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10080134 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 855 BETTE AVE CONTRACTOR:JAMES DENOYER PERMIT NO: 10080134 OWNER'S NAME: JAMES DENOYER 855 BETTE AVE DATE ISSUED:08/19/2010 !ER'S PHONE: 4087170827 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUIL DING PERMIT INFO: BLDG r— ELECT F PLUMB r License Class Lic.# MECH r RESIDENTIAL r- COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMAINDER OF HOUSE 900SQFT(9SQ)1/2"OSB (commencing with Section 7000)of Division 3 of the Business&Professions #30 FI LT CLASS A 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.Fr Floor Area: Valuation:$900 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Vumber:36927043.00 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, `'VITHIN 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 b Date. Signature Date bl" OWNER-BUILDER DECLARATION RE-ROOFS: All roofs 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 instal ed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature 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 ru I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the Calif mrnia Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. coml liance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety 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 Addi Jonally,should I use equipment or devices which emit hazardous air conte minants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain 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 Heal h&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 Own!pauthorized nt: become subject to the Worker's Compensation provisions of the Labor Code,I must atee 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 w hich this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Len(er'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 Len(er's Address •mnify 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 understand my plans shall be used as public records. 9.18. G! Lice rased Professional Signature Date I CITY OF CUPERTINO 3 ITEMS OF 7 PERMIT RE2EIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: LDt: APN 36927043 .00 DATE ISSUED. . . . . . . : 08/19/2010 RECEIPT #. . . . . . . . . BS000011223 REFERENCE ID # . . . : 10080134 SITE ADDRESS 855 BETTE AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER JAMES DENOYER ADDRESS 855 BETTE AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JIIM J DENOYER CONTRACTOR LIC # *OWNER* COMPANY . . . . . . . . . . : JAMES DENOYER ADDRESS 855 BETTE AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----- ----- ---------- ---------- ---------- 1BCBSC VALUATION 900 . 00 1. 00 0 .00 1. 00 0 .00 1BSEISMICR VALUATION 900 . 00 0 .50 0. 00 0. 50 0 .00 1REROOFRES SQ FEET 9.00 1.17 . 00 0 .00 117. 00 0 .00 ----- ----- ---------- ---------- ---------- TOTAL PERMIT :.18 .50 0 .00 118 .50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -• ------------------ CREDIT CARD 266 .50 D:.SCOVER --------------- TOTAL RECEIPT 266 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO REROOF CUPEkT1NO PERMIT APPLICATION APN # Date: Building Address: Owner's Name: d �� `- /V p y /2 Phone #: 410 '719 0 �� ? HOA: Yes No If yes, provide letter from HOA Contractor: Phone#: J� o 7 4C? &o9 4� y 0 v yL Fax #: Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: :Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles p ❑ Wood Shingles ❑ Other (Specify) G a/Yl / ❑ Other (Specify) &1 d Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: i Dar R ,� A( A ,41pe/-e c-2F �1GaSe Residential F71 Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicable, in de in plan set & the sheet index. Valuation: I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: S4 ature Revised 02/05/09 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMEN r•BUILDING DIVISION ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO,CA 9:1014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildin aCa)cupertino.org PROJECT ADDRESS y �7rC:- n, !�� APN# 3 G C? cz 7 OWNERNAME 41 /A,/o // 1 PHON 0 67 E-MAIL STREET ADDRESS //�Qj' LJ' ^�Y 4�:z�,!\(/c CITY, STATE,ZIP FAX CONTRACTOR NAME LICENSE NUMBER C/LICENSE TYPE BUS.LIC.# COMPANY NAME /jv ��j./ j�jt E-MAIL FAX J I l y i STREET ADDRESS P14-1— - CITY,STATE,ZIP c& 14- O G PHONE I UNDERSTAND AND AGRE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable pi ovisions of the 2007 California Building Code. 2. You must schedule all needed inspections a minimum of one day before the requested inspection date. Please schedule inspections online or call (408)777-3:1,28 between 7:30-3:30 (Mon-Fri). 3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this inspection. A building inspector will be available wit iin one hour. There are special hours for this service: 7:30 — 10:30am and 1:00—3:30pm (Mon—Thurs); 7:30 — 10:30am and 1:00—2:30pm (Friday). 4. If plywood is installed, a plywood nailing inspection is required. 5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is weather tight after installation of approximately 25% of the roofing material. 6. New roof coverings shall not be applied without first obtaining all inspections and written approvals from the building inspector. Any roofing which is ap 3lied without first obtaining an approved inspection will require the removal of all new material down to the sheathing so a proper inspection can be performed. 7. A final inspection and approval shall be obtained fror.i the building inspector when the re-roofing is complete. To receive a final sign-off, the following ilems will be verified: a. Flat roofs shall have a minimum of 1/4"per foot of slope and must demonstrate there is no ponding. b. Listings from approved testing agencies for all pie-manufactured products used shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation. 8. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection can be scheduled. By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the property owner's beha I unde nd and agree two comply with the re-roof policy stated above. Signature of Applicant/Agent: od��' / Date: Iq �11C� ReroofPo(icy_2010.doc revised 05/17/10 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMEN- • BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 9:'P014-3255 (408)777-3228- FAX(408)777-3333• buildina(d)CUDertino.org CUPERTINO Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS�t%_ � I` p`PN / /''� ��(3 BP# OWNER NAME `/J (.� O �L (/OWNER ADDRES i/� DESCRIPTION OF/WORK: % �\� zi L We are providing you with an Owner-Builder Acknowledgment aid Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitti-Ig authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builder"building permit that erroneously implies that the property owner is providing his or her own labor and.material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as a-i Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Z 2. 1 understand building permits are not required to be Signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. V 3. 1 understand as an"Owner-Builder" I am the respon 3ible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensod Contractor and having the permit filed in his or her name instead of my own. - 4. 1 understand Contractors are required by law to be I censed and bonded in California and to list their license numbers on permits and contracts. ,,p 5. 1 understand if I employ or otherwise engage any PE rsons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollar::($500), including labor and materials, I may be considered an"employer" under state and federal law. 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workerC compensation disability insurance, and contribute to unemployment compensation for each "employee." I also u iderstand my failure to abide by these laws may subject me to serious financial risk. 7. 1 understand under California Contractors' State Licanse Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. ,lip 8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderFonn 2010.doc revised 04/14110