificate of consent to self -insure for Worker's REV # 2 (4/13/16) - CHANGES TO INTERIOR & EXTERIOR Compensation, as provided for by Section 3700 of the Labor Code, for the ELEMENTS, INCLUDING ELEVATOR SHAFT L performance of the work for which this permit is issued. DEF # 3 (10/31/16) - CERTAIN WALLS, TOWERS 1,2 & 3 2. I have and will maintain Worker's Compensation Insurance, as provided for by DEF #2 - STAIRS 1, 2, AND 3 - ISSUED 12/2/16 Section 3700 of the Labor Code, for the performance of the work for which this **BIN A-3** permit is issued. DEF # 1 - STRUCTURAL DETAILS, METAL STUDS IN APPLICANT CERTIFICATION EXTERIORANTERIOR WALLS & FRAMING MEMBERS - ISSUED I certify that I have read this application and state that the above 4/5/16 information is correct. I agree to comply with all city and county ordinances REV # 1 - RFI'S 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 Sq. Ft Floor Area: Valuation: $16500000.00 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 r e Cupertino Municipal Code, Section 9.18. APN Number: Occupancy Type: ' Signature Date 12/02/2016 31620 115 OWNER-BUnVER DECLARATION PERMIT EXPIRES IF WORK IS NOT STARTED I hereby affirm that I am exempt from the Contractor's License Law for one of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR following two reasons: t. I, as owner of the property, or my employees with wages as their sole 180 DAYS F - ECTION. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Issued by: MELI A N 2. I, as owner of the property, am exclusively contracting with licensed Date --T7 � t Z- 1-6 contractors to construct the project(Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: RIF -ROOFS - 1. I have and will maintain a Certificate of Consent to self -insure for Worker's All roofs shall be inspected prior to any roofing material being installed. If a roof is Compensation, as provided for by Section 3700 of the Labor Code, for the installed without first obtaining an inspection, I agree to remove all new materials for performance of the work for which this permit is issued. 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 Signature of Applicant: permit is issued. Date: 12/02/2016 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE be deemed revoked. I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will APPLICANT CERTIFICATION maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I certify that I have read this application and state that the above information is Health & Safety Code, Section 25532(a) should I store or handle hazardous correct. I agree to comply with all city and county ordinances and state laws material. Additionally, should I use equipment or devices which emit hazardous relating to building construction, and hereby authorize representatives of this city air contaminants as defined by the Ba�7ity Management District I to enter upon the above mentioned property for inspection purposes. (We) agree will maintain compliance with the Cual Code, Chapter 9.12 and to save indemnify and keep harmless the City of Cupertino against liabilities, the Health &Safety Code, 5533, and 34. judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands Owner or authorized agent: and will comply with all non -point source regulations per the Cupertino Municipal Date: 12/02/2016 Code, Section 9.18. CON TRUCTIOLLI/NDING AGENCY I hereby affirm that there is a construction lending agency for the performance Signature Date 12/02/2016 of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(@cupertino.org 2 I 1 NFW (VINSTRI ICTICIN I I AIN)TTIOM M ALTERATION / TI M REVISION/ DEFERRED ORIGINAL PERMIT # 13120156 PROIECrADDRESS 19429 Stevens Creek Blvd, Cupertino, CA APN# OWNERNAME Sand Hill Const Management PHONE E-MAIL nkumar@shcmlic.