06060228 ITY OF CUPERTINO
'BUILDING DIVISION PERMIT 0ZfUgAC.,T,0R`,INF0RMATI0N
'V 'w'6' I X,
BUILDING ADDRESS: KNOLL SYSTEM CORP PERMf1rNO06060228
9 P
WY
147779 POPPY
�P
N 7
OWNERS NAME: PERMIT ISSUE DATE
MANISHA VAD�HIA, 5375 CLAYTON RD 06/27/2006
lip NE: SANITARY NO. CONTROL NO.
(925) 787-5626
ARCHITECNENGINEER: BUILDING PERMIT IWO
BLDG ELECT PLUMB MECH
C=
LICENSED CONTRACTOWS DECLARATION Job Description
no I Mmby affirm Oat I am licensed under provisions ofChapmr 9(Commencing
RE w
Zo, ith section 70(10)ofDivision 3 ofthe Business and Prolossons Code madl my Ikens,is
in full f.,and off REPLACE FURNACE 90K ON A/C 4 TON COIL
*X0 -7 Elf 3 all 7 ADD
5�jz km I Lie.as DISCONNECT CIRCUIT FOR A/C
,,�n DOW Contrathar
AR CTS DEC���
n&....d so pla I W
Licensed Professional
0 ,
o, �WNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Comeractor's License Law for the
C following reason.(section 703 I.S.Busineas and Proicandons Code:Any city or county
ff which requires a Permit to crooner,almr.himprow.dersolish,or torefit my surcento
in prior to its issuance.also requires the applicant for such permit to file a signed imicirmt
t� to the p.Aions of ft Cintuatux's License La,u(Chat.9 Sq.Ft.Floor Area Valuatl�6 3 5 0
, that he is licensed pureandam,
kincroonciiii;with Sectuint 7000)of Division Initiate Box.and I'miressums Cook).,
that M is exompt thorniness and the hadis for the alleged exemption.Any violad on of
Secism 7031.5 by my ppli.t far.pcenft subijocts On applicant to.chil ponat,of ON Number Occupancy Type
.or...thad I.hundred dallars(M), 3 15025 . 00
will do the ans"Limid the.intactim,is not inuound oraffened formic(Sec.7(N14.Business
and Formation Code:The Contracton's License Law does act apply to an Owner of Required Inspections
Property wind builds thimprow,s thercon.and who ddoz suchwork himselfordesugh his
hme�.ftWidingorhpmwmmt�mld��in=�ofmmpkdm,��r- Mat.
builder will hri�the hadrom of proving thsafte did not Wild or impumn,for purpose of
salo.). FINALEV
1-1 1,as owner of arce property,am exclusively contracting with licensed contractions to
construct the project(Sce.7(it,l.Business and limitations Code:)The Contractor's Lt.
come Law it=not"ply in an Owner of property who Wilds or impamwO,thimon.and
who contracts for such projects with a contracuu(s)Received Protestant in on,Contractors 2006
Lic'.Law.
exempt tmoc,Scc. _.B At P C for do.
RKER.1 COMPENSATION DECLARATION LL wz)l N LC�Y�
Connor Date— Bu
lbandrytiffirst �rpn4tyof�du��of�follmingkclmfiom
station,as novidaul far by Section 37M of the Later Code.to,the performoreass Of the
woric for which this mmit is Wood.
I� haw and will maintain Werion's Conapmention as required by Sciorm,
7'lof On Labor Code for this,Performance ofthe wors:for which this porrait is issomi.
MyWorkef�CoT d I
=nouraden carricr and Policy number are
Career. -Poll,No.:17 1/0 91 G
CERTIFICATE OF EXEMPTION MOM WOMERS'
COMPENSATION INSURANCE
(This sectand need nor W completed ifthe Krem,Is face.handed thell.(SIM)
or less.)
I coniry On,in On performistance of use work for which Ous remit is handed.I short Out
empic,any person in my momeras as to Ixemae subject to On Wolacra'Compansation
Laws or California Date
Applicants
NOTICE To APPLICANT.If,after malting this Cmificarc of Exemption.you should
become subject in the Worluces Compensation proyations of ffic,Litua Cmh%you must
z forthwith comply with each pardividims Of this remoL shall Ite doomed Onnalkil.
z 0
CONSTRUCTION LENDING AGENCY
I turclayidly.died thicen is.construction Imilm',mey for On afficannumaxtif
1:4 use work for which this pindiL is issued(Scc.3097,Civ.C-)
La Lcmicer None
z Lencer's Addrend
0 1 cinfify Oal I haw,read On application sual Soon that On bOW Information LS
it, CO=CL I agree in comply with all city and county Ordinances and Stshe laws totaling 10
building construction,and hereby authori7a rcproacnuti�Of this City to crucr umn the
U move mentioned property for inuMedon purposes-
0. (We).9.0 1.som mulcondry and Icerp homeless the City.1 C.,cruiro.gain"
Cn lialdlificajudgmeno.cmus and expenses which may in My way Acerne ZgMML=d City
ar f of th� PC LL CO Y Wrlili ALL N POINT ed by: Date
in cornme"* 0"
APP CM _IssuS4��d�
Re-roofs —G7
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will On applicant or lot=Wilding wourrescrode,or handle hazindurs material
as dchrod by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Soction 25532(a)'i
0y. All roofs shall be inspected prior to any roofing material being installed.
