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03070081 CITY OF CUPERTINO "' ' BUILDING DIVISION PERMIT CON'TRACTORINFORMATIO`�N BUILDING ADDRESS: CARY C. HOVER CONST. PERMrr N003070081 OWNER'S NAME: 5768 PONTIAC DR. SIT EFUE DATE °NE: (408) 569-9293 SANITARY N0. CONTROL N0. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 B86 LICENSED CONTRACTOR'S DECLARATION Job Description Z1 Mnby affirm that 1 am licensed under previsions of Chirac,9(commencing < wish Semi 7 par Di m.r3mfthc Bus sand Pmfesainm Cnde,and mylicentt is mfull farm effect. i'q z LiLentt ,.4� ADD 110 SQ. FT. /REMODEL 5 Due ream use AR HT E RA CONTRACTOR: CARY C. HOVER CONST. 'd I understand my plans shall be used es public re Ja pl�U G Licenced PnJeuinnal OWNER-BUILDER DECLARATION a8 I hammy affirm on 1 em exempt fano Jin f Contractor',License Law for my - i e O following scribbles a (Section 7031.5.Balboa and w.de mil Looe:Any city o,Loamy e which requires•permit re,ares he elme i t for su demolish,or e a sig any ttroment Fly tpoor hat he slcensece,alsunt to the previsions o far Conch tractor's Blc•sigacdnnemem .� £ < (comm is licenced refimtion 7 the pmviviom nl the fe Business License lUons Codmf9 1" Sq..I'l:'FIOOl'Area Valu $"000 (comm I...c with Section l And of Division 3 once aged eat and Professions hilon 1 '7 .- that he B 31.5 b tang applicant li and the bus for the alleged etemp0on.Myvlbliymn a! \ `\ Section 7031.5 by any•replicant for a Permit.uhjects(hc applicani to a civil pemity of nm mac Nan fico hundred dollars(5500), f t `32�AI"Pb181�er0 0 Occupancy Type ❑h b owner of the property,or my ample a with wages u(heir sole compensation, will d0 the walk.and the structure It nn(Intent ofnRemdfornle(SCL.7844,BYSIntss antl Professore,[Code:The Combucim't Lie -'lawld.nottapply m'an owner or ,I Required Inspections Property he builds or improves Qummm,and docs•ucbwor himselfdrMmughmt )] 1 - FOUNDATION own employees.provided that such impoweme art nminmd r Are, ramictf. 102 — PIERS however,me building or improvement is old comp n,the owner. builder will hiw 0m burden of proving that he "-" dor Improve for purymtt of 103 - UFER builde 4]1.as owner of the property,am Cac1toIVLIY Contracting with licensed eonmctors to 104 - REBAR construct the project(Sec.7044,Business and Professions Code:)The Contractors LL 105 - ANCHOR BOLTS. ceme law docs not apply to an owner of property who builds or improv Nemon.and 106 — SEWER & WATER who contracts for such projects with a contractor([)licensed pursuant to the CamnctoM1 0.ntt law. 202 — UNDERFLOOR PLUMBING C I am e,emp(undo,Sec. .B&P C far this rcuon 203 — UNDERFLOOR MECHANICAL Owner Dma WORKER'S COMPENSATIONDECLARATION 204 — UNDERFLOOR FRAME Ihenbyaf ndunder Penally of oduryone othe following deel.rayons: 205 — UNDERFLOOR INSULATION thaw and will notorious a Ceniyc•teof Consent o sal r-insum for Worker's Conran. 301 - ROUGH PLUMBING - n,•s provided for by Section 3700 of use Tabor Code,for the Pmrtormal.of the 302 — TUB & OR SHOWER it for which this Permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 303 — ROUGH MECHANICAL 3700 of the LaborCode,for the performance or the work for which this permit it issued. 304 - ROUGH ELECTRICAL My Workers Compensation Insurance carrier and Policy number m: 305 - FRAME Grrier: CERTIFICATE OFE%EMMOPoliNFROM WORKERS' 306 — HOLDOWNS COMPENSATION INSURANCE 307 — INSULATION (rhts section need nm heLomplmmil inceP.it is forms,hundwd.11.(SIM) '308 - SHEETROCK nr leas.) ' 1 certify that in the pert once of the work fm which thin Permit"issued,10.15 not 3 09 — EXTERIOR LATH employanypeno mann oh m Gemco me Wm1xo,'Crm Aomm Mm 310 — INTERIOR LATH Lew.of Celifomia. r. Areoil,m 311 _ SCRATCH COAT NOT( 0 APPLICAN� If.arcr making this Ccnificam of Exemption,you should 313 ROOF NAIL no ure bjat to the Wor er.Compensation provisions of Ne lobo Cnde,you mum .J'Z for th comply with such pro.isions or his Permit.hall bre de,mcd remked. 