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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 2001 Crow Canyon Road, Suite 100 co� I San Ramon, CA 94583-5387 CONSOLIDATED ENGINEERING Tel. 925 314-7100 Fax. 925 855-7140 L A 0 0 R 'A T O R I E S � �03If) ) www.ce-labs.com Date Of Issue: 2/20/2019 RE: Hyatt House - Cupertino 10380 Perimeter Road Cupertino, CA 95014 Permit 15030181 CEL# 1031052 FINAL REPORT FOR SPECIAL INSPECTION AND MATERIALS TESTING SERVICES (For Services Through 01/14/19) In accordance with Section 1704 of the California Building Code, Consolidated Engineering Laboratories has provided the requested special inspection and testing on the subject project as listed below: 1. Reinforcing steel placement 2. Prestressed steel tendon placement and stressing 3. Concrete placement and testing 4. Structural masonry 5. Grout placement, sampling and testing 6. Shotcrete placement and testing 7. Installation of epoxied anchors, epoxy dowels and screw anchors 8. Proofload testing of anchor bolts 9. Structural steel shop and field including material ID 10. Shear walls and floor systems used as shear diaphragms including hardware and ATS systems 11. Hold-downs These inspections were performed by personnel under the general supervision of a Registered Civil Engineer in the State of California. Details of our work on this project are contained in our testing and inspection reports, issued during the course of construction. Based solely upon the inspections and tests performed and upon our substantiating reports, it is our professional judgment that the inspected work was performed substantially in conformance with the approved plans and specifications, approvals by the Engineer of Record and the applicable workmanship provisions of the California Building Code. CC: Reviewing Engineer: Wilson Ye, P. E. Gene Fong Associates (ER) City of Cupertino (P). South Bay Construction (ER){+` Cupertino Property Development II, LLC (ER)`f DCI Engineers (ER) fY1 KCR Development (ER) DCI Engineers (ER) " South Bay Construction, Inc. (ER) South Bay Construction (ER) South Bay Construction + (ER)j OF V��" All reports are submitted as the confidential property of clients. Publications of statements, conclusions, or extracts is reserved pending our written approval M DC1 E n G I n e e R 5 E Seattle q Portland m Spokane San Diego M c Austin T Irvine San Francisco February 20, 2019 Anchorage 3 Los Angeles Randolph M. Itaya, AIA Principal Axis/GFA Architecture + Design 1130 Westwood Boulevard Los Angeles, CA 90024 Re: Hyatt House Cupertino Shell and Core Substantial Completion 10380 Perimeter Road Cupertino, CA 95014 Application No. 15030181 Dear Mr. Itaya: 15OWI DCI #14051-0044 Based upon our visual observation of the structure and our review of testing and inspection reports that were provided, to the best of our knowledge the primary structural system for the Hyatt House Cupertino project located in Cupertino, California appears to be constructed in general conformance with the intent of the approved structural plans and general notes. We are not aware of any outstanding structural deficiencies. This letter does not address any portions of the structure other than those areas mentioned, nor does it provide any warranty, either expressed or implied, for any portion of the structure. It shall be understood that DCI Engineers has not provided inspection of the structure. If you have any questions or need any further assistance, please contact us. Sincerely, DCI Engineers 2 E' Jeff D. Brink, PE, SE, LEEDO AP Principal One Post Street, Suite 1050 San Francisco, CA 94104 (415) 781-1505 ;Service Innovation Val ue