06070112 CITY OF CUPERTINO ��" "' �`�""`' `"` °",
BUILDING DIVISION PERMIT uPt .R:AC�T' TI�'F,URMA'TIaN
x .nf:fin!! t s.^4r'..uti,yi •.iart v.-atlstsa;&x%w ..brT'�+
BUILDING ADDRESS: , ELECTRICAL PERMITNO.O6O70112
913 MILLER AVE
OWNER'S NAME: PERMIT ISSUE DATE
ROBIN ERLACH 10210 STERLING BLVD 07/18/2006
NE: SANITARY NO, CONTROL NO.
(408) 557-8899
ARC HIECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� 0
op LICENSED CONTRACTORS DECLARATION
Job Description
i 1 hereby affirm that I am licensed under provision orCNpter 9(commencing
with Section 7000)of Dlvi,ion 3 ofthe Bout fes i�om Code.a yl&ensu
in full force e -./1/' INSTALL 6 20AMP 120VOLT CIRCUIT TO KITCHEN
r viz Wcenm Lie.K
1t Dan: Contractor
tg5fj ARCHITECTS DECLARATION
S I uMersund my plan shall Ite used an public record,
G Licensed Professional
s OWNER-BUILDER DECLARATION
l c I hereby affirm on 1 am exempt from dao Conuampr, :Auy C Law for ase
:cc O following wen.permit
t ?..tam Business and Pmfasriun Cade:My city m county
i$ which mqulros a permit m construct.ober.nt forsu demolish.Permitu or repair ed nmmem $2000
Hy pmorniu umanc0.abo requice theappliant the Conpermi'nicense Law
(that com lAiegns Snuan„0 the pmvis 1.of the Contractor's ftf.1d.(chapter Sq. Ft.Floor Area Valuation
$ (canmemm.g wird Smian 7000)of DivuionJaf the Burinessand Professions Code)a
that he"Ln,exempt therefrom and the basis for Ne alleged exemption.Any violial,on of
Section 7031.5 by my appliant for a permit subjects the app0an,in a civil prnsity or r Occupancy Type
trot mom than five hundred dollars(SSW).
❑
1.as owner ofuu pmpcny,or my employee with wage as their mm compounds",
will do dm wok and Nesbucture m oatimended"offered formin(Sec.7044•Business
Md Preresaloa Cade The Commode,Lksrus Law deer sot apply m an owner of Required Inspections
property who buildsorimproves deem ns,and who daes,uch work humelforthrough his
howorwaever,
the
ebuiprovided mar Impuch rovement
is improvements ase net year
ofcded,patina the ownPit-r.. fs
however,me have
the
or improvement u ret he did"sue yeaa mpro a forn.dao ore of RN
builder will have Un burden o(proNng fun k did ret build a improve for purpose of py(r (�
01. �'f Jri.�
❑h u asvnt of the property,am exclusively contracting with licensed cenummn m (y'P9Im�!,frr f/jJ
construe me project(Sec.7014.Business uW Profession Cede:)Th Condmmr,Ll-
center:law does nu,apply an an owner of property who build,or Impmvea Unman•and,
who conuams for such pmjeeu with a cenvuyor(s)licensed pumunt an me Comoscmh
License law.
❑i em exempt under 9ca .B At P C for mu recon
Owner Data fS\IIYI/(lfPa/pJ]
WORKERS COMPENSATION DECLARATION ..
1 hereby all.under Penalty of perjury aro of the following demsedoru:
1 haveand will mamado a CeniOom of Consent to self-Insure far Worker's Cooper-
,Nan,an
provided for by Seedon 37M of the Labor Code,far the performance of dac
wort for which dais permit is issued.
❑1 hoe and will mainuln Woolues Compensation Insurance,as required by Section
3700 of the labor Code.for ne perfosmanee of the work for which miss permit la issued '
My Worker, pe,ad,Insurance artier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This seelan need Irotbecompleted little permit Is fnronchundred dollars($1 00)
or la,.)
1 cerdfy that In the performance or the work for which thin it mil is issued I stall net
employ anypermn in my macer an as an became subject to the Worken'CompenWlce
Laws of California.Dam
Appliem
NOTICE TO APPLICANT:If.saner making this Certincam of Exemption,you should
become subject n the Workers Compensation previsions of see LAW Cade,you most
.J O forthwith comply with such provisions or this permit Mall be deemed rooked.
.Zi=
CON NG AGENCY
t•. I Row'amre as"g � raga eery far
Cit the. ran wAlchthispe .
