08030157 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ®IYTRr1. �RI1yUT.tMATION
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Bu 11-o�b�G�,�M�(I36�ORTHWIND SQ SARRAF ESKANDER AND PERMIT08030157
OWNER'S NAME: BRIGITTE M PERMIT ISS(IE DATE
SARRAF ESKANDER AND BRIGITTE 11997 HILLTOP DR 03/27/2008 ,
ONB: SANITARY NO. CONTROL NO.
ARCHIEC lENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�a p LICENSED CONTRACTOR'S DECLARATION Job Description
d 1 hereby afflnn that 1 am Iimnsed under provisions of Chapter 9(commencing P
wish Session 7")of Division 3aftheBusiness And Profession,Code.aadmyliccmcis FIRE DMG REPAIR,ASBSTS ABTMNT,UNIT RESTORD TO
^< in full force and effect.
;gz License Class Lic.g ORIG
Dam.Contractor
ARCHITECTS DECLARATION
J
1 understand my plans Nall bo used as public resents ....
g
Licensed ProfeMioal
'm OWNER-BUILDER DECLARATION
j�S I Wmby affirm that I am exempt from mm Contractors License Law for the
0 O following mason.(section 703 M,Busimms and Prmossians Code:Any city or county
$�a which requires a permit in cmnues,slims.impnwe.demolish,or repair any souctmre
prior in its issuaree,&to require the applicant for such Permit to rile a signed statement
< that he is licensed pwWaat to me povisiona of do CanbKbrs Uceme Law(Chapter 9 Sq.Ft.Floor Area ((.. Valuation
g $ (commencing with Section 70007 of Division 3 of the Business and Professions Cads)to y 3(]0(]0
3— thatk is AttemptNenfrora and Ne alleged e basis for mat Mee Any Nolauw of
Section 7031.3 by any applicant for a Permit subjects me applicant to a civil penalty of �,p Number Occupancy nut come Ilan five hundred dollars(SM. 3 16 3 8 0 51`.V� P y 3YPe
1,u owner of W properry,m fuse emPloyow wIN vngu u Heir sok campeotamon,
mid dotawark.and Neavucmrekaet.Licen draw does
Apply An
Butanes Required Inspections
propend Prof.1ko W came The Cauacmr. rad W Law doh mt appy w all awmr is q P
own employees,
Wudsarimpawlnumrovemeho daasanended mffewd fm ugh his
awn wo.the Wilding
that Men at i improvements art not intended ofo moRered fel dela TL _
however,the ave ft m improwmm�k sold did one year or mpro a far me apse of
Wilder will have Ibo burden of proving that he dim cot build car Improve far purport of
sok.).
❑1,As owner of the property,am exclusively contracting with licensed contractors to
construct the Profen(Sec.70th.Business,sad Professions Cade)The Catrwax's U.
come Law dao not appy b an owner of Property who milds or hnproves menton,And.
who contracts for such projects withs canuacmr(s)licensed Furan,to the Canu muse.
License Law.
❑I am exempt under/See / ,B A P C far this won
Owner l .e..—q Dam
WORKERS COMPENSATION DECLARATION
1 hereby affirm ceder penalty at penury man of the fallowing declarations:
haveCarol will M.W.mM.W.a CM%WcaM of Caroto self-Insure far Wmimes Compel-
m,u provided for by Scotian 3700 of Ile label Code.for the performance of the
wart for which this Permit is road.
❑1 have and will maintain Workers Compensation Insurance,as retired by Section
3700 of the label Code.for me perfarmame of she work felwhich this permit u issad.
My Workers Compensation Insurance artier and Policy number are:
Carrier: Policy Na.:
CERTIFICATE OF EKEMP TON FROM WORKERS' '
COMPENSATION INSURANCE
(Tab seNmr rcd cot As eampk m!if the pemlt Is fmamhunmed collas(SIM)
or kis)
1 certify that In the performance of the work for which this panni,is IMad.l shall not
employ any person in any At uwbecome Mbject to the Workers'Compeasadm
Laws of Califomia.Dais
Applicant -
NO ICE TO APPLICANT:If.aftcr making N diBex o Eacmptian.yrs shell
become subject to she WmkuY Compensation provisions of Ne Latter Code,yam muss
OZ forthwith comply with such proven.or mil Permit shall be dmmee rooked.
r O - CONSTRUCTION LENDING AGENCY
[—i 1Wroby.M.that them it.comuuction lending agency,for me Performance of
C' > the murk for which this PermitIsissued(Sm.3097,Cih,C.)
1210 undoes Name
LeadersAddw
V Q I salify that I have read this applicamm and soak Nat the abow Information Is
U, coma 1 agree to comply wish Nl city and county ominances and utak laws totaling k
.c) building camsection.and hereby awmim tcpwntatiwa of mis city to enter open me
IT7 above-mentioned pmpeny fm inspection purpmes
�!y (We)a&=to save,indemnify and keep homeless the City of Cupertino Rains,
V7 liabilimu,Judgments.costs And..peau which coq In Any way oma Raul Mid City
V Z in enruegance of the{taming of this Permit.
�--� APPLICANT UNDERSTANDS AND WILL OMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
'�--- 3 Z7 Re-roofs
Sigtwme of AppliaulConuacmr Dam
HAZARDOUS MATERIALS DIS SURE Type of Roof
Will oro applicant or raw.building occapma.mm or handle haeamau mamrial
M eeRncd by me Cupertino Municipal Code.Chapter 9.12,and me Health and Safety
Code,Sermon 25132(.)7 All roofs shall be inspected prior to any roofing material being installed.
[DY" RK
Will de applicant or Name e Wilding occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
s hamml -a air contaminants As de0nm by me Bay Area Air QwIlly Maul;..A, all new materials for inspection. '
❑Yu eNu
I have mad the hnudtw maeriats requirements under Chaper 6.95 of me Califon- /
nil Haw&SafctyCede Smsimm 25505,25533 uW 25534.I uadvRanl list if to building
does cot commody have a Imam that It is my responsibility to ratify me occupant of de
requircmonts which muss mel prior wissu (a Ccrurl of Occepmry.
Signature of Applicant Date
A, 12 All roof coverings to be Class'W'or better
Owner or mthornmd agent Dam