The URL can be used to link to this page

15030181 - MISC CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15030181 10380 PERIMETER RD CUPERTINO CA 95014(316 20 092) S B C C INC CAMPBELL,CA 95008 OWNER'S NAME: ( DATE ISSUED:06/03/2016 OWNER'S PHONE:( PHONE NO:(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 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: HYATT HOUSE-CONSTRUCT(N)5 STORY HOTEL WITH 148 1 hereby affirm under penalty of perjury one of the following two declarations: GUEST ROOMS(88,857 sq ft);ASSEMBLY USES(13,843 SQ FT); 1. I have and will maintain a certificate of consent to self-insure for Worker's UNDERGROUND PARKING STRUCTURE(35,800 SQ FT). Compensation,as provided for by Section 3700 of the Labor Code,for the RFI#343-GARAGE GSF HEAD CLEARANCE performance of the work for which this permit is issued. RFI#368-GREASE DUCT NEW ROUTE&SIZE-ISSUED 1/28/2019 �. I have and will maintain Worker's Compensation Insurance,as provided for by RFI#353- 14"X 14"FIRE SMOKE DAMPER ABOVE ROOM 030 Section 3700 of the Labor Code,for the performance of the work for which this (INSTEAD OF 16"X 16")-ISSUED 02/05/2019 permit is issued. RFI#311 Elevator Lobby 020 Wall Covering-ISSUED 1/28/2019 APPLICANT CERTIFICATION REV#5-REPLACE FIRE RATED WINDOWS WITH A FIRE certify that I have read this application and state that the above SPRINKLER DELUGE SYSTEM-ISSUED 7/18/2018 information is correct. I agree to comply with all city and county ordinances REV#4-RFI'S(TO REMAIN OPEN TILL FINAL)**COUNTER and state laws relating to building construction,and hereby authorize DRAWER A** representatives of this city to enter upon the above mentioned property for REV#1-ADDRESS OSHA ROOF AND FACADE ACCESS inspection purposes. (We)agree to save indemnify and keep harmless the REQUIREMENTS,SOLAR AND HOTEL BRAND ISSUES-ISSUED City of Cupertino against liabilities,judgments,costs,and expenses which 7/26/2016 may accrue against said City in consequence of the granting of this permit. Additionally,the a ca t understands and will comply with all non-point REV#2-SHORING PLAN-ISSUED 12/14/2016 DEF#5-KITCHEN LAYOUT&EQUIPMENT-ISSUE 3-22-2019 I hereby affirm that I am exempt from the Contractor's License Law for one of the DEF#6-PUBLIC SPACE ACCESS CONTROL following two reasons: DEF#7-FOLDING PARTITION SUBMITTAL 1. I,as owner of the property,or my employees with wages as their sole DEF#8-HAZARDOUS MATERIALS SUBMITTAL-ISSUED 1/3/19 compensation,will do the work,and the structure is not intended or offered for DEF#9-SIGNAGE-ISSUED 3/22/2019 sale(Sec.7044,Business&Professions Code) DEF#10-ANCHORING PREVIOUSLY APPROVED EQUIPMENT z. I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). Sq.Ft Floor Area: Valuation:$24650000.00 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 APN Number: Occupancy Type: performance of the work for which this permit is issued. 316 20 092 i. 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 EXPIRES IF WORK IS NOT STARTED permit is issued. 3. I certify that in the performance of the work for which this permit is issued,I WITHIN 180 DAYS OF PERMIT ISSUANCE OR shall not employ any person in any manner so as to become subject to the 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by:Alex Vallelun�a be deemed revolted. Date:06/03/2016 APPLICANT CERTIFICATION certify that I have read this application and state that the above information is RE-ROOFS: correct.I agree to comply with all city and county ordinances and state laws All roofs shall be inspected prior to any roofing material being installed.If a roof is relating to building construction,and hereby authorize representatives of this city installed without first obtaining an inspection,I agree to remove all new materials for to enter upon the above mentioned property for inspection purposes. (We)agree inspection. to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Signature of Applicant: consequence of the granting of this permit. Additionally,the applicant understands Date:3-22-2019 and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Signature Date 3-22-2019 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 Owner or authorized agent: Date:3-22-2019 CONSTRUCTI N LENDING AGENCY 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 BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15030181 10380 PERIMETER RD CUPERTINO CA 95014 (316 20 092) S B C C INC CAMPBELL, CA 95008 OWNER'S NAME: ( ) DATE ISSUED: 06/03/2016 OWNER'S PHONE: ( PHONE NO: (408) 379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #336974 Contractors 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) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: HYATT HOUSE - CONSTRUCT (N) 5 STORY HOTEL WITH 148 I hereby affirm under penalty of perjury one of the following two declarations: GUEST ROOMS (88,857 sq f1); ASSEMBLY USES (13,843 SQ FT); 1. I have and will maintain a certificate of consent to self-insure for Worker's UNDERGROUND PARKING STRUCTURE (35,800 SQ FT). Compensation, as provided for by Section 3700 of the Labor Code, for the REV #5 - REPLACE FIRE RATED WINDOWS WITH A FIRE performance of the work for which this permit is issued. SPRINKLER DELUGE SYSTEM - ISSUED 7/18/2018 I have and will maintain Worker's Compensation Insurance, as provided for by REV # 4 - RFI'S (TO REMAIN OPEN TILL FINAL )**COUNTER Section 3700 of the Labor Code, for the performance of the work for which this DRAWERA** permit is issued. REV #1 - ADDRESS OSHA ROOF AND FACADE ACCESS . APPLICANT CERTIFICATION REQUIREMENTS, SOLAR AND HOTEL BRAND ISSUES - ISSUED certify that] have read this application and state that the above 7/26/2016 information is correct. I agree to comply with all city and county ordinances REV #2 - SHORING PLAN - ISSUED 12/14/2016 and state laws relating to building construction, and hereby authorize REV #3 - CHANGE IN FOOTING DESIGN - ISSUED 1/27/2017 representatives of this city to enter upon the above mentioned property for DEF #1 - TRUSS CALCS-ISSUED 5/25/2018 inspection purposes. (We) agree to save indemnify and keep harmless the DEF #2 - ELEVATOR SHOP - 07/18/2018 City of Cupertino against liabilities, judgments, costs, and expenses which DEF #3 - STORE FRONT - ISSUED 10/23/2018 may accrue against said City in consequence of the granting of this permit. DEF #4 - GENERATOR Additionally, the applicant understands and will comply with all non-point source regula ' ns per the Cupertino Municipal Code, Section 9.18. DEF #5 - KITCHEN LAYOUT & EQUIPMENT DEF #6 - PUBLIC SPACE ACCESS CONTROL DEF #7 - FOLDING PARTITION SUBMITTAL Signature Date 1/3/19 DEF #8 - HAZARDOUS MATERIALS SUBMITTAL - ISSUED 1/3/19 OWNER-B LDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the Sq. Ft Floor Area: Valuation: $24650000.00 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 APN Number: Occupancy Type: sale (Sec.7044,,Business & Professions Code) 316 20 092 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: PERMIT EXPIRES IF WORK IS NOT STARTED 1. I have and will maintain a Certificate of Consent to self-insure for Worker's WITHIN 180 DAYS OF PERMIT ISSUANCE OR Compensation, as provided for