00040051 CITYBUILDING mySiON CONTRACTOR INFORMATION: PERMIT NO.
PERMIT'. _
BUILDINC9AUURFSS: Cc
C /J 0 j� - SANITARY NO. APL ATI B
SMIITAL DATE
(� i_ ell, r Y/(`�F.d(�,f Lr!
OWNER'S A E: -••)
'g� ( 3 / '/ zV/' w.0 NO CG
r NTROL II
0AHIT ^' �! � N' / ��� / BOLDING PERMIT INFO_.
F.Cf/EJ r4 �
I NGINEER
Fac- . /
6
t. Z LICENSED CONfRA=R'S DECLARATION
ZD Z= 1 hereby affirm that 1 em licensed trader provisions of Chapter 9(commestmi Job Description
F_1_u with Section)000)of Division 3 of the Business anal profession,Code.end my license is
4yf"'1 in Nil force end elf
Liceve �y Lic.N
u�3 eaz
0"y One-.jf.�— �.Convamr ��✓/N ,�/- z++f'� N/rvl z`
0 o I moderated my plus Nva t W uauewblic thakands '� Cl VQ�4!-1\ ,�✓/��
OWNER-BUILDER DECIARATION
4442 Q 1 bemby aRnn mr,I am exempt from the Convectors U..".for the _
Q
following mown.(Section 7031.3.Box.,and Prufnsiom Code:Any ar,or county,
Fa.3 which requires a permit m construct,alter,improve,demolish,to repair any ntucmre Sq.F[.Floor Area Valuation
pdmtomies..alwrof.imssWappgunt for such permit w Elle slgnndmamem - •1
met he is licensed pursuant to de pmvimom of Im Convamora License law(Cluptn 9 CJ Q
(commcnci."do Section T ).f..0lmSof the Binfieza and Prefeasiom Create, APN umber Occu enc e
WW is.e
t mPt therefrom and the basis for Ne alleged exemption.Any smisom of -7 um
_ m p y Typ
Section 7031.3 by any aPPRcot for•pe rrduubjmu the applicant me civil penalty or
s mere slum five hundred dollen($W).
❑1..owner of the property,or my empl.yns with wages an their role compematim, Required Inspections
will do the work,endthmtrmen.is nm maende im.ffered Nestle(Sm 9Df0.Busimla
and Pofesalom Code:The Contractors I.keme law men trot"Ply tam owner m
property who builds or improv.thereon,W wW don wch work himself.through
his own employees,provided Nan such improvements ere am intended or offered for
nle.If.however,ape building or improvement timid within one year o(completion,the
owo.-Wilder will haus the Wrden of proving Net W did not Wild or improve fee pur-
'poseof real s). '
❑1,an owner ofthenproperty,,B exclusively convecting with:)TIM Connector's
U.
El 1,an Na project(Sm.e UCO,m exelmusine.and profession;Code:)The tmaducha to
came law docs rot apply to m owas.of property wW Wilds or improves thereon,and -,
who contracts for such projects wish a convectorfs)Warned pointed to Ne Contractors
Limme law.
❑lam exempt under Sec. _.B R P C for this moon
Owner Dea
WORKER'S COMPENSATION DECLARATION
1 hcmby affirm under penalty of perjury one of de fallowing declination:
Ilareand will trainWna Certlfi.a of Comut to if-mom fiewaince.c.anim- - C
REa and fer by Sudo.3700 of the Ulu Code,for the performance of de
wor which this permit is issued.
love end will maintain Wadmrs Compematim Imuretmc istimintorcil by Sutton
3900of the labor Cade,for Neff fNe wqt
My Wo
hid is perosit is iswW. '•
tion t^. d�;®f
Canriee !C// Policy O
CERTIFICATE OF ER "PON MOM WORKER
COMPENSATION INSURANCE
(mi.reComnam rot Wcomplet9d athe permit is freom hundeal"Ina(3100) ,
or let..)