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 1-A\ CONTACT NAME Nandy Kumar PHONE 650.344.1500 E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX OWNER 0 OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT 77 CONTRACTOR NAME Majid Tavakoli LICENSE NUMBER 336974 T77SE TYPE B BUS. LIC # 5655 COMPANY NAME South Bay Construction E-MAIL mtavakoli@sbci.com FAX STREET ADDRESS 1711 Dell Ave CITY, STATE, ZIP Campbell, CA 95008 PHONE 727.470.7255 ARCHITECT/ENGINEER NAME N i n ad C h a u kka r LICENSE NUMBER BUS. LIC # COMPANY NAME ARCHITECTS ORANGE E-MAIL NinadC@Architectsorange.com FAX STREET ADDRESS 144 North Orange Street CITY, STATE, ZIP Orange, CA 92866 PHONE 714.639.9860 DESCRIPTION OF WORK Deferred submittal for Stairs #1, 2, and 3 (shop drawings & calculations) EXISTING USE PROPOSED USE CONSTR TYPE I # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA ATTACH [TOTALDECKAREA DECK/PORCH AREA GARAGE AREA: DETACH d DWELLING UMTS: IS A SECOND UNIT ❑ YES BEING ADDED? []NO SECOND STORY []YES ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # NO PLANNING APPROVAL LEITER IS THE BLDG AN E] E? EICHLER HOME? ❑ NO RE IVED BUIAAY: TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent & act on 1he property owner's behalf. I have read this application and the information I have 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 uild' construction. I autho esentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent:AIN Date: SUPPLEMENTAL INF TI N REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ EXPRESS ❑ STANDARD ❑ LARGE El MAJOR ❑ BUILDING PLAN REVIEW ❑ PLANNING PLAN REVIEW ❑ PUBLIC WORKS ❑ FIRE DEPT Ll SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121111 ti w4'C.l9s� CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 • bullding&Dcupertino.Orq f]/� r, -A Horn T /TL cvDDDn IIDT!_TT.TAT DFDTiiTTif 13120156 1- I INFPVY I. INJaa\Vli11V1`I LJ. t"a✓✓aaava� - VJ •++-•++"•�4 +��- -- rte•. -- ------ PRQJECTADDRESS 19429 Stevens Creek Blvd, Cupertino, CA APN# OwNERNAME Sand Hill Const Management PHONE E -mom nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX CONTACT NAME Nandy Kumar PHONE 650.344.1500 E-MAIL nkumar@shcmllc.com STREETADDREss 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX LXowNER ❑. OWNERBUMDER ❑ OWNERAGENTCONTRACTOR ❑CONTRACTOR AGENT l] ARCHITECT ❑ENGINEER ❑ 'DEVELOPER ❑ TENANT CONTRACTORNAME MajId Tavakolr LICENSENUMBER 336974'., LICENSE TYPE B BUS.Lic# 5655 COMPANY NAME South Bay Construction E-MAIL mtavakoli@sbcl.com FAX STREET ADDRESS 1711 Dell Ave CITY, STATE, ZIP Campbell; CA 95008 PHONE 727.470.7255 ARCHITECT/ENGINEERNAME Nlnad Chaukkar LICENSE NUMBER _ BUS. LIC# coMPANYNAME ARCHITECTS ORANGE E-MAIL NinadC@Architectsorange.com FAX STREET ADDRESS 144 North Orange Street CITY, STATE, ZIPOran e, CA. 92866 g PHONE 714.639.9860 DESCRIPTION OF WORK Deferred submittal for Curtain Wall, Towers #1, 2, and 3 (shop drawings & calculations) EXISTING USE PROPOSED USE - - ; CONSTR. TYPE - 4 # STORIES - - USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR - AREA DEMO AREA TOTAL NET AREA, BATHROOM REMODELAREA KITCHEN .OTHER REMODELAREA , REMODELAREA PORCHAREA DECKAREA. TOTALDECK/PORCHAREA - GARAGEAREA: UDhrACH ❑.ATTACH - - #DWELLING UNITS: IS A SECOND UNIT []YES BEINGADDED? [:]NO SECONDSTORY ❑YES ADDITION? ❑NO, PRE -APPLICATION ❑ YES IF YES; PROVIDE COPY OF IS THE BLDG AN ❑S ` RECEIVE " UATION: PLANNING ADPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? By my signature below, I certify to each of the following: f am the property owner or authorized agent to act on the property owner's behalf. I have read this Work and verify it is accurate. I agree to comply with all applicable local application and the information