by Section 3700 of the Labor Code, for the 180 DAYS FROM LAST CALLED 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 Section 3700 of the Labor Code, for the performance of the work for which this Issued by: Alex Vallelun�a permit is issued. Date: 06/03/2016 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 RE-ROOFS: Worker's Compensation laws of California. If, after making this certificate of All roofs shall be inspected prior to any roofing material being installed. If a roof is exemption, I become subject to the Worker's Compensation provisions of the installed without first obta' be deemed revoked. APPLICANT CERTIFICATION Signature of Applicant: certify that I have read this application and state that the above information is Dater 1/3/19 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE consequence of the granting of this permit. Additionally, the applicant understands I have read the hazardous materials requirements under Chapter 6.95 of the and will comply with all non-point source regulations per the Cupertino Municipal California Health & Safety Code, Sections 25505, 25533, and 25534. I will Code, Section 9.18., 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 Signature Date 1/3/19 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15030181 10380 PERIMETER RD CUPERTIN0 CA 95014 (316 20 092) S B C C INC CAMPBELL, CA 95008 OWNER'S NAME: ( CUPERTINO PROPERTY DEVELOP LLC ) DATE ISSUED: 06/03/2016 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 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 - CONSTRUCT (N) 5 STORY HOTEL WITH 148 I hereby affirm under penalty of perjury one of the following two declarations: GUEST ROOMS (88,857 sq ft); ASSEMBLY USES (13,843 SQ FT); 1. I have and will maintain a certificate of consent to self-insure for Worker's UNDERGROUND PARKING STRUCTURE (35,800 SQ FT). Compensation, as provided for by Section 3700 of the Labor Code, for the REV #5 - REPLACE FIRE RATED WINDOWS WITH A FIRE performance of the work for which this permit is issued. SPRINKLER DELUGE SYSTEM - ISSUED 7/18/2018 ' have and will maintain Worker's "Compensation Insurance, as provided for by DEF #3 - STORE FRONT - ISSUED 10/23/2018 ' Section 3700 of the Labor Code, for the performance of the work for which this DEF #4 - GENERATOR permit is issued. . REV # 4 - RFI'S (TO REMAIN OPEN TILL FINAL)**COUNTER APPLICANT CERTIFICATION DRAWER A** I certify that I have read this application and state that the above REV #1 - ADDRESS OSHA ROOF AND FACADE ACCESS information is correct. I agree to comply with all city and county ordinances REQUIREMENTS, SOLAR AND HOTEL BRAND ISSUES - ISSUED and state laws relating to building construction, and hereby authorize 7/26/2016 representatives of this city to enter upon the above mentioned property for REV #2 - SHORING PLAN - ISSUED 12/14/2016 inspection purposes. (We) agree to save indemnify and keep harmless the REV #3 - CHANGE IN FOOTING DESIGN - ISSUED 1/27/2017 City of Cupertino against liabilities, judgments, costs, and expenses which DEF #1 - TRUSS CALLS-ISSUED 5/25/2018 may accrue against said City in consequence of the granting of this permit. Additionally, the appyt understands and will comply with all non-point DEF #2 - ELEVATOR SHOP - 07/18/2018 source regulation er t e Cupertino Municipal Code, Section 9.18. Signature �'°�. Date 10/23/2018 Sq. Ft Floor Area: Valuation: $24650000.00 O NER-B ILDE. 'DECLARATIO APN Number, Occupancy Type: I hereby affi that I am exempt from the Contractor's License Law for one of the 316 20 092 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 PERMIT EXPIRES IF WORK IS NOT STARTED sale (Sec.7044, Business & Professions Code) WITHIN 180 DAYS OF PERMIT ISSUANCE OR z, I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by: Alex Vallelun�a Compensation, as provided for by Section 3700 of the Labor Code, for the Date: 06/03/2016 performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by RE-ROOFS: Section 3700 of the Labor Code, for the performance of the work for which this All roofs shall be inspected prior to any roofing material being installed. If a roof is permit is issued. installed without first obtaining an inspection, I agree to remove all new materials for 3. I certify that in the performance of the work for which this permit is issued, I inspection. 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 Signature of Applicant: exemption, I become subject to the Worker's Compensation provisions of the Date: 10/23/2018 Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revolted. ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is HAZARDOUS MATERIALS DISCLOSURE correct. I agree to comply with all city and county ordinances and state laws I have read the hazardous materials requirements under Chapter 6.95 of the relating to building construction, and hereby authorize representatives of this city California Health & Safety Code, Sections 25505, 25533, and 25534. I will to enter upon the above mentioned property for inspection purposes. (We) agree maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the to save indemnify and keep harmless the City of Cupertino against liabilities, Health & Safety Code, Section 25532(a) should I store or handle hazardous judgments, costs, and expenses which may accrue against said City in material. Additionally, should I use eq�d nt or devices which emit hazardous consequence of the granting of this permit. Additionally, the applicant understands air contaminants as defined by thXAupertino y Area it Quality Management District I and will comply with all non-point source regulations per the Cupertino Municipal will maintain compliance with tl Munici al Code Cha ter 9.12 and Code, Section 9.18. p �' p p the Health & Safety 25534. Signature Date 10/23/2018 Owner or authorized agen Date: 10/23/2018 CONST.RU N LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance • CITY OF CUPERTINO BUILDING PERMI-T BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15030181 10380 PERIMETER RD CUPERTINO CA 95014(316 20 092) S B C C INC CAMPBELL,CA 95008 OWNER'S NAME: ( DATE ISSUED:06/03/2016 OWNER'S PHONE:( PHONE NO:(408)379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class)a Lie.#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-CONSTRUCT(N)5 STORY HOTEL WITH 148 I hereby affirm under penalty of perjury one of the following two declarations: GUEST ROOMS(88,857 sq ft);ASSEMBLY USES(13,843 SQ FT); a I have and will maintain a certificate of consent to self-insure for Worker's UNDERGROUND PARKING STRUCTURE(35,800 SQ FT). Compensation,as provided for by Section 3700 of the Labor Code,for the RFI#368-GREASE DUCT NEW ROUTE&SIZE--ISSUED 1/28/2019 Section 3700 of the Labor Code,for the performance of the work for which this RFI#311 Elevator Lobby 020 Wall Covering-ISSUED 1/28/2019 permit is issued. REV#5-REPLACE FIRE RATED WINDOWS WITH A FIRE APPLICANT CERTIFICATION SPRINKLER DELUGE SYSTEM-ISSUED 7/18/2018 I certify that I have read this application and state that the above REV#4-RFI'S(TO REMAIN OPEN TILL FINAL)**COUNTER information is correct.I agree to comply with all city and county ordinances DRAWER A** and state laws relating to building construction,and hereby authorize REV#1-ADDRESS OSHA ROOF AND FACADE ACCESS representatives of this city to enter upon the above mentioned property for REQUIREMENTS,SOLAR AND HOTEL BRAND ISSUES-ISSUED inspection purposes. (We)agree to save indemnify and keep harmless the 7/26/2016 City of Cupertino against liabilities,judgments,costs,and expenses which REV#2-SHORING PLAN ISSUED 12/1412016 may accrue against said City in consequence of the granting of this permit. REV#3 CHANGE IN FOOTING DESIGN-ISSUED 1/2.7/2017 Additionally,the applicant understands and will comply with all non-point source regulatio ".