501 — FINAL ELECTRICAL ENERGY 'Z CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY H� Ihereby affirm that there its construction lending agency for the performance of 503 — FINAL MECHANICAL ENERGY a G' the work for which this permit Is issued(Sec.3097,Civ.Cd w G nal,:Name 504 — FINAL BUILDING ENERGY Lander.Add.. U Z 505 — FINAL ELECTRICAL p rtee that 1 Aar tad thirty and County and sun that N,•have infmmatlon is 506 — GAS TEST {k.. building i agree to comply with all city and coumy ntaliws or and cute raw.reusing e pUbuilding consWetion,and herchyaummprpoesenutivesofUlf city menmrupnnNe FIN PLUMB G U above-noem{oned property for inspection rurrotts. gL (We)agree m saw,indemnify and keep coyotes the City of Cupertino ii;h s V-5 L vA liabilities,judgments,costs and expenses which may in any way accrue against said CityZ nn comequence of the granting of this permit.APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: ING Date RCE GULATION iO �/ e-roofs14 NAL PUBLIC WORK � sure o�aLcare-hol ar HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will 0W applieam ser fuort building occupant some urban haraiduus materiel M defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Cale.S,ction 25532(87 � All roofs shall be inspected prior to an roofing material beim dye, p p y g g installed. Will the Applicant o,I..'arelains occmpam un cquirmem oreevlLes which If a roof is installed without first obtaining an inspection,I agree to remove habalous air...Wo tadeyncd by the Bey Arca Air Quality Mm.,emem all new materials for inspection. - let7 ❑Yc, o 1 have mail the haurdam materials requirements under Chapter 6.95 of the Celifor. is Health&Safety Gbe,Soct une 25505,25533 end 25534.1 find rsland Nat if the building Nxs not currently haw a mnam,Nat it is my Tesponsihiliny o m 'ly t upon(of Ne yutmm iswhknmusbcmaprionniuuancesfaCcnlficto Pana. Signature of Applicant Date cru, mori egcnl Dam All roof coverings to be Class "B" or better St CITY OF CUPERTINO v 3 -7 0-0 E-1 CITY OF PERMIT APPLICATION FORM CUPEkTINO lip PN # �a _97 5-3 Date:© r 05 Building Address: Mailing Address 4if different from building address): o e C'e- C,C_ Owner's Name: Phone#: 57 if UC 5mkox1rA Contractor: License#: qr C. 910 cr CenS . 636 00d Conta t: Phone: 5 69-9X j5 Cupertino Business License#: f O V c I^ Fax: a2, A_213 Building Pe it Info: Bldg ElectPlumb Mech Job Descri tion: ,1l ' Residential 7C�t 1/)C L Coe cial El Sq.Ft. Floor Area: $/Sq.Ft.: _ 0 3og �' ��25 Cost of Project: Occupancy Group: GO � Type of Constructio . Please check this box i t e project is a (b0 L second-story addition: ❑ nuanti Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC1000 Elec 600V<= 1000A ELECTRICAL BELEC1001 Elec 600V> I OOOA ELECTRICAL i BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING Z �4 1of3 ZG � � . 7� c1CITY OF CUPERTINO Ciro o PERMIT APPLICATION FORM CUPERTINO uanti Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BP URE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <=,10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM 3USWAY Remodel Busways ELECTRICAL BREMFD{T Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL / BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 Sam" CITY OF CUPERTINO / CUPERTFIN(� PERMIT APPLICATION FORM Quantity, Fee ID Fee Description Fee Grou BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rcpt], Switch &Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs,Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL RSCRT.VD Scb Snecific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING , ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG PlumbingFee s foot PLUMBING ZADDCHG Address Chane J BUILDING 3 of 3