06060228 (2) CITY OF CUPERTINO
'BUILDING DIVISION PERMIT �'C0NTRACTnR,INFORMATION
'.^V ma's.,
BUILDING ADDRESS: KNOLL SYSTEM CORP PER""'RNO06060228
1479 POPPY WY
OWNER'S NAME: PERMIT ISSUE DATE
MANISHA VADHIA 5375 CLAYTON RD 06/27/2006
lip NE: SANITARY NO. CONTROL NO.
(925) 787-5626
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
�Oo LICENSED CONTRACTOR'S DECLARATION
m 1 Mmby affirm Nat I am licensed under provisions ofChapmr 9(commencing Job Description
Zo, with Smtion70(10)of Division 3 of Ne Business and Profession4s Code,rid my)kens,is
n<a. in fun fume and aft zO � S�✓ C' O REPLACE FURNACE 90K .ADD ON A/C 4 TON COIL
5'jz Licensed Lie'" O ✓ / DISCONNECT CIRCUIT FOR A/C
,,Fn
Dass: Contracmr
AR CTS DECLARATION /
w< 1 undersundso la all W u M1liryv c rteord�� ,vy�
JaU Y�>
k LL Licensed Professional�o< OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Comeractoh License Law for the
p o following mason.(Section 703 1.3,Busineas and Profesdons Code:Any city or county
m ff which requires a Permit to crooner,altar.improve,demolish,or repair any swmare
a prior ah its issuance also requires the applicant for such permit to Ole a signed stammem
i
i x o that he is licensed pis uant to the p.A ions of dm Conuacur's License taw(Chapter 9 Sq.Ft.Floor Area Valuatlp 6 3 5 0
(commencing with Senior 7000)of Division Initiate Box.and Proreuiom Cndc)or
-
that M is eumpr themfmm and the hanis for the alleged exemption.Any violadon of
Sector 7031.5 by arty applicant far a pesmh objects the applicant too civil pdnahy of ON Number Occupancy Type
not marc Nan free hundred dollars(5500). 3 6 615025 . 00
❑Las owner of me pmpeny,m is employed with wages r Nov sole co14.Business will Formation and the he Coeunotinmndedo affened Law formicact apply 7061.Bredrof Required Inspections
and Formation
wind ns Code:The COnuacmrs Licenseand
who law sou tort apply lf an owner of q P
Property who builds orimprovu thereon,and who fides suehwork himself ar Wough his
owremPl ft turgor pmwmmtmvlden ire not inteMedmpkdm,or r- �'
builder.Use building or improvement u sold within one)ear or mpumn,for
Ne awuer-
buildcr will have me WNcn of proving Nor he did not Wild or improve far purpose of
sale.).
NALEV
Q 1,as owner of the Property,am exclusively contracting with licensed contractions to
construct the project(Sec.7(44.Business and Profusions Code:)The Contractor's Lt. _
come taw area not apply in an owner of property who Wilda or impmwO,hhdmon.and -1�O �QO[`
who contracts for such projects with a contracur(s)Received Pursuam Protestant Ne Contractors U
h
License Law.
❑nom
exempt under See Date Cfor thio won Bu p�® �l
Connor Date °[�tl�dF��It 6fy,7tLt�'1
WORKER'S COMPENSATION DECLARATION
1 bdmby affirm under penalty of perjury one of the following declmfions: -
Ihamendwinlfarby eCeWOmm of thrum Code.
wmfar Worked Cs Of the
cation, r provided fm mi Section 3]00 of to tabor Cade.far the peAarmarh¢of the
work for which this permit is issued.
1 have and will maintain Workers Compensation Irumanee,u required by Section
700af the labor Code,for this,performance of Ne wort for which this permit is isoed.
My Workers Com nsatirn Insurance carrier and Policy number are
Cartier. S- '�'R' Policy No.:1 7 V°49 6
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not W completed if tee permit Is face.handed dollars(3100)
or less.)
I comfy Nat in the performsme of use wart for which Nis permit is handed.I shell not
employ any person in my momerm as to Weome subject to Na Workers'Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Cmificam of Exemption,you should
become subject in the Workces Compensation provisions of tee Labor Coda you must
.,O forthwith comply with each provuirns m permit
this shall W doomed revoked.