-r th Cupertino Municipal Code,Section 9.18. DEF#1-TRUSS CALLS-ISSUED 5/25/2018 DEF#2-ELEVATOR SHOP-07/18/2018 DEF#3-STORE FRONT-ISSUED 10/23/2018 C Signature Date 02/05/2019 DEF-#4--GENERATOR-ISSUED 02/05/2019 DEF#5-KITCHEN LAYOUT&EQUIPMENT • i 1 I hereby affirm that I am exempt from the Contractor's License Law for one of the DEF#7 FOLDING PARTITION SUBMITTAL following two reasons: DEF#8-HAZARDOUS MATERIALS SUBMITTAL-ISSUED 1/3/19 t. I,as owner of the property,or my employees with wages as their sole DEF#9-SIGNAGE compensation,will do the work,and the structure is not intended or offered for DEF#10-ANCHORING PREVIOUSLY APPROVED EQUIPMENT 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). Sq.Ft Floor Area: Valuation:$24650000.00 I hereby affirm under penalty of perjury one of the following three declarations: i. I have and will maintain a Certificate of Consent to self-insure for Worker's APN Number: Occupancy Type: Compensation,as provided for by Section 3700 of the Labor Code,for the 316 20 092 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 EXPIRES IF WORK IS NOT STARTED permit is issued. WITHIN 180 DAYS OF PERMIT ISSUANCE OR a. I certify that in the performance of the work for which this permit is issued,i 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued.-by:Alex Vallelunga Labor Code,I must forthwith comply with such provisions or this permit shall Date:06/03/2016 be deemed revoked. APPLICANT CERTIFICATION RE-ROOF& I certify that I have read this application and state that the above information is All roofs shall be inspected prior to any roofing material being installed.If a roof is correct.I agree to comply with all city and county ordinances and state laws installed without first obtaining an inspection,I agree to remove all new materials for relating to building construction,and hereby authorize representatives of this city '" judgments,costs,and expenses which may accrue against said City in Date:02/05/2019 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. ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER HAZARDOUS MATERIALS DISCLOSURE Signature Date 02/05/2019 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:02/05/2019 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 BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15030181 10380 PERIMETER RD CUPERTINO CA 95014 (316 20 092) OWNER'S NAME: (CUPERTINO PROPERTY DEVELOP LLC) DATE ISSUED: 06/03/2016 OWNER'S PHONE: PHONE NO: 1 RAD"to) t 1 License Class Lic. # Contractor 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 6/3/2016 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) , as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). hereby affirm under penalty of perjury one of the following three 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. 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 - 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. Date/6 312016 BUILDING PERMIT INFO: BLDG — ELECT _PLUMB MECH _ RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: HYATT HOUSE - CONSTRUCT (N) 5 STORY HOTEL WITH 148 GUEST ROOMS (88,857 sq ft); ASSEMBLY USES (13,843 SQ FT); UNDERGROUND PARKING STRUCTURE (35,800 SQ FT). 9/22/15 PERMIT APPL EXTENDED TILL 12/26/15 Sq. Ft Floor Area: I Valuation: $24650000.00 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 CALLEDTSPECTION. Issued by: Alex Vallelunga 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: 6/3/2016 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: 6/3/2016 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15030181 10380 PERIMETER RD CUPERTINO CA 95014 (316 20 092) OWNER -BUILDER OWNER'S NAME: (CUPERTINO PROPERTY DEVELOP LLC) DATE ISSUED: 06/03/2016 OWNER'S PHONE: PHONE NO: LICENSED CONTRACTOR'S DELL RATION BUILDING PERMIT INFO: License Class Lie. # Contractor OWNER -BUILDER 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: HYATT HOUSE - CONSTRUCT (N) 5 STORY HOTEL WITH 148 1 hereby affirm under penalty of perjury one of the following two declarations: GUEST ROOMS (88,857 sq ft); ASSEMBLY USES (13,843 SQ FT); 1. 1 have and will maintain a certificate of consent to self -insure for Worker's UNDERGROUND PARKING STRUCTURE (35,800 SQ FT). Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. #1 - ADDRESS OSHA ROOF AND FACADE ACCESS 2. I have and will maintain Worker's Compensation Insurance, as provided for by .REQUIREMENTS, SOLAR AND HOTEL BRAND ISSUES -ISSUED Section 3700 of the Labor Code, for the performance of the work for which this 7/26/2016 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above. information is correct.: 1 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 9/22/15 PERMIT APDL EXTENDED TILL 12/26/15 inspection purposes. (We) agree to save indemnify and keep harmless the Sq. Ft Floor Area: Valuation: $24650000.00 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 regulations per the Cupertino Municipal Code, Section 9.18. 316 20 092 Signature Date 07/26/2016 PERMIT EXPIRES IF WORK IS NOT STARTED OWNER -BUILDER DECLARATION 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 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 S Issued by ME A N 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. 1 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: 07/26/2016 s Compensation laws of California. If, after making this certificate of HAZARDOUS MATERIALS DISCLOSURE exemption, I become subject to the Worker's Compensation provisions of the I have read the hazardous materials requirements under Chapter 6.95 of the Labor Code, I must forthwith comply with such provisions or this permit shall 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 Health & Safety Code, Section 25532(a) should I store or handle hazardous APPLICANT CERTIFICATION I 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 air contaminants as defined by the Bay Area Air Quality Management District I correct. I agree to comply with all city and county ordinances and state laws will mainta with the Cupertino Municipal Code, Chapter 9.12 and relating to building construction, and hereby authorize representatives of this city . the Health &Safety C�o�e,�Sec' 25505, 25533, and 25534. a Health & S 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 Owner or authorized ;irn/t: consequence of the granting of this permit. Additionally, the applicant understands Date: 07/26/2016 and will comply with all non -point source regulations per the Cupertino Municipal CONSTRUCTION LENDING 