I have pr ided is correct. I have read the Description of and state laws relating to buil cons�n. �I authorize presentative of Cupertino to enter the above -identified pro for inspection purposes. ordinances r Signature of Applicam/Agent: i I i e � Date: SUPPLEMENTAL INF ATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BuH,DING PLANRBVIEw New SFD or Multifamily dwellings: Apply for demolition permit for _ existing building(s). Demolition permit is required prior to issuance of building 1:1 EXPRESS 11 PLANNING PLAN REVIEW permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure D STANDARD ❑ PusLlc WORKS _ To—nn if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT _ submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 13120156 19429 STEVENS CREEK BLVD (316 20 115) S B C C INC CAMPBELL, CA 95008 OWNER'S' NAME: ( MAIN STREET CUPERTINO AGGREGATOR LLC) DATE ISSUED: 07/17/2015 OWNER'S PHONE: 650-344-1500 PHONE NO: (408) 379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 13 Lic. #336974 Contractor S B C C INC Date 03/31/2018 —BLDG — ELECT — PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH _ RESIDENTIAL — COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: MARRIOT CONSTRUCT SUPERSTRUCTURE (5) STORY HOTEL, 142,487 SQ FT TO INCLUDE 180 GUESTROOMS 1. i have and will maintain a certificate of consent to self-insure for Worker's REV # 2 (4/13/16) - CHANGES TO INTERIOR & EXTERIOR Compensation, as provided for by Section 3700 of the Labor Code, for the ELEMENTS, INCLUDING ELEVATOR SHAFT performance of the work for which this permit is issued. k2.%I have DEF # 3 (10/31/16) - CERTAIN WALLS, TOWERS 1,2 & 3 and will maintain Worker's Compensation Insurance, as provided for by DEF #2 - STAIRS 1, 2, AND 3 - ISSUED 12/2/16 -section 3700 of the Labor Code, for the.p�rformance of the work for which this **BINA-3** 4ermit is issued. DEF # 1 - STRUCTURAL DETAILS, METAL STUDS IN APPLICANT CERTIFICATION EXTERIOR/INTERIOR WALLS & FRAMING MEMBERS - ISSUED I certify that I have read this application and state that the above 4/5/16 information is correct. I agree to comply with all city and county ordinances REV # 1 - RFI'S 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 Sq. Ft Floor Area: Valuation: $16500000.00 source regulations r he Cupertino Municipal Code, Section 9.18. APN Number: Occupancy Type: Signaturef Date 12/02/2016 31620115 % OWNER-B Tii�FR DECLR TION PERMIT EXPIRES IF WORK IS NOT STARTED I hereby affirm that I am exempt from the Contractor's License Law for one of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR following two reasons: 1. I as owner of the property, or my employees with wages as their sole 180 DAYS F ECTION. compensation, will do the work, and the structure is not intended or offered for — - - sale (Sec.7044, Business & Professions Code) Issued by MELI A Nf�� 2. I, as owner of the property, am exclusively contracting with licensed Date: t Z 16 contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following 'three declarations: RE-ROOFS: t. I have and will maintain a Certificate of Consent to self-insure for Worker's All roofs shall be inspected prior to any roofing material being installed. If a roof is Compensation, as provided for by Section 3700 of the Labor Code, for the installed without first obtaining an inspection, I agree'to remove all new materials for performance of the work for which this permit is issued. 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 Signature ofApplicant: permit is issued. Date: 12/02/2016 s. 