15030181 - APP CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15030181
10380 PERIMETER RD CUPERTINO CA 95014(3'16 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:(408)777-3081 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(35,800 SQ FT).
Compensation,as provided for by Section 3700 of the Labor Code,for the RFI#343 -GARAGE GSF HEAD CLEARANCE-ISSUED 5/15/19
A� - performance of the work for which this permit is issued. RFI#368-GREASE DUCT NEW ROUTE&SIZE-ISSUED 1/28/2019
'\ i. 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 perfonnance 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-RFPS(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 applicant understands and will comply with all non-point REV#2-SHORING PLAN-ISSUED 12/14/2016
source rE*ulations per the Cupertino Municipal Code, Section 9.18. REV#3 -CHANGE IN FOOTING DESIGN-ISSUED 1/27/2017
DEF#1 -TRUSS CALLS-ISSUED 5/25/2018
DEF#2-ELEVATOR SHOP-07/18/2018
Signatur Date 5/15/19 DEF#3 -STORE FRONT-ISSUED 10/23/2018
DEF#4-GENERATOR-ISSUED 02/05/2019
OWNER-BUILDER DECLARATION 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(Sce.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:824650000.00
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
APN
Compensation,as provided for by Section 3700 of the Labor Code,for the Number: Occupancy Type:
316
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 perfonnance of the work for which this
permit is issued. PERMIT EXPIRES IF WORK IS NOT STARTED
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.
Workers Compensation laws of California. If,after making this certificate of
exemption,I become subject to the Worker's Compensation provisions of the J;r.
Labor Code,I must forthwith comply with such provisions or this permit shall Issued by:Alex Vall'elunga
be deemed revoked. Dat'06/03/2016 ''
a'
APPLICANT CERTIFICATION
I 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 shal'1, e inspected prior to any roofing material being installed.If a roof is
relating to building construction,and hereby authorize representatives of this city installed withQ, t'fi.rst 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:54-5/19
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 5/15/19
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 ertino Municipal Code,Chapter 9.12 and
the Health&Safety Co e,S ctions 25505,25533,and 25534.
Owner or authorized agent:
Date:5/15/19
CONSTRUC 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.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
understand my plans shall be used as public records.
Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENTo BUILDING DIVISION
10300 TORRE AVENUE u CUPERTINO, CA 95014-3255
(408)777-3228 o FAX (408)777-3333•buildin. Qcuperfino.org
CUPERTINO:
El NEW CONSTRUCTION El ADDITION [I ALTERATION TI REVISION DEFERRED ORIGINAL PERMY-1-4 15030181
X
PROJECT ADDRESS 10380 Perimeter Road APN 9
-.�� �D
OWNER NAME KCR Development PHONE 408-343-1088 E-MAIL dchan@kcrdevelopment.com
STREET ADDRESS C11"Y, STATE,ZIP Cupertino, CA 95014 FAX
19620 Stevens Creek blvd
CONTACT NAME Dan McCarty PHONE 408-680-4642 E-MAIL dmccarty@sbci.com
STREET ADDRESS 1711 Dell Ave I"Y,STATE, ZIP Campbell, CA, 95008 FAX
❑ OWNER ❑ OWNER-BUILDEROWNER.AGENT Xj CON'TRACT'OR ❑CONTRACTOR AGENT ❑ ARCHITECT 11 ENGINEER ❑ DEVELOPER 11 TENANT
WANOININOWM M
CONTRACTOR NAMEICENSE NUi\4BER LICENSE TYPE BUS.LIC 9
Dan McCarty- 336974 B 5655
COMPANY NAME South Bay Construction E-MAIL dmccarty(@sbci.com FAX
S'FRE ET ADDRESS 1711 Dell Ave CITY,STATE,ZIP uampbel l, CA 95008 PHONE 408-680-4642
ARCHITECT/ENGINEER NAME Randy Itaya LICENSE NUMBER BUS.LIC 9
COMPANY NAME Gene Fong Associates,, E-MAIL ritaya@axisgfa.com FAX
STREET ADDRESS 1130 Westwood blvd CITY,STATE,ZIP,Los Angeles,CA 90024 PHONE 310-209-7520
DESCRIPTION OF WORK
L/
R1=1 #343
moo"
EXISTING USE PROPOSED tJSE CONSTR,TYPE 4 STORIES
ff I USE TYPE OCC. SQ.FT, VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA RENIODEL AREA —1 R1MODEL AREA
PORCH AREA DECK AREA TOTAL DECK/POR-CH GARAGE.AREA: []DETACH
❑ATTACH
.......................................
DWET-LANG LTNITS: IS A SECOND UNIT ❑YES SECOND ST011Y ❑YES
BEING ADDED? ONO ADDITION? []NO
P R.E-APPLICATION E]YES IF YES,PROVIDE COPY OF JS THE BLDG AN ❑YES RECEIVED B)(1 TOTAL VALUATION:
PLANNING ADPL 9 []NO PLANNING APPROVAL,LErTEIR EAC11LER 110'NIE? ❑NO
By my signature below,I certify to each of the fol[lowing- I ain, jie property owner or authorized agent to act on the propeh owner's behalf. I have read this
application and the information I have provided is correct. I 4ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building onStrl1 et i 0 11./1 ti10-ize re)resentatives Of Cupertino to enter the above-identified property for inspection PLIrPOSeS.
Signature of Applicant/Agent: Date: 1-25-18
PLAN CHECK TYPE ROUTING SLIP
SUPPLEMH .A I T\TI`-0T?N/t A TIC)\T V T-,nT TTP 1:7n' 11
New SFD or Multifamily dwellings: Apply For demolition permit for El 0VE`R-T1IE.COLJN-rER El BUILDING PLAN REVIE%�'
existing building(s). Demolition permit is required prior to issuance of building
per-mit for new building. 1:1 EXPRESS E3 PLANNING PLAN REVIEW
Commercial Bldgs: Provide a.completed H(azcardous I'vlaterials Disclosure El STANDARD E3 PUBLIC WORKS
form if any I I.azardous Materials are being used,as part ofthis project. 1:1 LARGE: Cl FIRE DEPT
- —Copy of Planning Approval Letter or Meetilig with P.,anning prior to ❑ MA.JOR ❑ SANITARY'SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEAL-rn
Bkl gAj)j)_20 11.doc r-evised Ob/21/11