I certify that in IforrmsueoIeN�e�ywork for which this permit is iaued,I shall -
notemployanypen m ymmmr war/u� ee{todmWohen'Compen-
wionlawaofcdi i Dare
Applicant -
NODCE TO A .IL a i,Are.,IftifftEffilture of E.cmpum,you should ,
become,subject to the Worker"Compensation provisions of that UW,Code,you mann
Nallrwith comply with wch provisions or this permit Pall W demand rooked.
z CONSTRUCTION LENDING AGENCY c
'O O
I hereby affirm mat them is a construction leading agency for the performance of - -
z the wank fm which this permit is iuued(Sec.30YI.Civ.C.) '
E:e lender.Name -
CL Lenders Address .
Liz Q 1 unify Nan 1 have read Nis application and ewe that the above intermarket is
a. cadect.I amen to mi with ell city and county ordimues and sum laws mhdng to
;D z building comboction,oral hereby wdariu repreeenwivesof Niscity manor ren Ne
V O abovememiomd property for inspection perform.
W tr. (We)agree he save,indemnify and kap hanmless the City of Cupertino ageiot C'
O V Eehilidn,jndgmena.cosaandexpenes which may in wY way accme against laid City
�ra W 'o conerapore of the groaning of Nis permit. _
n 0. APPLICANT UNDERSTANDS AND WILL COMPLY WITH AIJ,NON-MINT
V z SOURCB REGULATIONS. ^
Signature of Applicam Centnctor Dau
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant minute Wilding occupant store rehandle herandom manenial Re-roofs `
as definad by the Cupertino Municipal Compiler 9.12,and the H.Ith and Safety
Code,Smile.2553811)? Type of Roof
❑Yes. p
W01 Ne applicmtrerumre Wading mcupmt ula muiPmem ord.ices worn All roofs shall be inspected prior to any roofing material being
emit hewdom eirconwminamu ax de Arm d by Ne Bay AAir Q.wity Ma 'w
Management installed. If a roof is installed without first obtaining an inspection
DistrictQ
Y. p - Iaggr remove all n - terials for inspection; Applicant • ;'
ghm.,loomdoommavn'ala immenuund.Chapur6.93oftMCali- and rst ds and wil o y with all non point source regulations.tomoeCademoa ,25333 end 25330.I sand 6.95 o ton if cthe'ee to .thm it is mynzporuibility to why the oximiemwhich mnss r 'uwuwerce ofeCenific fOeeupeuy.
ei c Sig lure of Applicant Dat
andlefired.lim V )raw `All roof coverings to be Class"B"or better
OFFICE
CITY OF CUPERTINO
.>m 1 of 1 BUILDING PERMIT RECEIPT .OPERATOR: nancyc
COPY # 1
SOC: Twp: Rng, sub: Blk: Lot:35611065.00
DATE ISSUED.......: 04/10/2000
RECEIPT #.........: 11934
REFERENCE ID # ...: 00040051
SITE ADDRESS .....: 929 LIBERTY CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: JOHNSTON LAWRENCE L AND JOAN V
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4018
RECEIVED FROM ....: JERRY
CONTRACTOR .......: LIC #
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP .... ,
TELEPHONE ........:
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEN SAL
_______ __________ __________ __________ __________ __________
BPREPIPE NO OF FIXTURE 1.00 8.33 0.00 8.33 0.00
BUSLIC FLAT RATE 1.00 90.00 0.00 90.00 0.00
PERMITFEE FLAT RATE 1.00 35.52 - 0.00 -- -35.52 -- 0.00
'AL PERMIT 133.85 0.00 133.85 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ____________ __________________
OTHER 133.85 VISA
............
TOTAL RECEIPT 133.85
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ............................
202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING
502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING
•
CITY OF CUPERTINO
�m 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY N 1
Sec: Tap: Rng: Sub: Blk: Lot:35611065.00
DATE ISSUED.......: 04/10/2000
RECEIPT R......... : 11934
REFERENCE ID # ...: 00040051
SITE ADDRESS ...... 929 LIBERTY CI
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER .... ........:.JOHNSTON LAWRENCE L AND JOAN V
ADDRESS ...........
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4018
RECEIVED FROM ....: JERRY
CONTRACTOR .......: LIC N
COMPANY ..........:
-ADDRESS ..........:
CITY/STATE/ZIP ....