Z� CONSTRUCTION LENDING AGENCY
I--h I herchyalfhrm tha these iso construction Imilm',mey for Nepaficnnammuf
0: use work for which this prmit is issued(Scc.3097,Civ.U
La Lenders Name
Z Lenders Addw
C.J Q 1 certify Net I have read this application and sun that the above information u
it, F Correct,l agree in comply with all city and county Ordinances and sum Laws totaling 10
�U building construction,and hereby authorise repreunutims of this city m corer upon the
move
cajdgmentioned prono.cry for iexpenses purposes-
0.
urposes
Fy (We)vgme 1r sore,indemnify and keep harmless the City or Capcninoagainst
h livbiliuu.judgmcnts.cmu and expenses which may in any way accrue againsrseid City
(„)z in caueguence of tin6 Of Nie pe Date
APPLICANT U SAND LL CO Y WI'GH ALL N -POINT ed by:Issu
SOURCE E 3 ` r
S4��d�
Re-roofs
Sgnarurt of ApplicanuComrpati
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will On a Cupertino
or(Muni Wilding e.Chanrnme m Wndlc Heallou material
u dchrod bySocio the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Cwt,Saction 23532(1)? All roofs shall be inspected prior to any roofing material being installed.
41 ❑Yu
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant infume Wilding, de,Br tau equipment il devices which P g
emit hvardnus air cmuminants u dcfrcd by Nd Bay Arta Air Quality Management all new materials for inspection.
Disuin7 .L-Jar'aV/
❑Yes
I have mal the haaarmmsma erialsio umcmcnts underCha1ter6.95 of Nd Califor-
-ia Hculds&SaloYCodc Scetmn25505,25533 and 25534.1 understand tha ifthe Wilding
does not curtcndy hast an.that t . m ans11111 hyi rmufY Nc omupant of Nc
eyaimments whkh Weed a :Trace mmrrxmOccapa Signature of Applicant Date
Owner orauthomedage � D/r1�e 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
•
Jun 27 2006 9: 48RM HP LASERJET FAX p. 1
¢6/26/2006 22:49 5105383252 LEGALITIES INK PAGE 01
Cvu=vasty Devdoponat
10300 Tare Avenue
Cupefto CA,95014
Tekph=(403) 777322!
• .CUPE TINOFv,�(409)777-3333
Building Department
JOB ADDRESS: PERMTr
OwNEx'S NAME oI PHONE 1
GENERAL CONTRACTOR 1 FAX#
7Y 7 am not using any,subcontractors: L X7/0 L
Signature Date
Please check a livable subcontract0r5 and nom let:e.the followinglaforalation:
SHCON E ACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets do Millwork
; C.ectent Finishin
Electrical
Excavation
F
Flooring. B
Linoleum/Wood:
Glass/Glazin
Heating
Insulation
Landwa Ing
-Laffiins
Masonry
Ortisaterftal Sheet Metal
Painting/ Wallpa
Fav
Plan
Plumb
f Roofing .
Se ' Tank
sheet Metal
Sheet Rock
Tile
Owner/Contractor gtwture —'x}
Date
•
n
�-� CITY OF CUPERTINO
<«e}- FURNACE/AC
E�T
OUPINO PERMIT APPLICATION FORM
APN # �Ob— 1' �W� Date: la 17Ip 6
Building Address: /V71 � - (,c�
Owner's Name: Phone#:
Contractor: Phone: License#:
G8/ -o `17`I 78g3t49
Contact: Phone: a-+ x_ Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect Plumb Mech
Job Description: Dom, y� ,KA �jK • ��/�pyt ��G �{%UYt d-
Residential Commercial ❑
For Residential I t Ilations:
Attic 1:1151 floor 2"d floor❑
Adhere to min set back requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction: Occupancy-goup:
6 3 So , d-t)
Strapped El On Platform LJ Bonded Sq.Ft. Floor Area:
New Location 2r,� Re lacement m
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
/ BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10, 000 efm MECHANICAL
1 BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
1 BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILIDNG
1 EPERMITFEE Elec Permit Issuance ELECTRICAL
f MPERMITFEE Mech Permit Issuance MECHANICAL
P 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