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE be deemed revoked. I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will APPLICANT CERTIFICATION maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I certify that I have read this application and state that the above information is Health & Safety Code, Section 25532(a) should I store or handle hazardous correct. I agree to comply with all city and county ordinances and state laws material. Additionally, should I use equipment or devices which emit hazardous relating to building construction, and hereby authorize representatives of this city air contaminants as defined by the Bay Area Air Quality Management District I to enter upon the above mentioned property for inspection purposes. (We) agree will maintain compliance with the Cuperp o H dcipal Code, Chapter 9.12 and to save indemnify and keep harmless the City of Cupertino against liabilities, the Health & Safety Code, S Mons 25 5, 25533, and 5534. judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands Owner or authorized agent.. ,. and will comply with all non-point source regulations per the Cupertino Municipal Date: 12/02/2016 Code, Section 9.18. CONSTRUCTIO NDINGAGENCY hereby affirm that there is. a construction lending agency for the performance Signature Date 12/02/2016 of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE-,CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingCa)cupertino.org CUPERTINa Ll NEw CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI, R REVISION / DEFERRED . ORIGINAL PERMIT # 13120156 PROJECT ADDRESS 19429 Stevens Creek Blvd, Cupertino, CA APN# oWNERNAME Sand Hill Const Management PHONE E-MAIL nkumar@shcmllc.com STREETADDRESS 2822 Sand Hill Rd, Ste, 241 CITY, STATE, --IP Menlo Park, 94025 FAX CONTACT NAME Nandy Kumar PHONE 650.344.1500 7 -E-MAIL nkumar@shcrnllc.com STREETADDRESs 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX D(OWNER ❑. OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR 0 CONTRACTORAGENT ❑ ARCHITECT 11 ENGINEER 0' DEVELOPER ❑ TENANT CONTRACTORNAME Maid Tavakoll LICENSENUMBER 336974 LICENSE TYPE B BUS. LIC# 5655 COMPANYNAME South Bay Construction E-MAIL mtavakoli@Sbci.com FAX STREET ADDRESS 1711 Dell Ave CITY, STATE, ZIP Campbell, CA 95008 PHONE 727.470.7255 ARCHITEMENGINEER NAME.. N I n a d.. -lam h a U kka r LICENSE NUMBER BUS. LIC # coMPANYNAME ARCHITECTS ORANGE E-MAIL NinadC@Architectsorange.com FAX STREET ADDRESS 144 North Orange Street CITY, STATE, ZIP 'Orange, CA 92866 PHONE 714.639.9860 DESCRIPTION OF WORK Deferred submittal for Stairs. #1, 2, and 3 (shop drawings & calculations) EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES - - I . A L U - - . USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN .. - - OTHER - REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTALDECK/PORCH AREA I GARAGE AREA: LIDEIACH M ATTACH # DWELLING UNITS:. IS A SECOND UNIT L]YES SECOND STORY LJ YES BEINGADDED? []NO ADDITION? ]NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES REC41VED.BY: TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO. By my signature below, I certify to each of the following: I am the property owner or authorized agent act on a property owner's behalf. I have read this application and the information I have 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 IuIdin construction. I autho representatives of Cupertino to enter the above -identified property 19 - SUPPLEMENTAL inspection purposes.. Signature of Applicant/Agent: f� \\ . Date: 6 _ 9. , st o 1 9 - SUPPLEMENTAL INFATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building, ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BIdgApp_2011.doc revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR:. PERMIT NO: 13120156 19429 STEVENS CREEK BLVD (316 20'115) SOUTH BAY OWNER'S NAME: 650-344-1500 DATE ISSUED: 07/17/2015 OR'NER'S PHONE: PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lia #33B374 Contractor SOUTH BAY Date —BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing. — MECH — RESIDENTIAL — COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: MARRIOT CONSTRUCT SUPERSTRUCTURE (5) STORY HOTEL, I hereby affirm under penalty of perjury one of the following two declarations: 142,487 SQ FT TO INCLUDE 180 GUESTROOMS 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 Ct ---DEF #I -STRUCTURAL DETAILS FOR METAL STUDS IN performance of the work for which this permit is issued. EXTERIOR & INTERIOR WLLS & FRAMING MEMBERS - ISSUED z1 I have and will maintain Worker's Compensation Insurance, as provided for by r 4/5/16 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION REV # I - RFI'S I certify that I have read this application and state that the above Sq. Ft Floor Area: Valuation: $16500000.00 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 APN Number: Occupancy Type: inspection purposes. (We) agree to save indemnify and keep harmless the 316 20 115 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 underst nds and will comply with all non -point source regulaf ns per the Cupe no Municipal Code, Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR Signatur !% Date 04/05/2016 180 DAYS FROM LAST C INSPECTION. OWNER -BUILDER DECLARATION Issued by I hereby affirm that I am exempt from the Contractor's License Law for one of the Date: 07/ /2015 following, two reasons: 1. I, 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 offeredfor All roofs shall be inspected prior to any roofing material being installed. If a roof is sale (Sm7044, Business & Professions Code) installed without first obtaining an inspection, I agree to remove all new materials for 2. I, 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 of Applicant: i. I have and will maintain a Certificate of Consent to self -insure for Worker's Date: 04/05/2016 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. I certify that in the performance of the work for which this permit is issued, I California Health & Safety Code, Sections 25505, 25533, and 25534. I will shall not employ any person in any manner so as to become subject to the 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 Air Quality Management District I be deemed revoked. will maintain compliance with the Cu ertino Municipal Code, Chapter 9.12 and the Health & Safety Code ecfions 25505, 2!55$, and 25534. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is Owner or authorized agent: correct. I agree to comply with all city and county ordinances and state laws Date: 04/05/2016 relating to building construction, and hereby authorize representatives of this city CONSTRUCTION LENDING AGENCY to enter upon the above mentioned property for inspection purposes. (We) agree 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 DECLARATION Signature Date 04/05/2016 1 understand my plans shall be used as public records. Licensed CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION F¢ ADDRESS: 19429 STEVENS CREEK BLVD DATE: 11/06/2015 REVIEWED BY: MELISSA APN , 316 20 085 BP#: *VALUATION: Iso —� *PERMIT TYPE: Building Permit PLAN CHECK TYPE; Alteration /Addition/ Repair PRIMARY Commercial Building USE: Civil Religious activities in BQ zone? Yes E) No PENTAMATION PERMIT TYPE: 1 GENCOM WORK DEF #.:1 -STRUCTURAL DETAILS FOR METAL STUDS IN EXTERIOR & INTERIOR WLLS & SCOPE.- FRAMING MEMBERS :%lech. I'la, C-h,,k !'ftatsth. Plan Check b.lec. Plan Check y ch. Ilernzit bee: Plumb. Permit Fee: FE lec. Permit Fee: O thea 12eeh. ;lnrp ' Other Plumb Imp. Other f lee. Imp. lecda. lful�. ec Plumb. Imp. Fee: Elec, Imp Fee: NOTE: `This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dictriet.