06070136 (2) CI•TY OF CeUPERTINO '•P�7'~ .as+rsN�� '/��y a" �
BUILDING DIVISION PERMIT ° C�1'f'';Yr -TT01(c "`0 •'v' :
BUILDING ADDRESS: KNOLL SYSTEM CORP PF"m"N0'06070136
22009 OAKDELL PL
OWNER'S NAME: PERMIT ISSUE DATE
GRACE KIM 5375 CLAYTON
NE: SANITARY NO. CONTROL NO.
(925) 787-5626
ARCHrrECT/ENGINEER: BLDG BUILDING PERMIT INFO MECH
00 LICENSED CONTRACTORS DECLARATION lob Description
'�
1 bandry adust 1 con limaeed under provision,of Chapter 9(commencing p
with Suction 7001))ofDivlelon 3 of due Busfnamand I'mfusaione Co m,aM my license is
arum dust
REPLACE FURNACE 70K .ADD ON A/C 3 TON. 40 AMP
i�Z Lken GIus ��"'� Lk.g 4 t� 9
DamCoat semi DISCONNECT
ARCHITECTS DECLARATION
i I understand my plans shall W used a public necorde
c 3 Licensed preform...I
OW NER.BUILDER DECLARATION
I hemhy affirm the'I am exempt from the Canrecmes License Law for the
.p O following mason.(Section 703 1.5,Business and Profession Cade:Any city or county
$fi which requires a permit to emmrucL alma reprow,dcmulish.m repair any structure
prior m it iuuame,also IMPAITa me applicant for such permit m file a signed exac nt
: < mat hekRcen¢dupsuantmthe provisions ofdocommmor'sLimmeLaw(Chapter 9 Sq.Ft.Floor Area Valuation
S $ (commencing with Section 7000)ofDivision 3ofdcBusiness and PmfessiomCode)m $6911
•�.- that he u exempt mamfrom W the butt for due alleged uemptiara MY Nmation of
Section 7031.5 by airy applicant for a permit subjecushe aPplkanl he a civli Penalty of APN Number Occupancy Type
an,ne.man Rw hundred dol WS(55118).
❑1.25 owser of the property.Or my employees who urges u their mm compemadom.
and mthe work.
n;Coume aaamomlanotmmnded«Law domramrsec.7a..eaatmua Re ¢n
and property
who W case:The eom'mamn License law don,Out applhim if rt owmm of
is roam
Own employees.
IXid that
ach I.P and who m lin',uch Itlmxel(mmmmeugh his
own employees,prog Or i duo'arch Improwmwt art-1in',OfO maRerW fm axle H,
bawewn IT Wilding orimprovement4halt withinarcyea a(comonat( .me owrcrf
builder wIB haw the When of proving mu k did rot 4dW IX improve(m purpose of
ale.). AN 2007
❑1,u=am of the property am exelumvely,competing with Ilcemed combamop m
cometh ct the project(Sec.7044,Business and Pm(easiam Cade:)The Conuacures Li. 1gBj (r�)�j}p rrrttt��� ay
cense Law don,wt apply m an owner omanaperty who Wilds or intro the
Coman.see, �rye r}�v
cwho ause aw doforampproject with A who
Wil pursuant arduemontrhamnd
Lkemat Law.
❑I sec exempt under Sea .B de P C for this moon
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one or the following deeWatimtc
1 haw am will maintain a Certificate of Consent self-iuvm for Wartefs Compere
cation,u Provided for by Section 3700 of the Mbar Code,for the anImmeaa of the
wort for which this permit Is bused.
1 haw and will maintain Wortrn Compensation lmenanue,as required by Sermon
700 of lobar Cade.(m me PeRo ranee of the what fIX which mu permit is iuue4
My Workeke Ya C mpensauoe Insuranam artiu and Polity numbs am:
Policy No.:114 d"!9 �
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu xNan reed not W completed line permit u(mane hanmNdaOan 15100)
or less.)
I certV,v thm In me performance of the work fm which this Permit u Wood.i mol rat
employ any person in any mannerm as In became subject to the Workus'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cer ifrca a of Exemption.you should
become subject to the Worker's Compemadon provisions of the tabor Code,you mum
.JO forthwith comply with such provislam or this Permit Mall W doomed mucked.