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.) ` Lender's Name Signature/ Date 07/26/2016 Lender's Address CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15030181 10380 PERIMETER RD CUPERTINO CA 95014 (316 20 092) S B C C INC CAMPBELL, CA 950C 8 OWNER'S NAME: (CUPERTINO PROPERTY DEVELOP LLC) DATE ISSUED: 06/03/2016 OWNER'S PHONE: ( PHONE NO: ( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic. #336974 Contractor S B C C INC Date 03/31/2018 _BLDG _ ELEC PLUMB MECH RESIENTIAL COMMERCTAI 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 DESCRIPTI N: HYATT HOUSE - CONSTRUCT (N) 5 STORY HOTEL WITH 148 1 hereby affirm under penalty of perjury one of the following two declarations: GUEST ROOMS (8 3,857 sq ft); ASSEMBLY USES (13,843 SQ FT); 1. I have and will maintain a certificate of consent to self -insure for Worker's UNDERGROUND PARKING STRUCTURE (35,800 SQ FT). Compensation, as provided for by Section 3700 of the Labor Code, for the REV #1 - ADDRES 5 OSHA ROOF AND FACADE ACCESS performance of the work for which this permit is issued. REQUIREMENTS, SOLAR AND HOTEL BRAND ISSUES - ISSUED have and will maintain Worker's Compensation Insurance, as provided for by 7/26/2016 Section 3700 of the Labor Code, for the performance of the work for which this REV #2 - SHORING PLAN - ISSUED 12/14/2016 permit is issued, APPLICANT CERTIFICATION I certify that I have read this application and state that the above Sq. Ft Floor Area: Valuation; $24650000.00 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize APN Number: Occupancy Type: representatives of this city to enter upon the above mentioned property for 316 20 092 316 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 PERMIT E IRES IF WORK IS NOT STARTED source regulations pert ertino Municipal Code, Section 9,18, WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST a D INSPECTION. Signature Date 12/14/2016 Issued by: MELISS OWNER -BUILDER DECLARATION Date: a6f'83f ftt6- I2 / K I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE 1. I, as owner of the property, or my employees with wages as their sole All roofs shall inspected -ROOFS: prior to any roofing material being installed. If roof is compensation, will do the work, and the structure is not intended or offered for installed withoutt first rials for agree to remove all new materials btaining an inspection,pe sale (See.7044, Business & Professions Code) inspection. ns p tion 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). Signature ofApplican : I hereby affirm under penalty of perjury one of the following three declarations: Date: 12/14/2016 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 ALL ROO COVERINGS TO BE CLASS "A" OR BETTER 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 t11e work for which this HAZARDOUS I have read the ha MATERIALS DISCLOSURE ardous materials requirements under Chapter 6.95 of the permit is issued. s. I certify that in the performance of the work for which this permit is issued, I California Health maintain compliant & Safety Code, Sections 25505, 25533, and 25534. I will with the Cupertino Municipal Code, Chapter 9.12 and the shall not employ any person in any manner so as to become subject to the Health & Safety Gode, Section 25532(a) should I store or handle hazardous Worker's Compensation laws of California. If, after making this certificate of material. Additiona ly, should I use equipment or devices which emit hazardous exemption, I become subject to the Worker's Compensation provisions of the air contaminants as defined by the Bay Area Air Quality Management District I Labor Code, I must forthwith comply with such provisions or this permit shall will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and be deemed revoked. the Health & Safety Code, Se ti 5, 25533, and 25534. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is Owner 4/2aut016iz d agent: correct. I agree to comply with all city and county ordinances and state laws Date: 12/14/2016 2/ ONSTR C performance to enter upon the above mentioned property for inspection purposes. (We) agree of work's for which this permit is issued (Sec. 3097, Civ C.) to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands Lender's Address and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ARCHITECT'S DECLARATION understand my plans shall be used as public records. Signature Date 12/14/2016 Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15030181 10380 PERIMETER RD CUPERTINO CA -95014 (316 20 092) S B C C INC CAMPBELL, CA 95008 OWNER'S NAME: (CUPERTINO PROPERTY DEVELOP LLC) DATE ISSUED: 06/03/2016 OWNER'S PHONE: ( PHONE NO: ( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lie. #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; HYATT HOUSE - CONSTRUCT (I) 5 STORY HOTEL WITH 148 1 hereby affirm under penalty of perjury one of the following two declarations: GUEST ROOMS (88,857 sq ft); ASSEMBLY USES (13,843 SQ FT); 1. 1 have and will maintain a certificate of consent to self -insure for Worker's UNDERGROUND PARKING STRUCTURE (35,800 SQ FT). Compensation, as provided for by Section 3700 of the Labor Code, for the REV #1- ADDRESS OSHA ROOF AND FACADE ACCESS ,performance of the work for which this permit is issued. REQUIREMENTS, SOLAR AND HOTEL BRAND ISSUES - ISSUED { I have and will maintain Worker's Compensation Insurance, as provided for by 7/26/2016 Section 3700 of the Labor Code, for the performance of the work for which this REV #2 - SHORING PLAN - ISSUED 12/14/2016 permit is issued. REV #3 - 12-20-2016 -CHANGE IN FOOTING DESIGN - ISSUED APPLICANT CERTIFICATION 1/27/2017 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 Sq. Ft Floor Area: Valuation: $24650000.00 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 APN Number: Occupancy Type: may accrue against said City in consequence of the granting of this permit. 316 20 092 AdiJitionally,, the a nt understands and will comply with all non -point source regulati, s per th Cupertino Municipal Code, Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED Date 01/27/2017 WITHIN 1.80 DAYS OF PERMIT ISSUANCE OR Signature,- 180 DAYS FROM LAST C LED INSPECTION. _B D I I hereby affirm that I am exempt from the Contractor's License Law for one of the Issued by: ME I SAN S following two reasons: Date: "` 49. � r. 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 RF ROOFS• sale (Sec.7044, Business & Professions Code) All roofs shall be inspected prior to any roofing material being installed. If a roof is a. I, as owner of the property, am exclusively contracting with licensed installed without first obtaining an inspection, I agree to remove all new materials for contractors to construct the project (Sec.7044, Business & Professions Code). inspection. I hereby affirm under penalty of perjury one of the following three declarations: r. I have and will maintain a Certificate of Consent to self -insure for Worker's Signature of Applicant: Compensation, as provided for by Section 3700 of the Labor Code, for the Date: 01/27/2017 performance of the work for which this permit is issued. 