950 S. Park Rim Circle
TYPEOFPEflMIT CITY
Reroof" \
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765' 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
, , QUARTER SECTION: 217'
BUILDING PERMIT NO. BLD2005,01666
DATE: 6/3/2005
JOB ADDRESS: 950 S PARK RIM CIR
LEGAL DESCRIPTION: N TR 8513 LOT 7
CONTRACTOR INFORMATION:
HOYT ROOFS
1809 N ORANGETHORPE PARK
, ANAHEIM, CA 92801 0000
BUSINESS PHONE: 714773-1820
JOB DESCRIPTION: "'fear off existing and re-roof 20 squares of .Westile Sub 6-; ICBO# 7984; 5.9Ibs.
APPLICANT: JONATHAN ACOSTA
OWNER INFORMATION:
Bradford Hi:1uk
950 S Park Rim eir
Anaheim, CA 92807
ARCHITECT/ENGINEER INFORMATION:
VALUATION:
7,000.00
PROCESSED BY: SAM
OWNER-BUILDER DECLARATION
r hereby affirm under penalty of perjury that I am exe.mpt from the <{ontractor's license Law for the following reason ( ee. 7031.5 Business and
Professions Code: any. city or county which requires a permit to construct, atter, improve, demolish or repair any structure, prJor to its issuance, also
requires the applicant for such permit to file a-signed statement that he is licensed p.ursuant to the provisions oftl;1e Contractor's License Law-(Chapter
9)'(commencing with Section 7000 of Division 3 of. the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7Q.31.5,by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollarS
($500). ' " ,
D' I, as qwner of property, or my employees with wages as their. Sole compensation, will do the worl( and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License "LaVl does not apply to an owner of property who builds or improves
thereon, and who does such work himself or he~elf or through,his or her own employees, provided that such improvements are not intendedor
offered for sale. If, however, the building or improvement is sold with one year of completion, the owner-builder will hav~ the burden ofprqving that he
did not build or improve forthe purpose of sale). .
D, ,I, as the'Owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 70"44 Business,and Professions
Code,: The Contractor's License Law does not apply-to an owner of property w-ho builds or improves thereon, and who' cOntracts for su'ch projects with
a contractor(s)" licensed pursuant to the Contractor's License Law).
D I am exempt under Sec. , B & P,C. for this reason;
Date: . Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm-under penaltY of perjury one of the-following declarations: .
D "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 forwhich
~hi permit is issued. " '.. " , .
. i have and will maintain worker's compensation insurance, a~ required, by Section 3700-of
he Labor Code, for the performance of the work for which this permit is issued. Myworker's
Compensation insurance'carrier and policy are: ~
Carrier: STATE FUND Policy Number. 1700471-02
LicEIiISED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under'pi: visio of chapter 9 (commencin'g
with tion 7 0) 0 i ion 3 of the Business and
Prof,es . ns e.
-~-
Contractor
This section need not be completed if the pennit is for one hundred dollars ($1 00) or less.
~ certify that in the perfonnance o:f the work for which this permitis iss!Jed, l shall not
employ any person in any manner SQ as to become subject to the worker's compensation laws
of California, and -agree that if I sho Id be<;:o b' ct to, the worker's compensation
provisions of Section 3700 of the Labe, I s forthwith comply with those provisions.
, /'~
Date: 6/3/2005 Applicant:' V ~
'WARNING: FAILURE TO SECURE ' MPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EM OYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED lH' USAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION ~706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm. under penalty of p.erjury that there-Is a constructipl1lending age_~yfor the
performance of the work for which this permit is issued (Sec~3097.Civ.C):
Lender's Information:
NUMBER
606111
TYPE
EXPIRATION'DATE
12/31/2006
C~9,
ConstrUCton Types:
VN, ,
I certify that I have read this application and state that the above information is correct. I
agree to mply with 'all city ordinances and state laws relating to building construction, and
ere by uthorize representiv8:s of this city to enter upon the abov~ mentioned property for
.in i ri purposes _
, Date: 6/3/2005
Fees paid for Pe'rmit:
Total:
160.81
I n of Applicant or Agent
The perm's pire by limitation and become null and void if the building or
work has not passed final inspection 365 days frOm the date of permit issuMCe. A
new permit is required to~commence or continue work.
INSPECTION RECORD
FINAL INSPECTIONS,
INSPECTION . DATE. . INSPECTOR EI
Temporary Power Pole. . PI
Plumbing (DrainlWaste Pipe) . M
Electrical Grpund Electrode/Ufer .'
SetbacklFormsrtrenches (Footil!gS) . G
:Do not install subfloor or pour floor slab until the En
following applicable items liave been Signed~. .
Plumbing (Water Plpe.Sprinkler Valves) Fi
Mechanical (Grpuildwork) . . W
Electrical (underground Conduit) .
Pre-slab (Compaction/Membrane.Rei nt. . Sil
'.
Underpinning (Floor Joist/Girders) . . . . Zo
Do not cover or conceal the work below. until the Bu
followiog applicable items have been signed:
1st Floor Shear . .
Fii'esprinkler (Rough) . . .
2nd Floor Shear ,,,," Bu
Roof (Sheathing/Diaphragm/Frame)' / .<LAS ---
Masonry (ReinfJBond BeamlPre-Groulj
Rough Plumbing (Top Out) '. . .
Rough Mechanical ... .'
Rough Electrical (Dry Wall) ,
Rough ElectriCal . .'
Framing (Only after PJbg.. EJec;, Mech. and Fire)' ..
Insulation (SoundlEnergy) .
po not tapeorpla~ter until the following applicable Me
Items have been signed: .'
Drywall .
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations,(Fire Rated) Plumbing . . .
Interior Lath .
Exterior Lath . . . PI
GENERAL ITEMS
Exterior Plaster (BraNn Coal)
T -Bar Electrical . .
T -Bar Mechanical . I . .
T -Bar Structural
Sewer .
Water engineering Backflow . . Ele
Water Service , .'. '-
ectrical Final
umbing Final'
echanical Final
as Test
gineer'i(lglGrading Final 765-5126
re Dept. Final 765-4040. .
ater Engineering 765.5268
b'List/Business License 765-519
Date, - Inspector
" -, \.
nlng765.-5139
i1ding Final (Lastlnspeet;on. Only
. - After Above Complete)
'PARTIAL INSPECTIONS
i1dina InSDe'ctions
__/u
chanicallnspections
umbina Inspections
ctricallnspections