09100135 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 915 MILLER AVE CONTRACTOR:AAA ELECTRIC PERMIT NO:09100135
OWNER'S NAME: STEPHEN&ROBIN ERLACH 3249 STEVENS CREEK BLVD DATE ISSUED: 10/21/2009
'NER'S PHONE: 8314621171 SAN JOSE,CA 95117 PHONE NO:(408)557-8899
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG[_ ELECT PLUMB
License Class Lic.#
MECH f— RESIDENTIAL r COMMERCIAL F
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:UPGRADING COUNTERS AND CABINETS&
(commencing with Section 7000)of Division 3 of the Business&Professions UPGRADING
Code and that my license is in full force and effect. ELECTRICAL IN KITCHEN
I hereby affirm under penalty of perjury one of the following two declarations:
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 Sq.Ft Floor Area: Valuation:$3300
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:36919046.00 Occupancy Type:
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 and state laws relating
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section /
9.18. Issued
Signature Date
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
1,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 sale(Sec.7044, Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintai compliance with the Cupertino Municipal Code,Chapter 9.12 and the
1 certify that in the performance of the work for which this permit is issued,I shall Health fety Code,Sections 25505,25533,and 25534.
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 exemption,I Own h agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
'mnify and keep harmless the City of Cupertino against liabilities,judgments,
s,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-poin o e gulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date1-101
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36919046 . 00
DATE ISSUED. . . . . . . : 10/21/2009
RECEIPT #. . . . . . . . . BS000008991
REFERENCE ID # . . . : 09100135
SITE ADDRESS . . . . . : 915 MILLER AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : STEPHEN & ROBIN ERLACH
ADDRESS . . . . . . . . . . : 915 MILLER AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : STEPHEN PETER U ERL
CONTRACTOR . . . . . . . : WILLIS TANG LIC # 27828
COMPANY . . . . . . . . . . : AAA ELECTRIC
ADDRESS 3249 STEVENS CREEK BLVD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95117
TELEPHONE . . . . . . . . : (408) 557-8899
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 3, 300. 00 1.00 0 . 00 1. 00 0 . 00
1BREMRECEP NO. OUTLETS 1. 00 42 . 00 0 . 00 42 . 00 0 . 00
1BSEISMICR VALUATION 3, 300 . 00 0 .50 0 .00 0.50 0 . 00
1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0.00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 127 .50 0. 00 127.50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 127 .50 #8703
---------------
TOTAL RECEIPT 127 .50
Ugl00135
CITY OF CUPERTINO
ADDITION/REMODEL
CUPERTINO PERMIT APPLICATION FORM
APN #�f Date: T
Is a 2" 2� QA unit being added? Yes ❑ No If yes, please fill out the permit application for 2" unit.
Building Address: 1/6 iqlu rn AVE,
Mailing Address (if different from building address): 13G� � � , � (/� M—/Z5
Owner's e � I Phone# / � 16Z-11-7� G � ��u �T
Contractor: /
Phone#: �0,k 57S�'
MA Fax #:
Contractor License#: 7W Q
Cupertino Business License#:
Contact: wf L-1, Phone
Fax #:
Building Permit Info:
Bldg. ❑ Elect. Plumb. ❑ Mech. ❑ Hillside ❑
Job Description:
Addition-What is being added?(Be Specific): ()X W/X/J i0ilA/7M.-8+l TS
-FUPtIR0I4161 a4SZ�740&,
What is being remodeled (not including addition)?
Remodel Includes Re-Roof. Yes ❑ No If yes list number of squares
Remodel Includes Structural: Yes ❑ No
/5—
Do you have the pre-application planning approval? Yes ❑ No ❑
If yes, please provide a copy of your planning approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen - Bath Other
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-B E5,` 2 7
Valuation+. Please check this box if the project is a
second-story addition ❑
Project Size: Ex resstandard ❑ Large ❑ Ma
'or❑
Please complete relevant portion of the Green Building
Checklist& attach it to the application or if applicable, Green Building Points Achieved:
include in plan set& the sheet index.
***For Office Use Only***
Over-the-Counter ❑ Revised 07/06/09
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
1 REMRES2 Remodel Residential B
Greater than 1000 sq ft
1REMRES3 Remodel Residential B
Greater than 2500 sq ft.
1REROOFRES Residential Re-roof Each B
100 SF
REMODEL PLNCK
ISTPLNCK(1-3 for Standard Plan Check B NOT FOR OVER THE
remodel) COUNTER PLAN CKS.
WINDOW/SLIDING 1R3SFDREM
GLASS DOOR
1 WINREP Replacement windows B
(ea 8 windows)
1 WINNEWNSTR New Window (non- B
structural)
1WINMEWSTR New Window(Structural B
Shear Wall/Masonry)
1 WINBAYSTR Bay Window (Structural) B
SKYLIGHTS 1R3SFDREM
1 SKYL<10 SF Skylight less than 10 sf B
1 SKYL>10SF Skylight greater than 10 B
sf or structural
1STAIRS Stairs-first flight/ea addt'l B
1 EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln E
Ck (hourly)
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
1MECPLNCK Stand Alone Mechanical M
Pln Ck(hourly
1PLMPLNCK Stand Alone Plumbing P
Pln Ck(hourly)
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
/ Commission Fee
l 1BSEISMICRE Seismic Residential B
1 TRAVDOC Travel &Documentation B
1 BUSLIC Business License B
f
H�SIDENTIA�.L� PROJECT CODER SHEET
Assessor's Parcel Number:
Name of owner. W &61A)
Project address. 9/6"" MI AVE
Contact person. 11�3mp,;150 Phone.Cf-30 �6Z r—//��
Fax. PR
Net square footage of lot.
Existiniz Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Lre there at least two 10 foot by 20 foot clear spaces inside the garag �<YN
Is privacy protection planting required for the project? Y N
On what floor(s) is work being done? Isilfi'
Brief description of work. 00 P5 f
Code editions:2008 CBC (Y -N)2008 CFC (Y -N)2008 CMC (Y-N)
2008 CPC 6)-N)2008 NEC (0-N)
APPROVED
IN ACCORDANCE WITH THE CITY OF
Effective 1/1/08 CUPERTINO GODES AND ORDINANCES
D
SI .EDATE_
- ---.This set of plans and specifications MUST
be kept on the job at all times and it is
unlawful to make any changes or alterations
on same without written permission from
the Building Department,City of Cupertino.
The stamping of this plan and specifications
SHALL NOT be held to permit or to be an
approval of the Violation of any provisions
of any City Ordinance or State Law.
Plan Review Process Work Book Page-8-Revised 1/1/08
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Community Development
_. 10300 Torre Avenue
` Cupertino CA 95014
Telephone(408)777-3228
C1TY OF
.:UPEI�TINO Fax(408)777-3333
Building Department
JOB ADDRESS: PERMIT #
lig ctyl
O R'S NAME: +&6jN6X42RW PHONE # Z—/17
GENERAL CONTRACTOR: AA4 &716ZMe, FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Til
6p /&f
Owner/Contractor Signature ate