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. s. I certify that in the performance of the work for which this permit is issued, I HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the shall not employ any person in any manner so as to become subject to the California Health & Safety Code, Sections 25505, 25533, and 25534. I will Worker's Compensation laws of California. If, after making this certificate of maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the exemption, I become subject to the Worker's Compensation provisions of the Health & Safety Code, Section 25532(x) should I store or handle hazardous Labor Code, I must forthwith comply with such provisions or this permit shall material. Additionally, should I use equipment or devices which emit hazardous be deemed revoked. air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cuper ' o unicipal Code, Chapter 9.12 and APPLICANT CERTIFICATION the Health & Safety Code, S tions 505, 25533, and 25534: 1 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 Owner or authorized agent to enter upon the above mentioned property for inspection purposes. (We) agree Date: 01/27/2017 TRUCTI AGENCY to save indemnify and keep harmless the City of Cupertino against liabilities, CON I hereby affirm that there is a construction lending agency for the performance judgments, costs, and expenses which may accrue against said City in this Additionally, the applicant understands of work's for which this permit is issued (Sec. 3097, Civ C.) consequence of the granting of permit. and will comply with all non -point source regulations per the Cupertino Municipal Lender's Name Code, Section 9.18. Lender's Address Signature Date 01/27/2017 ARCHITECT'SDECLARATION I understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:15030181 10380 PERIMETER RD CUPERTINO CA 95014(316 20 092) S B C C INC CAMPBELL,CA 95008 OWNER'S NAME:(CUPERTINO PROPERTY DEVELOP LLC) SUED:06/03/20 R'S PHONE:(408)777-3081 PHONE NO:(408)379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 13 Lie.#336974 Contractor S B C C INC Date 0 3131/2 01 8 —BLDG ELECT_PLUMB I hereby affirm that 1 am licensed under the provisions of Chapter 9(commencing —MECH_RESIDENTIAL—COMMERCIAL with Section 7000)ofDivislon 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: HYATT HOUSE-CONSTRUCT(N)5 STORY HOTEL WITH 148 I hereby affirm under penalty of perjury one of the following two declarations: GUEST ROOMS(88,857 sq ft);ASSEMBLY USES(13,843 SQ FT); r. I have and will maintain a certificate of consent to self-insure for Worker's UNDERGROUND PARKING STRUCTURE(35,800 SQ FT). Compensation,as provided for by Section 3700 of the Labor Code,for the REV#5-REPLACE FIRE RATED WINDOWS WITH A FIRE performance of the work for which this permit is issued. SPRINKLER DELUGE SYSTEM I have and will maintain Worker's Compensation Insurance,as provided for by REV#4-RFI'S(TO REMAIN OPEN TILL FINAL)**COUNTER - Section 3700 of the Labor Code,for the performance of the work for which this DRAWER A** permit is issued. REV#1-ADDRESS OSHA ROOF AND FACADE ACCESS APPLICANT CERTIFICATION REQUIREMENTS,SOLAR AND HOTEL BRAND ISSUES-ISSUED I certify that I have read this application and state that the above 7/26/2016 information Is correct.I agree to comply with all city and county ordinances REV#2-SHORING PLAN-ISSUED 12/14/2016 and state laws relating to building construction,and hereby authorize REV#3-CHANGE IN FOOTING DESIGN-ISSUED 1/27/2017 representatives of this city to enter upon the above mentioned property for DEF#1-TRUSS CALCS-ISSUED 5/25/2018 Inspection purposes.(We)agree to save indemnify and keep harmless the DEF#2-ELEVATOR SHOP City of Cupertino against liabilities,judgments,costs,and expenses which q.Ft Floor Area: Valuation:$24650000.00 Additionally,th appll ant understands and will comply with all non-point source regul ions p r therti Municipal Code,Section 9.18. APN Number: Occupancy Type: 316 20 092 Signature Date 5/25/2018 owNER-BUILDER 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 followingtwo reasons: 1. 180 DAYS FROM LAST CALLED INSPECTION. 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 //��aa� sale(S-7044,Business&Professions Code) Issued by:.Adex 1rs118fi+nea VMU7 (ry� 2. I,as owner of the property,am exclusively contracting with licensed Date:96/-03 2,04.6 (� 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: r. I have and will maintain a Certificate of Consent to self-insure for Worker's All roofs shall be inspected prior to any trading material being installed.If a roof is Compensation,as provided for by Section 3700 of the Labor Code,for the installed without fust obtaining an inspection,I agree to remove all new materials for performance of the work for which this permit is issued. inspection. 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 Signature of Applicant; permit is issued. Data:5/25/2018 s. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any mamner 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 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 be deemed revoked. 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 stare or handle hazardous correct.I agree to comply with all city and county ordinances and state laws material.Additionally,should I us 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 Cmounictpal Code,Chapter 9.12 and to save Indemnify and keep harmless the City of Cupertino against liabilities, the Health&Safety Code Sections 5505,25533,and 25534. 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:5/25/2018 Code,Section 9.18. CONSTRU N 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.) Signature Date 5/25/2018 Lender's Name Lender's Address CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:15030181 10380 PERIMETER RD CUPERTINO CA 95014(316 20 092) S B C C IN C CAMPBELL,CA 95008 OWNER'S NAME:(CUPERTINO PROPERTY DEVELOP LLC) DATE ISSUE OWNER'S PHON 1 PHONE NO:(408)379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class @ C 4336974 BLDG ELECT—PLUMB Contractor S B C C INC Date 03!31!2020 — 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: HYATT HOUSE-CONSTRUCT(N)5 STORY HOTEL WITH 148 I hereby affirm under penalty of perjury one of the following two declarations: GUEST ROOMS(88,857 sq ft);ASSEMBLY USES(13,843 SQ FT); 1. 