`etn ). Thew foot aro hated an the nroliminary information availahle and aro ank an a.ctimata_ 17antart tho Dont Mr addn'I info_ FEE ITEMS. (Fee Resolution 11-053 Elf. 711113 FEE QTY/FEE MISC ITEMS Plan Check Fee:'` $0.00 1� # Deferred Submittal $286.00 IDEFSuBM Suppl. PC, Fee: (E)Reg. 00TW hrs $0.00 PME Plan Check: $0.00 Permt,F.ee i $0.00 Su0pL1nsp: Fee:Q Reg. 0 0T:10.0 hrs $0.00 PM E Unit; Fee: :. $0.00 PME Permit Feer $0.00 Construction Tak: IBCONSTAXC $0.00 rry�an�s,iraiiv� Fie:. 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure i f ru�rel Db uinena ation fees: Strong Motion Fee:' $0.00 Select an Administrative Item Bldg Stds'Commission Fee: $0.00 _ $0.00 $286.00T>E� w'= $286.00 Revised: 10/01/2015 X CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19429 STEVENS CREEK BLVD CONTRAC OR: NO: 13120156 k,,;PERMIT � OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LL DATE ISSUED: 07/17/2015 OWNER'S PHONE: 4087251955 PHONE NO: �d LICENSED CONTRACTOR'S DECLARATION JOB DESC ' IPTION: RESIDENTIAL COMMERCIAL 0 /— MARRI T- CONSTRUCT SUPERSTRUCTURE (5) STORY License CVss # ��-�J �i1 HOTEL, v— Cont r443 — Date I7 `/ 5 142,487S FT TO INCLUDE 180 GUESTROOMS I hereoy-attfrm 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 Sq. Ft Flooq Area: Valuation: $16500000 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 APN Numb r: 31620109.19429 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 PERM 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_ D FROD ED INSPECT ON. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granti=jt.the applic t understands and will complyate: with aer pertino Municipal Code, Section 9.18. Signaate -�7, { All roofs shall RE -ROOFS: be inspected prior to any roofing material being installed. If a roof is installed without inspection. first obtaining an inspection, I agree to remove all new materials for ❑ OWNER -BUILDER DECLARATION Signature o 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). I have read the hazardous materials requirements under Chapter 6.95 of the California ealth & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain c mpliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & S fety 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. 4dditionally, 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 Qu ity anagement District I performance of the work for which this permit is issued. will maintain compliance with a upertino icipal ode, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health Safety Code, ons 25505, 33, and 2 34. Section 3700 of the Labor Code, for the performance of the work for which this Owner or uthorized ag permit is issued. 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 CONSTRUCTION LENDING AGENCY 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 I hereby aff rm 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 understan 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 P ofessional 9.18. Signature Date CONSTRUCTION PERMIT APPLI COMMUNITY DEVELOPMENT DEPARTMItNT - BUI 10300 TORRE AVENUE - CUPERTINO, CA 960144 (408) 777-3228 - FAX (408) 777-3333 - buildinq@cu CVPE117-40 RM 19 X'2WC0N9_MIIrn0N F1 ArInITUIN F1 AT.TPRATTnWJ-J-I TIPVT TION G DIVISION LOX9 nPFPRRF.n nRinTNAT. PF.RM[Tfi PROJECT ADDRESS Ql� APNII O%A'NCR NAME Main Street Cupertino Aggregator, LLC P`O"4 -7 1 r- 08 2571955 AIL nkumar@shemile.com STREIiT ADDREss 12930 Saratoga Avenue Suite B-5 CITY, sTATE-zIP Saratoga, CA 95070 FAX (408) 725-9866 CONTACT NAME Nandy'Kumar PHONE 408-7251-1955 I E-MAIL nkumar@shcmllc,.com ITRIETAI)DWESS 12930 Saratoga Avenue Suite B-51 CrTY.STATr, ZIP Sarat9ga.., CA 95070 1 FAx (408) 725-9866 136 It 11 OWNER -BUILDER 11 OWNERAGENT 0 CONTRACTOR 000NTRACTORAGENT El ARCHITECT 13ENGIMER 0 DEVELOPER 13 TENANT CONTRACTORNAMIE