B-2019-0205 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0205
10605 N WOLFE RD CUPERTINO,CA 95014-0613(316 47 019) ZELHAM INC
5257 WEST FAIRVIEW
AVENUE BOISE,ID
83706
OWNER'S NAME: DATE ISSUED:04/10/2019
OWNER'S PHONE: PHONE NO:208-658-1700
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#855165
Contractor ZELHAM INC Date 02/28/2019 X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH_RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
COURTYARD MARRIOTT-TENANT IMPROVEMENT IN
I hereby affirm under penalty of perjury one of the following two declarations: GUESTROOMS WITH ACCESSIBILITY UPGRADES(18,023 SF)
1. I have and will maintain a certificate of consent to self-insure for Worker's REV#1 -WATER DAMAGE REPAIRS(RFI#6-12& 15)-ISSUED
Compensation,as provided for by Section 3700 of the Labor Code,for the 4/18/2019
performance of the work for which this permit is issued. REV#2-WATER DAMAGE REPAIRS(RFI#16-22)-ISSUED 4/18/2019
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. Sq.Ft Floor Area: Valuation:$2000000.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 31647019 A(Tenant Improvements)
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 4-18-2019 Issued by:Jasmine Archbold
Date:04/10/2019
O`VNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:,
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:4-18-2019
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued'I Health&Safety Code,Section 25532(a)should I store or handle hazardous
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall .
be deemed revoked. Owner or authorized agent: ,
APPLICANT CERTIFICATION Date:4-18-2019
I certify that I have read this application and state that the above information is CONSTRUCTION ENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code, Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 4-18-2019 Professional -
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0205
10605 N WOLFE RD CUPERTINO,CA 95014-0613(316 47 019) ZELHAM INC
5257 WEST FAIRVIEW
AVENUE BOISE,ID
83706
OWNER'S NAME: DATE ISSUED:04/10/2019
OWNER'S PHONE: PHONE NO:208-658-1700
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#855165
Contractor ZELHAM INC Date 02/28/2019 X BLDG _ELECT _PLUMB
_
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
COURTYARD MARRIOTT-TENANT IMPROVEMENT IN
I hereby affirm under penalty of perjury one of the following two declarations: GUESTROOMS WITH ACCESSIBILITY UPGRADES(18,023 SF).
1. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$2000000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 31647019 A(Tenant Improvements)
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN ISO DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatur -- Date 04/10/2019 Issued by:Jasmine Archbold
Date:04/10/2019
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(See.7044,Business&Professions Code). Date:04/10/2019
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this pen-nit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any per-son in any manner so as to become subject to the
material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent'
APPLICANT CERTIFICATION Date:04/10/2019
1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 04/10/2019 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0205
10605 N WOLFE RD CUPERTINO,CA 95014-0613(316 47 019) ZELHAM INC
5257 WEST FAIRVIEW
AVENUE BOISE,ID
83706
OWNER'S NAME: DATE ISSUED:04/10/2019
OWNER'S PHONE: PHONE NO:208-658-1700
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#855165
Contractor ZELHAM INC Date 02/28/2019 X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH_RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
COURTYARD MARRIOTT-TENANT IMPROVEMENT IN
I hereby affirm under penalty of perjury one of the following two declarations: GUESTROOMS WITH ACCESSIBILITY UPGRADES(18,023 SF)
I have and will maintain Worker's Compensation Insurance,as provided for by REV#3 -WATER DAMAGE REPAIRS RFI#20 REV#1,RFI#26-28
Section 3700 of the Labor Code,for the performance of the work for which this -ISSUED 5/1/19
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above Sq.Ft Floor Area: Valuation:$2000000.00
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 31647019 A(Tenant Improvements)
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 EXPIRES IF WORK IS NOT STARTED
source regulations per the Cupertino Municipal Code, Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED ED INSPECTION.
Signature— ` Date 5/1/19
OWNER-BUILDER DECLARATION Issued by: Jasmine Archbold
Date: 04/10/2019
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 RE-ROOFS:
compensation,will do the work,and the structure is not intended or offered for All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
sale(Sec.7044,Business&Professions Code) inspection.
2. 1,as owner of the property,am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business&Professions Code).
Signature of Applicant:
I hereby affirm under penalty of perjury one of the following three declarations: Date:5/1/19
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 ALL ROOF 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 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
maintain compliance 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 Code,Section 25532(a)should I store or handle hazardous
Worker's Compensation laws of California. If,after making this certificate of material. Additionally,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,Sections 25505,25533,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:5/1/19
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
understand my plans shall be used as public records.
Signature Date 5/1/19
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0205
10605 N WOLFE RD CUPERTINO,CA 95014-0613(316 47 019) ZELHAM INC
5257 WEST FAIRVIEW
AVENUE BOISE,ID
83706
OWNER'S NAME: DATE ISSUED:04/10/2019
OWNER'S PHONE: PHONE NO:208-658-1700
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#855165
Contractor ZELHAM INC Date 02/28/2019 06/12/2019 BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH—'RESIDENTIAL X COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
COURTYARD MARRIOTT-TENANT IMPROVEMENT IN
I hereby affirm under penalty of perjury one of the following two declarations: GUESTROOMS WITH ACCESSIBILITY UPGRADES(18,023 SF)
1. 1 have and will maintain a certificate of consent to self-insure for Worker's REV#1-WATER DAMAGE REPAIRS(RFI#6-12& 15)-ISSUED
Compensation,as provided for by Section 3700 of the Labor Code,for the 4/18/2019
performance of the work for which this permit is issued. REV#2-WATER DAMAGE REPAIRS(RFI#16-22)-ISSUED 4/18/2019
z. I have and will maintain Worker's Compensation Insurance, as provided for by REV#3-WATER DAMAGE REPAIRS(RFI#20 REV#1,RFI#26-28)
Section 3700 of the Labor Code,for the performance of the work for which this -ISSUED 5/1/19
permit is issued. REV#4-ADA REVISIONS TO FRONT DESK;CHANGES TO
APPLICANT CERTIFICATION CONCRETE PATIOS-ISSUED 06/12/2019
1 certify that I have read this application and state that the above REV#5-EXISTING TUB DRAIN(RFI#35);TITLE SHEET REVISION-
information is correct.I agree to comply with all city and county ordinances ISSUED 5-31-2019
and state laws relating to building construction,and hereby authorize REV#6-WATER DAMAGE 3RD FLOOR SOUTH WING(#37442)-
representatives of this city to enter upon the above mentioned property for ISSUED 06/12/2019
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:$2000000.00
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 reg7�
Cupertino Municipal Code,Section 9.18. APN Number: Occupancy Type:
316 47 019 A(Tenant Improvements)
Signature Date
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 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:Jasmine Archbold
sale(Sec.7044,Business&Professions Code) Date:04/10/2019
2. 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:
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 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
APPLICANT CERTIFICATION Health&Safety Code,Section 25532(a)should I store or handle hazardous
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
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 the Cupertino Municipal Code,Chapter 9.12 and
to enter upon the above mentioned property for inspection purposes. We agree the Health&Safety Code,Sections 25505,25533,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:
and will comply with all non-point source regulations per the Cupertino Municipal CONSTRUCION ENDING 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
Lender's Address