1 have and will maintain a certificate of consent to self-insure for Worker's UNDERGROUND PARKING STRUCTURE(35,800 SQ FT). Compensation,as provided for by Section 3700 of the Labor Code,for the REV#5-REPLACE FIRE RATED WINDOWS WITH A FIRE performance of the work mi far which this pert is issued. SPRINKLER DELUGE SYSTEM-ISSUED 07/18/2018 I have and will maintain Worker's Compensation Insurance,as provided for by REV#4-RFPS(TO RENJAIN OPEN TILL FINAL)--COUNTER Section 3700 of the Labor Code,for the performance of the work for which this DRAWER A** permit is issued. REV#1-ADDRESS OSHA ROOF AND FACADE ACCESS APPLICANT CERTIFICATION REQUIREMENTS,SOLAR AND HOTEL BRAND ISSUES-ISSUED I certify that I have read this application and state that the above 7/26/2016 information Is correct.I agree to comply with all city and county ordinances REV 92-SHORING PLAN-ISSUED 12/14/2016 and state laws relating to building construction,and hereby authorize REV#3-CHANGE IN FOOTING DESIGN-ISSUED 1/27/2017 representatives of this city to enter upon the above mentioned property for DEF#1-TRUSS CALCS-ISSUED 5/25/2018 inspection purposes. (We)agree to save indemnify and keep harmless the DEF 92-ELEVATOR SHOP-07/18/2018 City of Cupertino against liabilities,judgments,costs,and expenses which may accrue all.m said City fn consequence of the granting of this permi l comply with all non-point source regu tions per the Cupertino Municipal Code,Section 9.18. AI'N Number: Occupancy Type: 316 20 092 Signature Date 07/18/2018 OWNER-13111LIZECLARATIONPERMIT EXPIRES IF WORK IS NOT S'T'ARTED I hereby affirm that I mu exempt from the Contractor's License Law for one of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR following two reasons: 180 DAYS FROM LAST CALLED INSPECTION. r. 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) Issued by:Alex Valleluuga z. 1,as owner of the property,am exclusively contracting with licensed Date:06/03/2016 contractors to construct the project(Sce.7044,Business&Professions Code). I hereby affirm under penaltyofperjury 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 rooting material being installed.Ifo root'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 ofdre work for which this permit is issued. inspection. 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 Signature ufApplicant permit is issued. Date:07/18/2018 a. I certify that in the performance of the work for which this permit is issued,l 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,l become subject to the Worker's Compensation provisions of the HAZARDOUS MATERIALS DISCLOSURE Labor Code,1 must forthwith comply with such provisions or this permit shall I have read the hazardous materials requirements under Chapter 6.95 of the be deemed revoked. California Health&Safety Code,Sections 25505,25533,and 25534.I will APPLICANT CER'1'1 PICATION maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the certify that I have read this application and State that the above information is Health&Safety Code,Section 25532(1)should I she 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 dented th ti Cupertino unicipal Code Chapter 9.12 and to save Indemnify and keep harmless the City of Cupertino against liabilities, the Health&Safet ode Sec 25 05,25533,and 25534. 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 a and will comply with all non-point source regulations per the Cupertino Municipal Date:07118!2018 Code,Section 9.18. CONST. C N LE llING AGENCY I hereby affirm that there is a construction landing agency for the performance of work's for which this permit Is issued(Sec.3097,Civ C.) Signature Date 07/18/2018 Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO F � FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10380 Perimeter Road DATE: 03/30/2015 REVIEWED BY: Sean / Albert APN: BP#: 15030181 *VALUATION: 1$24,650,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY Commercial Building USE: Civil / Religious activities in BQ zone. 0 Yes E) No PENTAMATION PERMIT TYPE: 1 R1 H WORK Hatt House - Construct N 5 -Story Hotel with 148 quest rooms 88,857 s.f. ; Assembly Spaces SCOPE (13,843 s.f.); Underground Parking Structure (35,800 s.f OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.f.) PC FEES PC FEE ID BPFEES BP FEE ID R-1 (Hotels & Motels) II-A,111-A,V-A 88,857 $13,290.97 1RIHOTPLIV $46,959.39 IRIHOTINSP A-2 I-A,I-B 13,843 $11,598.34 IA2PLNCK $20,152.20 IA2INSP S-2 (Low -Hazard) 1-A,I-B 35,800 $12,096.62 IS2PLNCK $29,334.30 IS2INSP #new rooms $73,564.58 {nstructio ive Fee: 0 Work Without Permit? 0 Yes (9 No $0.00 TOTALS: 138,500 $36,985.93 TravelDocumentation 1tes: $9_6 Strong Motion Fee: IBSEISMZCO NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, fire, Nan1tary Newer U1Strtct, 3cnoot "t,. 1 Thera foo nag hnc?4 nru rho nrey"g Hary Fnfnrmatinn availahle and are only an estimate. Contact the Dent for addn't info.. FEE ITEMS (Fee Resolution 11-053 E . 711113) /hol llhiinb..Plap Check- fIc c'. Phl7 C, i2ec . A. ec'f . Pc f tat Fec: Cee: Phi}nr.". Pe flit C Elec. M—tFee w7ii`" Other i-Iech.171sp, Other /3l7?tt b hiss.EI-L- Other Elee. b-sp. Ll 11 -tech. hiss. Fee: Plumb- h74"p. Tee: Elec. 11tSF Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, fire, Nan1tary Newer U1Strtct, 3cnoot "t,. 1 Thera foo nag hnc?4 nru rho nrey"g Hary Fnfnrmatinn availahle and are only an estimate. Contact the Dent for addn't info.. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $36,985.93 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. 0 OTT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $96,445.89 Suppl. Insp. Fee: 1 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 n Tax: IBCONSTAXH Construction 148 #new rooms $73,564.58 {nstructio ive Fee: 0 Work Without Permit? 0 Yes (9 No $0.00 Advanced Planning Fee: IPLLONGC $40,165.00 Select a Non -Residential Building or Structure 0 TravelDocumentation 1tes: Strong Motion Fee: IBSEISMZCO $6,902.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $986.00 SUBTOTALS:$255,049.401 $0.00 TOTAL FEE: $255,049.40 Revised: 02/14/2015 CITY OF CUPERTINO FEE ESTIMATOR - _1111JILDING DIVISION ADDRESS: 10380 Perimeter Road 'DATE: 05131/2016 REVIEWED BY: Sean/Albert APN: BP#: 15030181 *VALUATION: 1$24,650,000 *PERMIT TYPE: Building Permit FPL; --N CHECK TYPE: New Construction PRIMARY Commercial Building USE: Civil / Religious activities in BQ zone? 0 Yes E) No PENTAMATION .1R1HM PERMIT TYPE: WORK Hyatt House - Construct (N) 5 Story Hotel with 148 quest rooms (88857 sq ft); Assembly Spaces SCOPE (13843 sq ft); Underground Parking Structure (35800sqft). OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (S.f.) PC FEES PC FEE ID BP FEES BP FEE 1D R-1 (Hotels & Motels) 11-A,111-A,V-A 88,857 $13,290.97 1R1H0TPLNi ($415,959.39 j]RIHOTINSP A-2 I-A,I-B 13,843 $11,598.34 IA2PLNCK f_$20,152.20 i / 1A21NSP S-2 (Low -Hazard) I-A,I-B 35,800 $12,096.62 IS2PLNCK $29,334.30 IS2INSP new rooms Adildnislrafivc Fe'e: �'R 4E ZA44-_- :I= E) 7^6 Work Without Permit? C) Yes (j) No TOTALS: 138,500 1 $36,985.931 Select a Non -Residential Building or Structure 0 A 1 0&_44"9-1 I aup. TN'unn"', 1-1arz � 111'e'r�,3". Pfwnb, perrs;,, Fee: 0,1he-i Phwnb huq% NOTE. This estimate does not inchtdefees due to other Departments (I a )rks, Fire, Sanitary Sewer Distr Dktriefetr) 77ipvp f,,,v are havid an the nrifimi"ary i"farninfin" availahle and are a"k an avtimah, C'n"tart the Dent far adfln'l info FEE ITEMS !F, C e Resolution 11-053 kff. 7111.13) FEE QTY/FEE7 MISC ITEMS Plan Check Fee: $36,985.93 Select a Misc Bldg/Structure or Ie ent Building ® Suppl. PC Fee: (E) Reg. 0 OT 0.0 1 hrs $0.00i PME Plan Check: $0.00 7-7 Permit Fee: $96,445.89 Suppl. Insp. Fee.