TELEPHONE ........:
FEB ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEN SAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPREPIPE NO OF FIXTURE 1.00 8.33 0.00 8.33 0.00
BUSLIC FLAT RATE 1.00 90.00 0.00 90,00 0.00
.PPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 ---- -0.00
AL PERMIT 133.85 0.00 133.85 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 133.65 VISA
.. •
TOTAL RECEIPT 133.85
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ............................
202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING
502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING
•
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: nancyc
Sec: Twp: Rng: Sub: Elk: Lot:35611065.00
INVOICE DATE......: 04/10/2000
REFERENCE ID # ...: 00040051
SITE ADDRESS .....: 929 LIBERTY CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............ : JOHNSTON LAWRENCE L AND JOAN V
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4018
CONTRACTOR .......: LIC #
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP .... ,
TELEPHONE ........:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
_______________ _-_ --------- ------------ __________-
SPREPIPE P 8.33 0.00 8.33
BUSLIC P 90.00 0.00 90.00
PPERMITFEE P 35.52 0.00 35.52
_________ ____________ ___________
133.85 0.00 133.85
..ID . .. DESCRIPTION ........ VOICE ID ------- DES-CR--I-PT--IO-N-......
...... ........ ...............
202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING
502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING
I
SREMACOVER IAC UNIT >I000GCF41 IN Erne NIC ALI
' I IBREMAIRHAN IAIC UNITS <= 10,OGCCFibI IMEC.HANICAL I
IBREMFURN IRELOCATION OF FURNACE IMECHANICAL I
• IBRENIFURNOV. IP.ELO FURNACE > 10K STU Iib1ECHANICAL
BREMINHOOD JINSTALLATION OF HOOD IMECHANICAL
BREIVIRELOCA IRELOCATION OF HOOD JIVIECHANICAL
BREMREPALT IREPAIRALTER HEATING MECHANICAL
BREMVENSYS IVENTILATION SYSTEMS MECHANICAL
PPERMITFEE JPLUMBNG PERMIT ISSUE PLUM8ING
BNUMULTI NEW MULIFAMILY RES PLUMBING
BNUSFD NEW SINGLEFAMILY RES PLUMBING
BPBACKFLOW ATMOSPHERIC VACUUM PLUMBING
BPCESSPOOL CESSPOOL PLUMBING
BPFIXTUREPBLG FIXTURE PLUMBING
BPGAS GAS PIPING SYSTEM FEE PLUMBING
BPINTERCEP IND WASTE INTERCEPTOR PLUMBING
SPREPIPE REPIPE OF FIXTURES PLUMBING
SPSEWAGE SEWAGE DISPOSAL PLUMBING
BPSEWER SEWERS PLUMBING
BPSPRINK LAWN SPRINKLER/BACKFLO PLUMBING
SPSTORM STORM/RAIN WATER PLUMBING
BPTRAP KITCHEN TRAP PLUMBING
BPVENT ALT OF DRAIN &VENT PLUMBING
BPWATER INSTALUALTER WATERPIP PLUMBING
BPWHEATER WATER HEATERNENT PLUMBING
• BPWSVCS MAIN WATER SERVICE PLUMBING
ZOEVAGREE DEVELOPMENT AGREEMENT PLANNING
ZDIRTM OIR TENT MAP PLANNING
ZFULLHR FULL APPL BASE+HR PLANNING