,Zs CONSTRUCTION LENDING AGENCY
[—r 1momysfOm that dome les construction lending agency for the Performance of
C'> the work for which dut permit Is Issued(Sm.3097,Civ.C.) ,
WM Q Lender's Nauru
.7 7.. Lendees Address
U Q I certify that I Its mad this appliudon and sum mer the allow im omthm Is
V. E" comet.I agree to comply with all city and county omiunces and sum laws relating m
0 Wilding conmuetion,and hereby authorise represtootOws of this city to cnmrupnn to
W show-mentiomd property for inspection purposes.
(We)agree to caw.indemnify and keep hmmleu the City of Cupenlno agmmt
cn Habitues.Judgmeno camas
t,cod expewhich may in any my acme almat aid City
UZ in consequence of the granting of this Permit,
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINr Issued by: Date /
SOURCERE ONS, •�—�
7 I'll-0/d b Re-roofs
Sigmturs of Appl' uCanuecmr came
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
MII the applicat m furore Wilding a Phatmme orhandle husrdou material
as defined by the Cupertino Municipal Code.Chapter 9.12 and the Health and Safety
Code.Section 25533(,)? All roofs shall be inspected prior to any roofing material being installed.
❑Yue Ba+u_41
Will the applicant or future Wilding occupant tax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
with hmeNnu air conmmmums u defined by me Bay Amo Air Qua11tY Management all new materials for inspection.
District?
El Yes
I haw mW the hammaus materials requirement under Chapter 6.95 ofthe Califor.
me Hcalth&SaretyCode,Semot,23505.25533 and 21534.1 undereand that i(Ihe building
does not currently haw a rear,that It u my mepamihility to notify the occupant of the
mquimmentwhichmost immetiortoimuanceof,
Cand'"'otDe reamer. Signature of Applicant Date
I. 7 20�06
Owner or authariP agent Date All roof coverings to be Class°B°or better
CITY OF CUPERTINO
,m 1 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32639005 . 00
DATE ISSUED. . . . . . . : 07/20/2006
RECEIPT # . . . . . . . . . 35328
REFERENCE ID # . . . : 06070136
SITE ADDRESS . . . . . : 22009 OAKDELL PL
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : GRACE KIM
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
�EE 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
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BSEISMICRE VALUATION 7 , 000 . 00 0 . 70 0 . 00 0 . 70 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 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 281 .44 0 . 00 281 .44 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
507 FINAL PLUMBING 508 FINAL MECHANICAL
•
Jul 19 2006 10: 16RM HP LASERJET FAX P. 1
07/102006 23:39 511,105303202 LEGALITIES IN< PAGE 01
co=mw spamm
- 1030O Tbne wvem
Cupwtbo CA 9!014
Tolepaoe(108)777.37.11
• . Fm(101)777.333)
UPEI�
NO
Building Department
JOB anpxEss: a a o 9 Oo�: Laoa.e._ QC YSRMiC a. a
owrrEx s NAM: . FIaoNE �i- y
GEhTBRAL CONI'RAM R FAX#
I �r
I lair hot Using any,subtoritractors:
Signature Date
Please.chaek a p plicable a actors and complete the.followin information:
SUBCONTCTOR BUSINESS NAME BUSINESS LICENSE s*
Cabinets&Mill ork
Celment F' Wan
Electrical
Excavation
Fencing
Flooring.
Linoleum /Wood
Glass/
Heating
Insulation
Landsca .
Wiling
0==wntal Shoat Metal
Fainting/ Wallpaper
Yavili
Flan
Pl
Roo
Septic Tank
sheet Metal
.Sheet Rock
Tile
A4 j�y
owner ontracw Signature
•
I
p1 CITY OF CUPERTINO 001DI�v
'CCaI- FURNACE/AC
•CUPEI�TIN0 PERMIT APPLICATION FORM
APN# 35w„ 3q-005
q_ 0�,^ Date: 7 d G
�
Building Address: 2ao T C)cL-�W-&,a —
Owner's Name: Phone*-7/L3--SL/ g
Contractor: Phone: License#: C ZO
a-S 6 /-o q7
Contact: � one: JI �— Cupertino Business License#:
Building Permit Info:
Bldg Electo Plumb Meeh
Job Description: d iHQ'
o K . meq°-on G3 W
ResidentialCo mercial ❑
Tl—
For FLUdential Installations:
Attic l" floor 2r 2nd floor❑
Adhere to min set back requirement ET
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Ofl Type o traction: Occupagcy group:
Strapped ❑ On Platform Bonded Sq.Ft. Floor Area:
New Location u Replacement
Qty. if
Applicable Fee ID Fee Description Fee Gro!!
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
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