(E) Reg. 0 OT 0.0 hrs $0.00 /,-;o ;7 49 PME Unit Fee: $0.00 PME Permit Fee: $0.001( 9—,, �,x:,-� 6jev 4.,Yc Construction Ti--,--: IBCONSTAXH"148 new rooms Adildnislrafivc Fe'e: �'R 4E ZA44-_- :I= E) Work Without Permit? C) Yes (j) No $0.00 Advanced Planning Fee:IPLLONGC Select a Non -Residential Building or Structure 0 A Strong Motion Fee: iBsEismco ) i $6,902.00 - Select an Administrative Item -- ----------- —7 Bldg Stds Commission FIBCBSC --- _-, C_ee: , $986.00 $IJBT,6TAL54256,588.90 $0.00 TQTAL FEE:: 1$256,588.90] Revised: 07/02/2015 t o]: FEE]�STIMA I OR — BUILDING DIVISION ]PC 16'dES PC FEE )<ID A1IDDRESS. Myatt House -Superstructure DATE. 02112120/6 REVIEWED B . A. Salvador BP FEE I(ID APN. BP#: �°VAl[,V7AT IST: $24,660,000 *PERMIT TYPE- Building Permit PLAN CH ECK'I YPE. INew Const ction IPRI[ VLh,RY USE:Commercial Building Civil /Religious activities in BQ zone? . 0 Yes m, No � P - 'I'ATION E][£1yIP]E, 1R1HM ,�1P�W�T �" WORK $20,152.20 1A21NSP SCOPE I-A,I-B 35,80 $12,096.62 ®CC`1ti1PA1�fC�''>('�']PIE: TYPE E EDF FLR AR EA CONSTR. (SX) ]PC 16'dES PC FEE )<ID IfIIP 1<+`IEIES BP FEE I(ID R-1 (Motels & Motels) II-A,III-A,V-A 102,700/13,667.71 Jthr�r Pfiewb lrup. IR1HOTPLN+ $50,893.77 IRIH07YNSP A-2 I-A,I-B 13843 $11,598.34 1-42PLNCK $20,152.20 1A21NSP S-2 (Low -Hazard) I-A,I-B 35,80 $12,096.62 IS2PLHCK $29,334.30 IS2INSP $0.00 PME Unit Fee: $0.00 PME Permit Fee; TOTALS- �i52,343 $37,362.67 $100,380.27. NOTE. T'hfs estimate does rept includefee dh e to ether Departinents (Le. Planning, Public Works, Fire, Sanitary Sewer District, School ,Y virlot. etc.). These fees are base al an tl a orelimintary information available and are o®aly an estimate. C'oneact the Detat.lbr atltltt'l info. IF9ElE ITEMS EMS Eec Rg. ,s glut on 1.1-0 Eff 7.11/13 Mach. Plast Check flan Check Ph7Phunh Elea Plan(Ywak rilFr.lr. P<arr» dt Fee: Perwit Fee: lile<;, pennit C1tFt4r llizclr.. Trasp.ET-L, Jthr�r Pfiewb lrup. Orher1:7ec. Insp. h�ech. lrrsll. Fee: Plumb. Anp. Fee: Rea Insp. Fee; NOTE. T'hfs estimate does rept includefee dh e to ether Departinents (Le. Planning, Public Works, Fire, Sanitary Sewer District, School ,Y virlot. etc.). These fees are base al an tl a orelimintary information available and are o®aly an estimate. C'oneact the Detat.lbr atltltt'l info. IF9ElE ITEMS EMS Eec Rg. ,s glut on 1.1-0 Eff 7.11/13 FEE QTY/FEIE M1ISC )<'I<'IEMS Plan Check Pee: $37,362.67 Select a Misc Bldg/Structure or Element of a Building Suppl, PC Fee: Reg, 0 G(T hrs $0.00 PME Plan Check: $0.00 Permit Fee: DI00,380.27 Suppl. Insp. Feer Reg. Lo OT� hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee; $0.00 Construction Tax: 1 BCONSTAXH 14g #a,ew $76,629.58 rooms <<lriiriitzisti cttiEfe Face Work Without Peiinit? Yes D No $0.00 Advanced PIan� 1PLLONGC $44,179.47 Select allon-residential Building or Structure D , ,el Doc:utrrentcah.)n 1"e'es: Strong Motion Fee: 1 BSEISh11C0 $6,902.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $986,00 c1 IG 65,439.99 $0.00 ,'icO'><'ALi>F W 6 ,439..99 Revised: 01/01/2016 CITY OF CUPERTINO BUILDING DIVISION FEE ESTIMATOR ADDRESS: 1®3a3® �C I< OMI�� R® DATE: 0313®/2015 REVIEWED BY: MELISSA APN: 316 20092 B?#: *VALUATION: $10,000"000 IFIERl�i[1<T TYPE: Building Permit DUAN CHECK TYPE: New Construction PRIMARY Civil / Religious activities I�IENTAI�i[A ]CSI N 1 R1 HM USE: Commercial Building in BQ zone? Yes No PERMIT � PE: WORK HYATT HOUSE -CONSTRUCT N 5 STORY HOTEL WITH 148 GUEST BOOMS 97 176 SF. SCOPE DINING/KITCHEN AREA (3,152 S.F.) & MEETING ROOMS (2,522 S.F TYPE OF OCCUPANCY TYPE: CONSTR. R-1 (Hotels & Motels) II-A,III-A,\/A A-2 I -A, I -B A-3 1 -A,1 -B lF]LR AREA -&ft FEES��PC.IFIEIE RD 97,176 $13,51 .56 IRIHOTPLNI 3,152 $9,239.41 1A2PLNCK 2,522 e//$8,173.44 l3leC. permit '"e : IA3PL4NCK BPFEES BP FEE ID $49,325.72 I RI HOTINSP $7,522.91 IA2INSP $3,535.40 IA3INSP TOTALS: 10g 50 $3®,93®414 $60;384.03♦ e.., ,.•a f,;....-tSt i'°...:3a;'='�a S'`.: �, i' r ., ,...k .� R'f-x .:.w^: 'n',%.°.. ^'ix.�p s..dS.�',..a(i_�..-,ss'L,-.�,...cx.xi�,x',.d� ss.a, 3„ S -r^ .-�Y- !'tx,�.A.. p'm"; �c`#;F w, ty, +�£'.,;F �, C !,£s: �,% :^ '4,�i°k,;;:i ,.`�r.;:- `a _?aid - `bi ,,ae 7. mr�t 5.rTQE`.x,,.'.7 -.d,�d .i "-„ e'e.., t,^,�'xr�s,�,.: :, y},�iae=, .. '"' �.:`. +,R`4 ,.r,. �}, 5.^+.. ,.,.;' <"� � 3"Y"+.^..�em� ,��+g �w 5 "aa57 .z. " ��2," .. sak Z"r' t:F ° 11=2 w,��F�'�5;:�,.kw€I�{'u�v�,Y;�',.1E.mx: 1'larttth. F'l�u t:'hc"k vq z $�s m .�r.. �`'�'`6`'d +� x'" °,� so - w�a e, EE s � dt�f An"._�Non! .5 3�TYd, ?E � C Flee. Plan Check ,FEE ITEMS (Fee Resolution 11-053 i . 711/13) tech. F'lcrrr C:�bu�ek QT�Y/g' IC' lE 1�lI1tSC ITEMS Ieta7. 1'etrPtlt t"ce:' - Plumb. Pet nil Fee: l3leC. permit '"e : Otrier !tt€:i'i:. Othe- Plifnzb Irup. Other 1<lec. Imp. Ic:c.'a. Irssp. I��,c: 1), w7b. bash. Fee: Elec. Insp. Fee: hrs $0.00 n,._._ V :s ".."Q,... niotwin*'.Qlnhnnl NOTE: This estimate does not ancludefees al!to other uepararnena (i.e. gcurcr9mg, r ssus�. y r• »•--- v __.. __ - -1--'-'- ___a _ ..r.. -4." ,f'ncoinnt tha Dont for rnddnI info. District, etc.. ihese ees are vasea on the ereurrurful rrc urritut Vrb lbY wcc.n.i•. .s. ras v .- _ _ __________ ,FEE ITEMS (Fee Resolution 11-053 i . 711/13) FEE QT�Y/g' IC' lE 1�lI1tSC ITEMS Plan Check Fee: $30,930.41 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: a Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: / $60,384.03 Suppl. Insp. Feer Reg. OT�oh $0.00 PME Unit Fee: / $0.00 PME Permit Fee: / $0.00 #new Construction Tax: PONS:TA H 148 rooms $49,874.48 0 AC, minisiral1 L'G .t t'Ea E) Work With Permit. 0 Yes E) No $0.00 Advanced Planning Fee: 1PLLONGC $29,826.50 " Select a Non -Residential ®' Building or Structure 0 Travel 1. ocuineni'ral on fi"ees: A Strong Motion Fee: IBsEisMico $,2,800.00 Select an Administrative Item Bldg Stds Commission Fee 1BCBSC $400.00 �f < ,: F80 F74)215.42 a ,><1C>FIFE74 215.42 $0.00 "Ne . 3, ��o � `Revised: 02/141ZUTb z CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15030181 10380 PERIMETER RD CUPERTINO CA 95014(316 20 092) SB CC INC CAMPBELL,CA 95008 OWNER'S NAME: ( DATE ISSUED:06/03/2016 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 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 lull force and effect, JOB DESCRIPTION: HYATT HOUSE-CONSTRUCT(N)5 STORY HOTEL WITH 148 I hereby affirm under penalty of perjury one of the following two declarations: GUEST ROOMS(88,857 sq ft);ASSEMBLY USES(13,843 SQ FT); a. I have and will maintain a certificate of consent to self-insure for Worker's UNDERGROUND PARKING STRUCTURE(35,800 SQ FT). Cgmpensation,as provided for by Section 3700 of the Labor Code,for the I RFI #368--GREASE DUCT NEW ROUTE&SIZE-ISSUED 1/28/2019 ,--:_,,'performance of the work for which this permit is issued. RFI#353- 14"X 14"FIRE SMOKE DAMPER ABOVE ROOM 030 . I have and will maintain Worker's Compensation Insurance,as provided for by (INSTEAD OF 16"X 16") Section 3700 of the Labor Code,for the performance of the work for which thiss.._ .