To Be Determined LICENSENUMBER LICENSETYPE BUS.LIClJ COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE ZIP PHONE ARCHITECT/ENGINEER NAME Henro LICENSE NUMBER C-;1 25, BUS. LIC COMPANY'NAME D. M.. Bergerson, Inn. I, AIL hen ..wong _.cimbarchiteots.cotri FAx 949-272-0201 STAEETADDRESS 8011 Research Drive, I st Floor CITY-STATE,IrvinerCA 9261E l-272-0171 DESCRIPTION OF WORK New 180 guestroom extended stay hotel, with meeting space, public afeas,� and supporting ancillary back of the house area. EXISTINP USE PROPOSED USE CONSTR. TYPE 41 STORIES n/a I hotel I -A & HIA 1 %5 USE� tYPE occ. SQ.FT. VALUATION($) 'EXISTO NEW FLOOR DEMO TOTAL. AREA n/a AREA AREA n/a NET AREA BATHROOM KITCHEN OTHER REMODEL AREA n/a REMODEL -AREA n/a REMODEL AREA PORCH AREA DECK AREA TOTAL DECKOPPORCH AREA GARAGE AREA: 8DETACH n/a n1a n/a ATTACH 4 DIVIILLINO UNITS: IS A SECOND UNIT E]YES SECOND STORY LJYES n/a BEING ADDED? ®NO ADDITION? U140 PRE -APPLICATION (:)YES IF YES, PROVIDE COPY OF ISTHEDLI)GAN J3 YES v RECET LU 0 PLANNINGAPPLO ONO PLANNING APPROVAL LETTER EICHLERHOME� ®NO By my signature Wow, I certify to each of the following: I am the property owner or authorized age11 to act on the property owner's behalf. I have read this application and the information I ha r Aded is corre read the Ddscription of Work. and v ify it is accurate. I agree to comply with all applicable local -4v " 11 __ I. " Ah.d. c ordinances and.statd'laws relatin n representatives of Cupertino to anter the abovelidenvRed property for inspection purposes. Signature of AppLiftn(/Api Date- 121 lbll_� SUPPLEMENTAL INFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demo - lition permit for ❑ 'a V11 existing building(s). Demolition permit is required prior to issuance of building permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Torm if any Hazardous Materials are being used as pail of this project,Ai _.Copy of Planning Approval Letter or Meeting with Planning prior to submittal ofBuildi19 Permit application. Bldg ,4pp_201 Ldoe revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: Main St- Hotel I DATE: 2/16/2013 1 REVIEWED BY: Sylvia r APN: BP#:*VALUATION: 1$0 1 *PERMIT TYPE: Building Permit PLAN CHECK YPE: New Construction PRIMARY Civil / Religious activiti s PENTAMATION USE: Commercial Building in BQ zone? Q Yels 0 No PERMIT TYPE: 1 R1 Hf WORK Marriot -Superstructure new 5 story hotel 142,487 sq to include 180 questrooms SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. C FEES PC FEE ID BP FEES BP FEE ID R-1 (Hotels & Motels) II-A,11[-A,V-A 142,487 $14,324.25 IRIHOTPLN, $60,428.00 1RIHOTINSP Permit Fee: $60,428.00 Suppl. Insp. Feer Reg. Cl OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXHrooms 180 #new $39,439.80 tiC t72iiiX,Sa7"c:ilil-f.' 1`'ee: 0 E) Work Without Permit? 0 Yes Q) No $0.00 TOTALS: 142,487 $14,324.25 X.�n.S' Yr Y ' �F:` $60,428.00 ti.1f '�A .., . �-:.; '"� :2„d \''%.. > Y k 4 r, .:,6 . Cr; b>..uv � K `. � `. ��k X! i.4: d .1.� , v_ .... ,(r.1 v:>.,�, �.... .., � :5 > .,, h•3�+�?' .. �'' i3� 1. ,hf .:cry., y ?i? ,� -�lech. 13'k i C!"zeck. QTY/4E le(,% Plan Umck 19ecl:. 1'z r'?P IZ 1'crt: pharl h, f'<',.,: h Fee: E's'ter.. Pe;r?ri; Fee: ofl!c'rMe. a?.. Insn• F-1 Other I31't?fitj7IPFSp. OiiZE:P'L_lC't', Irri'7.7, T_ ;19ecjr. Iizs,==�. Fee: F7rarniP, Ins?. Fee: Elec. hasp. Fee: NUM: This estimate does not include fees due to other Departments (i.e. Plan�dng, Public Works, Fire, sanitary sewer 1Jistric4 school 1 .Wrist_ etc_ 1_ Thace fees are hacad an the nrelin:inary infor madan availahle and are only an estimate. Contact the Dent for addu'l into. