07110002 CTTY OF CUPERTINO '.� �
BUILQING DIVISION PERNIIT ��������` ��������� �
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BUILDING ADDRESS: PERMIT NO.
10930 KESTER DR TBD T() BE DETERMINED 07110002 .
NER'S NAME: PIItM1T LSSUE DATE
JOHN & ANNE HANNIGAN � 11/01/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHI7EGT/ENGINEER: BUILDING PERMTTINFO
BL1X; ELECf PLUMB MECH
0 � 0 �
u p p LICENSED CONTRACfOR'S DECLARAT[ON JOb D6SCf1PLlOf1
� t hcreby affirm that I am licenscd undcr provisions of CAaptcr 9(comm ncing
�z� wiihscction�aw)oroiv 3ofihcBusincssand Coec .andmyli enscis SFDWL R:?MODEL EXISTING BATH . REGAN STUDIOS PD FOR
�� y in full forcc and cffecL
j�?[,icensc Clus � ��. �► B S L 11 /)1 / 0 7
� F � Datc Contracwr
ARCHITECI'S DECLARATION
� o�C < 1 undcrstanJ my plans shall be used as public rccords
�yU
4 O y Licensed Pmfcuionel �
y � OWNER-BUILDER DECLARATION
�' 1 hcrcby affirm that 1 am excmpt Gum �hc Convactor's Liccnsc Law for �hc
� p o foltowing rcason. (Scction 7(Y31.5, Business and Profcssions Ca1c: Any city or county
K,°, � which rcquires a pctmit to cnnswct, altcr, improve, dcmolish, or �epuir any swaure
' � z y prior a ils issuance. also mquires thc applicant for sueh pertnit to file a signcd statcmen�
� _ � that hc is licenscd pursuanl lo thc provisiona oC thc Canuactoc's Liccnsc Law (Chaptcr 9 Sq. Ft. Floor Area Valuation
y I- $ (commcncing wiih Sccdon 7000) of Division 3 of thc Busincss and Profcssions Codc) or � 1 5 � � �
y � that Me is exempt thuc[rom snd ihe bssis for the alleged exemption. Any violauon o(
Saction 7031.3 by arry applicani for a permit subjecu ihe applicant io a civil penalty of Number Oeeupancy Type
not more than five hund�cd dollars (5500). 3 5 6 2 g � 1 ���
❑ I. u ownu o[ tlie property. ar my employces with wages as their solc compensaUon.
will do the worlc. �nd ihe snucwce is notintendcd or otfeeed forsalc (Sa.7044. Business Re uired Ins ections
and Professions Code: The Conuactors Littnse Law daes not spply W an owner of 9 P
property who builds or improves ihe[con, and who does such work himael( or �lwugh his
own employces, provided that such improvemenu arc not in�ended w ottaed (or sala I[,
however, the building or impcovement is sold within one ywr oC compledon, the owner
builder will haw �he burden o[ proving Itiat he did not 6uild or improvc for puryose of
saleJ.
❑ I, as owner of �he property, am eaeclusively conuuting wiU� licensed conuactors to
consuvct the projm (Sec. 7044. Business and Professions Code:) "[]ie Conuacwr's Li•
cense [aw docs not apply �o an owner of property who builds or improves Ihereon, and ,
who conuacts [or such projects with a convactor(s) licensed pursuant m �he Convactor's
License Law.
'[ am exempt undu Sec. . H R P C tor �his �eason
Nner Date
WORKER'S COMPFNSATTON DECLARATION
I hemby affirm under penalty o[ perjury one o[ �he follawing declaratioas:
❑ I hsve and will mainuin a Cenifcate of Conxnt lo self-insure [or Worlrer's Compen-
sation, as providcd for by Section 3700 of �he Laba Cade, for �he performancc of ihe
work for which Ihis pertnit is issued.
❑ I have and will maintain Worker's Compensatian Insurana, ss �cquired 6y Scction
3700 af �he Labor Code. Cw the peA'ormance of the worlc for w6ich �his permit is issued
My Worker . ry� ' Inu n e d Poliry n�� �/U �� �
!/f/
Cartier. olity No.:
ER'17FICATE F EMPI'ION FROM WORKERS'
COMPENSATION INSURANCE '
(77�is sectian need not Ac completed if the pecmit is for anc hundred dallars (S l OQ)
or Icss.) '
I cenify that in thc performance of the work for which �his pertnit is issucd. I shall nat
employ any person in any manner so u b become wbjecl to the Workers' Compensation
Laws o( Califomia. Datc
Applicant
NOTICE TO APPLICANT: If, af�cr making this CcniGcam of Excmption, you should
bccome subjett to U+c Worlccr's Compensation provisions of U�c Ia6or Codc, you must
� O foMwi� comply with such provisions or this pcanit shall bc dccmcd revoked.
Z ""'' CONSfRUC770N LENDING AGENCY
(- ►�-� 1 hcreby alTirm that them is a consuucdon Icnding agc�y !ar thc performaecc uf .
p�., . �hc work for which ihis permit is iuued (Scc. 3097, Civ. C.)
W A Lendcr's Namc '
? z Lende�s Addmss
V Q I ceniCY �hat I have read this application and statc Uut thc abovc info�matiun is
w ►� corteci. l agme w comply with all ciry �nd county ordinances and sute laws reladng io
0 U building conswcdon, and hcreby authori�t rcprescntativcs of ihis city w cntcr upon Ihc
� W sAove-mcnGo�d properry for inspenion purposes
a (Wc) agree to save, indcmnify and kecp hazmless ihe Ciry of Cupertino against
�� liabilitiu, judgmen�s, cosu and expenses which may in any way acecue against seid City
(� z in consequence oC th ting o[ Ihis i ��j
�"� APPLICANT U E ANDS PLY WI AL i NO -P INT Issued by Date �
SOURCE REG� . � i � a
« Re-roofs
Signaturc of A can�Conuacwr � 1�
HAZARDOUS MA ALS D CLOSURE Type of R oof
Wil1 appliant or futurc buildin occupant storc ar handle ha•rudous malcrial
c6ncd by the Cupertino Mun' pal Code. Chaplcr 9.12. and tNe Hcal�h and Safcty
m. Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑ Ycs No
wll thc applicant or fuwre bui ing occupant usc cyuipmcn� or dcvices which
If a roof is installed without first obtaining an inspection, I agree to remove
cmit harardaus uir conuminan�t u mcd by the Bay Arca Air Qualiry Managcmcnt all new rr aterials for inspection.
as�;���
❑ Ycs u
1 havc rcad ihe hvardcws maicrials requiremcnu unAcr Chap�cr 6.95 of ihc Califor-
nia Hcal�h & S odc. Sec ' os 5, 25533 534.1 undcrsw�d thu if ihc building
docs not ntl nan it' s nsibility io no�fy ihc accupan nf
rcyu�re nuw m �tbe u aC fica�co�occ�u�y.� p Signature ofApplicant Date
� G
o � . All roof coverings to be Class "B" ar better
Owncr aulhori�.cd genl