(. .. -I-#311,Elevator Lobby 020 Wall Covering-ISSUED 1/28/2019 permit is issued. REV#5-REPLACE FIRE RATED WINDOWS WITH A FIRE APPLICANT CERTIFICATION SPRINKLER DELUGE SYSTEM-ISSUED 7/18/2018 I certify that I have read this application and state that the above REV#4-RFI'S(TO REMAIN OPEN TILL FINAL)**COUNTER information is correct.I agree to comply with all city and county ordinances DRAWER A** and state laws relating to building construction,and hereby authorize REV#1 -ADDRESS OSHA ROOF AND FACADE ACCESS representatives of this city to enter upon the above mentioned property for REQUIREMENTS,SOLAR AND HOTEL BRAND ISSUES-ISSUED inspection purposes. (We)agree to save indemnify and keep harmless the 7/26/2016 City of Cupertino against liabilities,judgments,costs,and expenses which REV#2-SHORING PLAN-ISSUED 12/14/2016 may accru ainst said City in consequence of the granting of this permit. REV#3-CHANGE IN FOOTING DESIGN-ISSUED 1/27/2017 Additional)�yt e pplicant understands and will comply with all non-point source DEF#2-ELEVATOR SHOP-07/18/2018 7 DEF#3-STORE FRONT ISSUED 10/23/2018 /.Signatur Date 01/28/2019 DEF#4-GENERATOR DEF#5-KITCHEN LAYOUT&EQUIPMENT OWNER-BUILDER DECLARATION DEF#6-PUBLIC SPACE ACCESS CONTROL - I hereby affirm that I am exempt from the Contractor's License Law for one of the DEF#7-FOLDING PARTITION SUBMITTAL following two reasons: DEF#8-HAZARDOUS MATERIALS SUBMITTAL-ISSUED 1/3/19 1. I,as owner of the property,or my employees with wages as their sole DEF#9-SIGNAGE 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). Sq.Ft Floor Area: Valuation:$24650000.00 I hereby affirm under penalty of perjury one of the following three declarations: i. I have and will maintain a Certificate of Consent to self-insure for Worker's APN Number: Occupancy Type: Compensation,as provided for by Section 3700 of the Labor Code,for the 316 20 092 performance of the work for which this permit is issued. 2 I have and will maintain Worker's Compensation Insurance,as provided for by PERMIT EXPIRES IF WORK IS NOT STARTED. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. WITHIN 180 DAYS OF PERMIT ISSUANCE OR a. I certify that in the performance of the work for which this permit is issued,I 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by:Alex Vallelunga Labor Code,I must forthwith,comply with such provisions or this permit shall Date:06/03/2016 be deemed revoked. APPLICANT CERTIFICATION RE-ROOFS: I certify that I have read this application and state that the above information is All roofs shall be inspected prior to any roofing material being installed.If a roof is correct.I agree to comply with all city and county ordinances and state laws installed without first obtaining an inspection,I agree to remove all new materials for relating to building construction,and hereby authorize representatives of this city inspection. to enter upon the above mentioned property for inspection'purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities, Signature of Applicant: judgments,costs,and expenses which may accrue against said City in Date:01/28/2019 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. ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Signature Date 01/28/2019 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 Y 1 hereby affirm that there is a cons ruffian 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 BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15030181 10380 PERIMETER RD CUPERTINO CA 95014(316 20 092) S B C C INC CAMPBELL,CA 95008 OWNER'S NAME: ( DATE ISSUED:06/03/2016 OWNER'S PHONE:( PHONE NO:(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 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: HYATT HOUSE-CONSTRUCT(N)5 STORY HOTEL WITH 148 I hereby affirm under penalty of perjury one of the following two declarations: GUEST ROOMS(88,857 sq ft);ASSEMBLY USES(13,843 SQ FT); 1. I have and will maintain a certificate of consent to self-insure for Worker's UNDERGROUND PARKING STRUCTURE(355800 SQ FT). Compensation,as provided for by Section 3700 of the Labor Code,for the RFI#343-GARAGE GSF HEAD CLEARANCE performance of the work for which this permit is issued. RFI#368-GREASE DUCT NEW ROUTE&SIZE-ISSUED 1/28/2019 1 have and will maintain Worker's Compensation Insurance,as provided for by RFI#353- 14"X 14"FIRE SMOKE DAMPER ABOVE ROOM 030 Section 3700 of the Labor Code,for the performance of the work for which this (INSTEAD OF 16"X 1611)-ISSUED 02/05/2019 permit is issued. RFI#311 Elevator Lobby 020 Wall Covering-ISSUED 1/28/2019 APPLICANT CERTIFICATION REV#5-REPLACE FIRE RATED WINDOWS WITH A FIRE certify that I have read this application and state that the above SPRINKLER DELUGE SYSTEM-ISSUED 7/18/2018 information is correct.I agree to comply with all city and county ordinances REV#4-RFI'S(TO REMAIN OPEN TILL FINAL)**COUNTER and state laws relating to building construction,and hereby authorize DRAWER A** representatives of this city to enter upon the above mentioned property for REV#1 -ADDRESS OSHA ROOF AND FACADE ACCESS inspection purposes. (We)agree to save indemnify and keep harmless the REQUIREMENTS,SOLAR AND HOTEL BRAND ISSUES-ISSUED City of Cupertino against liabilities,judgments,costs,and expenses which 7/26/2016 may accrue again aid City in consequence of the granting of this permit. Additional) Date 3-22-2019 DEF#3-STORE FRONT-ISSUED 10/23/2018 DEF#4-GENERATOR-ISSUED 02/05/2019 OWNER- UIL ER DECLARATION DEF#5-KITCHEN LAYOUT&EQUIPMENT-ISSUE 3-22-2019 I hereby affirm that l am exempt from the Contractor's License Lawfor one of the DEF#6-PUBLIC SPACE ACCESS CONTROL following two reasons: DEF#7-FOLDING PARTITION SUBMITTAL 1. I,as owner of the property,or my employees with wages as their sole DEF#8-HAZARDOUS MATERIALS SUBMITTAL-ISSUED 1/3/19 compensation,will do the work,and the structure is not intended or offered for DEF#9-SIGNAGE-ISSUED 3/22/2019 sale(Sec.7044,Business&Professions Code) DEF#10-ANCHORING PREVIOUSLY APPROVED EQUIPMENT 2. I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). Sq.Ft Floor.Area: Valuation:$24650000.00 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 APN Number: Occupancy Type: performance of the work for which this permit is issued. 316 20 092 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 EXPIRES IF WORK IS NOT STARTED permit is issued. 3. 1 certify that in the performance of the work for which this permit is issued,I WITHIN 180 DAYS OF PERMIT ISSUANCE OR shall not employ any person in any manner so as to become subject to the 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by:Alex Valleluna be deemed revolted. Date:06/03/2016 APPLICANT CERTIFICATION certify that I have read this application and state that the above information is RE-ROOFS: correct.I agree to comply with all city and county ordinances and state laws All roofs shall be inspected prior to any roofing material being installed.If a roof is relating to building construction,and hereby authorize representatives of this city installed without first obtaining an inspection,I agree to remove all new materials for to enter upon the above mentioned property for inspection purposes. (We)agree inspection. to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Signature of Applicant: consequence of the granting of this permit. Additionally,the applicant understands Date:3-22-2019 and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Signature Date 3-22-2019 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 tbtipertino Municipal Code,Chapter 9.12 and the Health&Safety/ 25533,and 25534. Owner or authorized agen Date:3-22-2019 CONSTRUCT N LENDING AGENCY 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 Professional