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13, FEE QTY/4E I MISC ITEMS Plan Check Fee: $14,324.25 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (R) Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $60,428.00 Suppl. Insp. Feer Reg. Cl OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXHrooms 180 #new $39,439.80 tiC t72iiiX,Sa7"c:ilil-f.' 1`'ee: 0 E) Work Without Permit? 0 Yes Q) No $0.00 Advanced Planning Fee. IPLLONGC $39,896.36 Select a Non -Residential G Building or Structure 0 Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 r SUBTOTALS 154,088.41 $p.00 '^ y t TOALtEE $154,088.41 Revised: 10/01/2013 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19429 STEVENS CREEK BLVD (316 20 115) CONTRACTOR: SOUTH BAY PERMIT NO: 13120156 OWNER'S NAME: 650-344-1500 DATE ISSUED: 07/17/2015 OWNER'S PHONE: PHONE NO: LICENSED CONTRACTOR'S DECLARATION License Class B Lic. #336974 Contractor SOUTH BAY Date 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. 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 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 04/05/2016 OWNER - BUILDER DECLARATION 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) 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 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 04/05/2016 BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: MARRIOT- CONSTRUCT SUPERSTRUCTURE (5) STORY HOTEL, 142,487 SQ FT TO INCLUDE 180 GUESTROOMS DEF # 1 - STRUCTURAL DETAILS FOR METAL STUDS IN EXTERIOR & INTERIOR WLLS & FRAMING MEMBERS - ISSUED 4/5/16 REV # 1 - RFI'S Sq. Ft Floor Area: Valuation: $16500000.00 APN Number: 316 20 115 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: MELISSA Date: 07/17/2015 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: 04/05/2016 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: 04/05/2016 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. Licensed CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.oro F-1 NFW CYINSTRI IC'TioN F-1 ADDITION n ALTERATION / TI M REVISION /DEFERRED ORIGINAL PERMIT # 13120156 PROJECT ADDRESS 19429 Stevens Creek Blvd, Cupertino, CA,�P,- OWNERNAME Sand Hill Const Management PHONE E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX CONTACT NAME Nandy Kumar PHONE 650.344.1500 E-MAIL nkumar@shcmllc.com STREET ADDRESS 2822 Sand Hill Rd, Ste 241 CITY, STATE, ZIP Menlo Park, 94025 FAX I�nq'S I'R ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ ILNAN1 CONTRACTOR NAME Majid Tavakoli LICENSE NUMBER 336974 LICENSE TYPE B BUS. I. WC 5655 COMPANY NAME South Bay Construction E-MAIL mtavakoli@sbci.com FAX STREET ADDRESS 1711 Dell Ave CITY, STATE, ZIP Campbell, CA 95008 PHONE 727.470.7255 ARCHITECT/ENGINEER NAME N i n a d C h a u k ka r LICENSE NUMBER BUS. LIC = COMPANY NAME ARCHITECTS ORANGE E-MAIL NinadC@Architectsorange.com FAX STREET ADDRESS 144 North Orange Street CITY, STATE, ZIP Orange, CA 92866 P110NI( 714.639.9860 DESCRIPTION OF WORK Deferred submittal for Curtain Wall, Towers #1, 2, and 3 (shop drawings & calculations) EXISTING USE PROPOSED USE CONSTR. TYPE I # STORIES I SH TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑YES BEING ADDED? ONO SECOND STORY OYES ADDITION? ONO PRE -APPLICATION OYES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ Y EICHLER HOME? RECEIVE UATION: By my signature below, I certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have prokided 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 to buil construe ' n. I authorize resentatives of Cupertino to enter the above -id e tified pro for inspection purposes. Signature of Applicant/Agent: ` 0 r Date: SUPPLEMENTAL INF MATION REQUIRED _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ EXPRESS ❑ STANDARD ❑ LARGE ❑ MAJOR ❑ BUILDING PLAN REVIEW ❑ PLANNING PLAN REVIEW ❑ PUBLIC WORKS ❑ FIRE DEPT ❑ SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06/21/11