W Q Leen Name
.a7 z Lenders Addocas
U Q 1 cerdfy the,1 have read this application and sun thri the above information is
U,P Coma I agree n Comply with all City and county ordinances and gam Tawe relating to
0 building convection,and hemby autharim representatives ofthis city to enter upon the
W aMvcmendoned P openy for moraccuon purposes.
lt•^•i 0. (We)agree m ave,indemnify and keep harmless the City of Cope
nino agaimt
c,I limilitia•Judgmenu,coau andespe hlchmaymanyw'ayaccmeag.1mussid try
U z In cornrguecee or ting ng of thi IL '� b
�'•' APPLICANT UND A L PLY WITH ALL NON-POINT Issued by: Dale
SOURCEREGU N .
Re-roofs
Signature of ppllaAZARDO Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII theapple=,Cupert or faun building e.Chapter
or handle hsardoa mamrie
a deOoeA by ITh Cupertino Municipal Code.CMpmr 9.1;and de Halm and S,fey
Code.section 25532(.)' / All roofs shall be inspected prior to any roofing material being installed.
40 c3y. Yl Na
Will the applicant or future building=upon(on equipment as device which If a roof is installed without first obtaining an inspection,I agree to remove
emit Imeandna air munrom nu as defined by the Bay Ara Air Quality Management all new materials for inspection.
District?
0*a
1havereadtillhaasdnus macerau mole. menmunder Chapmr6.95a(the Calif".
nu Health&Sa1cIYCedc,Seeuans d25534.1undcruandmLLifthebuilding
time not currently ham an e i u no aponobility m noufy up of do
regeremenra whic Co,cific.toof %p Signature of Applicant Date
owner oath, xd a ant �— Dan All roof coverings to be Class"B"or better
L� O
V
I� UVJ7 r 3
�u
/ UNC67
( `� [I
CDPy
SS�SgpR
P
P�,3 �
(?--r,, VoLT C?T:z 4r(ec,,'TT
•
19®a �®
v
fl
ti UoJ7 I
79 9
AP
IN ACCORDANCE WITH THE CITY Or � ✓ntlr
CUPE.RTINO CODES AND ORDINANCES JUL 1 8 2006 I
)ATE
• This set of plans and specifications MUS
This sejob at all times and it is un ®�
la kept on the I changes or alteration'
lawful tp make any Permission troll'
in wdhoutleof Cupertino.
Me building Dept. aficationr
The stamping this plan mm to ?nmA or to be ar
g11AL1. 1107
approval of ar a Katen Of "W
at floY CRY [
�Xczfk"0
qr3 /
•
at)rr ti�Z-ice.
�v �. :1) .1 N •'L.Y 91
f'.70 •h ill iL J i , .
•
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36919046 . 00
DATE ISSUED. . . . . . . : 07/18/2006
RECEIPT # . . . . . . . . . 35297
REFERENCE ID # . . . : 06070112
SITE ADDRESS . . . . . : 913 MILLER AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : ROBIN ERLACH
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : AAA ELECTRIC
CONTRACTOR . . . . . . . : WILLIS TANG LIC # 27828
COMPANY . . . . . . . . . . : AAA ELECTRICAL
ADDRESS . . . . . . . . . . : 10210 STERLING BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 557-8899
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BREMRECEPT NO. OUTLETS 6 . 00 7 . 20 0 . 00 7 . 20 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 2, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 80 . 93 0 . 00 80 . 93 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 80 . 93 VISA
TOTAL RECEIPT 80 . 93
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
•
, CITY OF CUPERTINO
CUPEI�r PERMIT APPLICATION FORM
1WLPN# �, n � Date:
Building Address:: • ,�1L[ Mailing Address (if d feren from building address):
Owner's Namep,) I v'=^� L� Phone#:�
Contractor: l C4�7ie C License#:
(�
Contact: // ff Phone: �� Cupertino Business License#:
�kj ii LL S Fax:
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mec ❑
Job Description:
Residential �S//1'� 'T"•���''ct ��a �cr1'�`"C'OTnmercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: Occupancy Group:
Type of Construction: Please check this box if the project is a
uv_ I second-story addition: ❑
ro'ect Size: Standard ❑ Large ❑ Ma or ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
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> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of
ZCITY OF CUPERTINO
CUPEI�TINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE 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 rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain & Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL
BREMAEUiAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> 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
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2of3
CITY OF CUPERTINO
CUPEkTINO PERMIT APPLICATION FORM
uantity Fee ID Fee Description Fee Group
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
BSCBLVD Scb Specific 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 Ternp 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 Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Chane BUILDING
•
3 of 3