10050144 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19917 BEEKMAN PL COP TRACTOR:FIVE STAR WINDOWS PERMIT NO: 10050144
OWNER'S NAME: SWAPNIL LADDHA 1450 DELL AVE STE C DATE ISSUED:05/18/2010
r 4ER'S PHONE: 4084202843 CAMPBELL,CA 95008 PHONE NO:(408)370-3331
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LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r— PLUMB
License Class B "► Lic # �
G' 11. (pa MECH RESIDENTIAL COMMERCIAL
Contractor / Sc' Vl NY! 0 Date Q
I hereby affirm that I am licensed under the provisions of Chapter 9 JOE DESCRIPTION:WINDOW REPLACEMENT LIKE FOR LIKE,NO
(commencing with Section 7000)of Division 3 of the Business&Professions STRUCTURAL
Code and that my license is in full force and effect.
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.I't Floor Area: Valuation:$10000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:31630136.00 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 Date/ 57`16
Signature :Td�)e fWJ J9 b Date #'W 0 —
LJ OWNER-BUILDER DECLARATION RE-ROOFS:
All r>ofs 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 insta led without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspe ction.
I,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, Sign iture of Applicant: Date:
Business&Professions Code) _
I,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
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I ha-e read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the CalFornia Health&Safety Code,Sections 25505,25533,and 25534. I 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 Safe y 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 Add tionally,should I use equipment or devices which emit hazardous air
cont►minants as defined by the Bay Area Air Quality Management District I will
permit is issued. mair tain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety 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 Owner ora rized ag'nt:
become subject to the Worker's Compensation provisions of the Labor Code,I must 7.J ate : f O
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I herby 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 m hich 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
-unify and keep harmless the City of Cupertino against liabilities,judgments,
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-point source regulations per the Cupertino Municipal Code,Section I uncerstand my plans shall be used as public records.
9.18.
* Lice ised Professional
fln
Signature �� pvt Yy Date —1 0
F CUIPERTWO,,
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-Location I n ormat on
1Q050144 �' Address" 11:1917 BEEKMAN PL
�.l City/State/Zip'CIJPERTINO SCA 95014
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( APN 3 630136.00
Notes 1 0� i
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05/18/2010 Operator �patg Owner Entity Infoirrietion
05/1$/2010 Operator 'p tg Owner Name` S NP'vJA IL LAD DHA
Operator [ Use Default ❑
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City/State/Zip CU—PE RT—IN O CA CA 95014 2452
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1GENRES IwINDOW REPLACEMENT LIKE FOR LIKE; NO STRUCTURAL
RESIDENTIAL GENERAL BUILDING��
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11/111 B IV-HT V B NEW
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Permit issued 0511812010
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 10i,
PERMIT# d C1
OWNER'S NAME: e�y� PHONE# q011- 1-IZ>
GENERAL CONTRACTOR: lam, �� BUSINESS LICENSE# 1-3t9 q O
ADDRESS: 4kLe 30— CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature— Date
Please check applicable subcontractors and complete I he 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
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date