B-2016-1481r
CITY OF. CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERM
T NO: B-2016-1481
10411 STERLING BLVD CUPERTINO, CA 95014-3831 (375 26 001)
(VENCO
MANAGEMENT INC)
WALNUT CREEK, CA
94597
OWNER'S NAME: SHAHBAZ MAHMOOD
DATE
ISSUED: 03/08/2016
OWNER'S PHONE: 408-205-5847
PHONE
NO: 408-224-7926
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-53 Lic. #775835
Contractor (VENCO MANAGEMENT INC 1 Date 03/08/2016
X BLDG —ELECT _ PLUB
MECH X RESIDENTIALM
COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
BUILD (N)240 SQ FT GUNITE
POOL
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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
p rfonnance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as provided for
by Section 3700 of the Labor Code, for the performance of the work for which
Sq. Ft Floor Area:
Valuation:
$35000.00
this permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy
Type:
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and hereby
37526 001
375
authorize representatives of this city to enter upon the above mentioned
property for inspection purposes. (We) agree to save indemnify and keep
harmless the City of Cupertino against liabilities, judgments, costs, and
PERMIT EXPIRES
IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS
OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will
LAST
comply with all non-point source regulations per the Cupertino Municipal
180 DAYS FROM
CALLED INSPECTION.
Code, Section 9.18.
ign a Date 03/08/2016
Issued by: ABBY AYENDE
Date: 03/08/2016
(�
Q&
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be inspected prior
installed without first obtaining an
to any roofing material being installed. If a roof is
inspection, I agree to remove all new materials for
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered
for sale (Sec.7044, Business & Professions Code)
Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date: 03/08/2016
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS
TO BE CLASS "A" OR BETTER
r. 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
HAZARDOUS
MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials
requirements under Chapter 6.95 of the
2. 1 have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety
Code, Sections 25505, 25533, and 25534. I will
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the lCupertino
Municipal Code, Chapter 9.12 and the
this permit is issued.
Health & Safety Code, Sect'on
25532(a) should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, shoul 11
I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by
will maintain compliance wit
the Bay Area Air Quality Management District I
the Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health &Safety
Code, Sections 25505, 25533, and 25534.
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
er or authorized a_
An
be deemed revoked.
03/08/2016
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
CONSTRUE
I hereby affirm that there is a construction
CTION LENDING AGENCY
lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is
issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant
ARCHITECT'S
I understand my shall be
DECLARATION
used as records.
understands and will comply with all non-point source regulations per the
plans
public
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date 03/08/2016
CUPERTINO
SWIMMING POOL / SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building aQcupertino.org
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PROJECT ADDRESS i (( (v J
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT �• CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT
❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE I
BUS. LIC #
COMPANY NAME
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PHONE
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DESCRIPTION OF WORK
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USE OF SFD or Duplex ❑ Multi -Family
TYPE
MATERIAL TYPE (CODE)
AREA (SQ.
FT.)
VALUATION ($)
STRUCTURE: ❑ Commercial
POOL
6_
I
POOL/SPA MATERIAL TYPE CODES:
SPA
V - VINYL -LINED
DEMO
F - FIBERGLASS
E
RECEIVED BY: j¢
LAM
TOTAL VALUATION:
- REFABRICATED
L/By
my signature below, I certify to each of the following: I am the property owner or hgent to act on the property
owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree
to comply with all applicable local
ordinances and state laws relating to building construction authorize representatives of Cupertino to enter the above-idei tified
property for inspection purposes.
Signature of Applicant/A nt: Date:
SUPPLEMENTAL INFORMATION REQUIRED
(OFFICE
USE ONLY
P N CHECK TYPE {
ROUTING SLIP
_ Commercial orMulti-Family Buildings with Public Swimming Pools:
Department of Environmental Health approval required.
ovER-THE-COUNTER
Bu l DEPT
❑ EXPRESS
PLANNING DEPT
❑ STANDARD
i
❑ PUBLIC WORKS DEPT
❑ LARGE I
❑ E VIRONMENTAL HEALTH
❑ MAJOR I
SANITARY SEWER DISTRICT
SwimPoolApp 2011.doc revised 03/16/11
' C-C'y'1