ZFULLTIVI FULL APPL TENT MAP PLANNING
ZFULLUP FULL APPL USE PERMIT PLANNING
ZFULLZONE FULLAPPLZONING PLANNING
ZGPAMEND GENERAL PLAN AMEND PLANNING
ZLIMAMEND LIMITED AMEND PLANNING
ZUMTM LIMITED TENT MAP PLANNING
ZUMUP LIMITED APPL USE PERMI PLANNING
ZMATEMPUP MIN AMEND TEMP USEPERM PLANNING
ZMINHILLEX MINOR APPL HILL EXC PLANNING
ZMINSIGNEX MISC SIGN EXCEPTION PLANNING
ZMINTM MINOR APP TENT MAP PLANNING
ZMINUP MINOR APPL USE PERMIT PLANNING '
ZMISCASA MISC ARCH SITE PLANNING
D-1 S—C-0 ff MISC TM AND UP EXT PLANNING
ZMISCFENCE MISC FENCE EXCEPTION PLANNING
' ZMISCGEN MISCELLAPPLGENERAL PLANNING
ZMISCPCINT MISC PC INTERPRETATION PLANNING
ZSIGN SIGN PERMI PLANNING
ZTEMPSIGN TEMPORARY SIGN PLANNING
ZVARIANCE IDIRECTOR VARIANCE PLANNING
2 of2
Revised NIG"
Fee Oescrl tion 'Fee Group
pry, i/ Applicable Fee 10 P
IBP�RNIF== (BLDG PERNII T FEES IBUILDING I
ISCONSTAX (CONSTRUCTION TAX IBUILDING •
IBENERGY (ENERGY IBUILDING
BENERGYA00 ENERGY A00 MULTI [BUILDING
I80VERTINIE INSPECTION OVERTIME IBUILDING
BTEMPPERM TEMPORARY BLDG PERNIIT IBUILDING
BNIITIGAT HOUSING MITIGATION FEE IBUILDING
BPLANCHK PLAN CHECK FEE BUILDING
BPLANCKADO PLAN CHECK ADD MULTI BUILDING
BPLANCICREP PLAN CHECK REPEAT FEE BUILDING
BREINSPECT REINSPECTION FEE BUILDING
BSCBLVD SCB SPECIFIC PLAN BUILDING
BSEISMICOM SEISMIC COMMERCIAL BUILDING
BSEISMICRE SEISMIC FEE RES BUILDING
BSPECIAL SPECIAL INSPECTION BUILDING
BSWIM SWIMMING POOL BUILDING
ZADDCHG ADDRESS CHANGE
BUILDING
EPERMITFEE ELEC PERMIT ISSUANCE ELECTRICAL
BELEC1000 ELEC 500V <=1000^ ELECTRICAL
BELEC1001 ELEC 600V >1000A ELECTRICAL
BELEC200 ELECT SVCS 600V <=200A ELECTRICAL
BNEWMULTI MULTIFAMILY RES ELECTRICAL
BREMBUSWAY REMODEL BUSWAYS ELECTRICAL
BREMFIXT LIGHTING FIXTURES ELECTRICAL
BREMMISC IS- APPARATUS ELECTRICAL
BREMNRAPP REM NON-R S APPLIANCE ELECTRICAL
BREMPO POLE/PLATFORM FIXTUR ELECTRICAL
BREMPOWER POWER DEVICE/APPARATUS ELECTRICAL
BREMRECEPT . RCPTL, SWITCH &OUTLETS ELECTRICAL
BREMRESAPP REMODEL RES APPLIANCE ELECTRICAL
BREMSIGNAD RMDL SIGNS ADD BRANCH ELECTRICAL
BREMSIGNS REMODEL SIGNS, MARQUEE ELECTRICAL
BREMTHEATR THEATRICAL LGHTNG FIX ELECTRICAL
BSF&ZFAM SINGLE&2 FAMILY ELECTRICAL
STEMP 'TEMPORARY POWER ELECTRICAL
BTEMPSVCS . TEMP DIST SVCS ELECTRICAL
MPERMITFEE MECH PERMIT ISSUANCE MECHANICAL
BAPPLOTHER 12THER APPLIANCES MECHANICAL
BBOILERt BOILER<= 100,000 BTU MECHANICAL
BBOILER2 BOILER>100KTO500KBTUMECHANICAL
BBOI 3 BOILER>500K OIMBTU MECHANICAL
BBOILER4 BOILER>1M TO 1.75M BTU MECHANICAL
BBOILER5 BOILER> 1.75M BTU MECHANICAL
BREMAPPLI APPLIANCE INSTALL MECHANICAL
BREMH HEA INST 0 MECHANICAL
BREMVENFAN VENT FAN SINGLE DUCT MECHANICAL
BMNEWMUL11 NEW mUL'n4lAmILY RES MECHANICAL
BMNEWSF&2F NEW SF&2F RES BLOGS MECHANICAL •
t oft
n..t�e class