41 Will the applicant or future Wilding Occupant use equipment or davioca which If a roof is installed without first obtaining an inspection,I agree to remove
cout InuOmunce air loodandins-ts as difined I, de,Bay A.Air Qtudil,Management all new materials for inspection.
0 Yes
I Its.read dic hatoodursormaderi-Isio�mconsits uriderCh.1.6.95 ofthe Calif.,-
-in IfOulds&SaloYCohn Sc.6.25505,25533 and 25534�1 understand Out ifthe Wilding
does can-tamen ly how, man.that t . 11111hy
A�mdfy the Occapart Of the
u face ..Of&—77k�_� Signature ofApplicant Date
i Owner or authomed agent All roof coverings to be Class"B"or better
CITY OF CUPERTINO
m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . 36615025 . 00
DATE ISSUED. . . . . . . 06/27/2006
RECEIPT # . . . . . . . . . 35036
REFERENCE ID # . . . 06060228
SITE ADDRESS . . . . . 1479 POPPY WY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . MANISHA VADHIA
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . .
RECEIVED FROM . . . . BONITA JENKINS
CONTRACTOR . . . . . . . KNOLL SYSTEM CORP LIC # 22929
COMPANY . . . . . . . . . . KNOLL SYSTEM CORP
ADDRESS . . . . . . . . . . 5375 CLAYTON RD
CITY/STATE/ZIP . . . CONCORD, CA 94521
TELEPHONE . . . . . . . . (925) 787-5626
kE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------- ------------- - --------- ------- - -- -- -------- ---------- ----------
BREMAIRHAN NO.UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00
BREMFURN NO UNIT 1 . 00 14 . 31 0 . 00 14 . 31 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 7, 000 . 00 0 . 70 0 . 00 0 . 70 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- - --------- ---------- -- --------
TOTAL PERMIT 176 . 44 0 . 00 176 . 44 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
-------- -- - - ----- -------- - --- ----- - ------------
OTHER 176 . 44 VISA
TOTAL RECEIPT 176 . 44
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
0
Jun 27 2006 9: 48RM HP LASERJET FAX P. 1
26/2005 22:49 5105383252 LEGALITIES INK PAGE 01
CQM=Ucdty Devdavocat
L0300 Tom Am=
Cupefto CA.95014
TokPh=(403) 777-3228
CUPE iNO Fv,�(409)777-3333
-3 T
r
Building Department
JOB A[
TDRESS: PERMTr
I PHONE*9i-f (41 04*7 7
Aa�tdi 1 FAX#
rt using any subcon.tr,actors: 4 X7/0 L
Date
FleaALidwk p1licable subcontract0fS And COm lete the following la0mation:
SHCONTELACTOR BUSINESS NAME BUSINESS LICENSE #
CAblfteb Millwork
Electrical
Excavation
F F
Flooring-
Lindleum Wood�
GIm
Hea
hwulation
Landwa Ing
-Laffiins
-Masonry
tal Sheet Metal
Painting/ pa
Fav
Phunb
R
Se i Tank
sheet MAW
Sheet Rock
Tile
L
OWner/Contractor
Date
CITY OF CUPERTINO
FURNACEAC
CITY OF
OCUPEkTINO PERMIT ,�kPPLICATION FORM
APN # �Ob- 1� �W� I Date: (6
Building Address: /V71 lqrly-1 L,)A�,
Owner's Name: Phone#:
Contractor: Phone: -0 4-71 License#:
7yq3t47
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Bldg 0 Elect Plumb Mech 59-
Job Description: -4-- co�p
Residential Commercial F]
ForResidentiall t Hations:
Attic 1:1 15' floorWJ2�g 2 nd floor
Adhere to min set back requiremenix
For Commercial Installations:
Replacement same weight E] Additional weight (structural calcs)
Structural Calculations required for new installation
New installation Planning Approval Required D
Cost of Project: Type of Construction: Occupancy-goup:
63so . d-7)
Strapped El On Platforryi LJ Bonded Sq.Ft. Floor Area:
New Location 2r,� Replacementm
Qty. if
Applicable Feell) Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAE—
BREMACOVER A/C Unit > 10,000 cfra MECHANICAL
BREMAIRHAN A/C Units<= 10, 000 efin MECHANICAL
I BREMRECEPT Recptl, Switch & Outlets ELECTRICAL
r BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BPGAS Gas Piping System Fee PLUMBING
BUSLIC Business License BUILDING