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715 & 715 1/2 S. Philadelphia CONTRACTOR INFORMATION: HOYT ROOFS 1809 N ORANGETHORPE PARK ANAHEIM, CA 92801 0000 BUSINESS PHONE: 71417.3-1820 JOB DESCRIPTION: Tear off existing and reroof 10 squares with 30-year C""'position shingles VALUATION: 2,000,00 . ,PROCESSED BY: JNJ I. . OWNER.BUILDERiDECLARATION. . I hereby affirm under penalty of perjury that I am exempt from the Contracto:~s License Law for the -following reason (8ec..7031.5 Business and . Professions Code:' any dty or county which requi~sa permit to construct, ali~r, improve, demolish or repair any structure, prior"to its issuance, also requires the applicant for such permit to file a signed statem~nt tha~ he is licensed pursuant to the provisions of the Contractor's. Lie'ense Law (Chapter 9)(commencing with Section 7000 of-Division 3 of the Business and Professi:?nS Code) or ~hat he is exempt therefrom and the basis for the alleged exemption. Any violation of Section-7031.5 by.any applicant for a permit slIblects the applicant to a civil penalty of not mare th_a n ,five hundred dollars ($500), . . . . .1. . .. . . .... . . o I, as .owner of property, or my empl,oyees with wages as their sole camtJensation, will do the wark, and the structure is nat intended .or .offered far sale (Sec. 7044 Business and.ProfeSsions Code: The Contractor's Ucense"~3w does net apply to an owner of property who builds or. improves therean, and who does such w-or.k himself or'herself or through his or her O\.;,~ employees. provided that such improvements ;:l:re not'intended or .offered for sale. If, however,' the b!Jilding or improvement !ssoldwith one ye~t of completion, the ownE;lr-builderwill have the burden qf pr.oying that he did not build or'improve for the purpose of sal-e). . '0;1 . . D I, as the owner of the property, am exdusively contracting with iicensed',lxmtractors to constroctthe project (5ec.1044 Business and Professions Code: The Contractors License law does-not apply' to an owner of propertY,Iwho buil(ls or improves thereon, and '~ho contracts for surt: projects with ~ontractor(s) licensed pursuant to the Contracto~'s license-Law). i Lj I am exempt under-Sec. ,8 & P.C. for this reason: Date: . Owner: I WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of peljuryone of the fOllowing declarations: 1 D. ,I have and will maintain a,certific;:ate ofoonsentto self-insure for workf=:(s-colnpensatipn, as provided for by Section 3700 of the labor Code, for the p'erfon:nance of tr.,h work for whid1 this ~is issued. '. i . . [Y/"I have and will maintain workeris compensation insurance, as required .';V Section 3700 of 4/5/2005 the labor Code, for the. perform.ance of the work for which this permit is jssu~,d. .Mywor:ker's Date: Compensation insurance carrier and policy are: ~ -J . Carrier: STATE FuND Policy, Number: 1700471r02 : BUILDING PERMIT NO. BLD2005.00917 ~ . .. TYPE OF PERMIT Reroof . CITY DATE: 4/5/2005 JOB ADDRESS: 7151/2 N PHILADELPHIA ST LEGAL DESCRIPTION: N TR 158 BLK BLOT 19 APPLICANT: BRIAN HOYT OWNER INFORMATION: Glen E Mcdoud 755 Hillsbore PI . Fullerton, CA 92833 ElM BUILDING DIVISION. 200 S. ANAHEIM BLVD. (714) 765- 5153 INSPECTION REQUEST LINE:. (714) 765- 4626 CENSUS CODE: 555 QUARTER SECTION: 82. ARCHITECT/ENGINEER INFORMATION: ---, ~ This section need not be completed if the pennit is tor one hundred dollars ($1 Gei. or less. D I certify that in the performance of the work for which this permit is issu~.j, I shall not employ any person in any manner so as to becqme subject to the worker's (:{)mpensation :aws of Califomia, and agree that if I should become subject to the worker's com::l~;l1sation provisions of Section 3700 of the labor Code, I shall forthwith comply with tnpse pr9visions. Date: 4i5/2005".. Applicant: . . .l/\~'.. . .. WARN.ING: FAILURE TO S.ECURE WORKER'S COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENA;.TIES AND CIVIL FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADQ;TJON TO THE Co.STOF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. I CONSTRUCTION LENDING AGENCY .1 h.ereby affirm under penalty of perjury that there is a construction lend ing aGency for the ,performance of tlie work for which this 'permit is issued (See.309? .Civ.C): lender's Informatio.n: . I certify that I have react this application and state that the above information is correct. I agree to comply with all city ordinances and. State laws relating tobuilding construction,_and hereby authorize representives of this city to enter upon the above mentioned -property for inspection pLirpose~. 1.-'"'\ . ~ :....!~ Date: 4/5/2005 o ~ignature of.Applicant or Agent The permit shall expire by limitation and become null and void if the building or work has riot passed final inspection 365 days from the date. of permit issuance. A new permit is required to commence or continue work. . LICENSED CONTRACTORS DECLARATION I I hereby affirm ~nder penalty of perjury that jam . iicensedunder provisions of chapter 9 (c'ommencing with Section 7000) of'Oivsion 3 of the Busines:s and Professions Code. . ~ Contractor NUMBER 606111 TYPE EXPIRATION DATE 12/31/2006 C39 Construcion Types: VN, , Fees paid for Permit: Total: 160.61 '. Ele .' '. INSPECTION DATE INSPECTO~ Temporary Power Pole' . . Plu . Plumbl ng (DrainlWaste Pipe) . Me Electrical Ground Electrode/Uter . SetbaeklFormslTrenches . (Footiilgs ) Ga Do not. install subfloor or p()Ur floor slab until the E following applicable iiems have been signed: . Plumbing (Water Pipe.Sprinkler Valves) . . Fir Mechanical (Gr()UndWOrk) I Wa Electrical (U~rground Conduit) . .' Pre-slab (Compaction/Membrane.Rei nt. . . Su Underpinning (Floor Joist/Girders) Zo Do not cover or conceal the work below until the B.ui following applicable items have been signed: 1st Floor Shear . . Firesprinkler (Rough) .... Sui 2nd 'Floo'r Shear .' . , .ROof (Shealhing/Di;jphragmlFrMle) ~ f!.I2 ~ ...--' Masonry (ReinfJBond BeamJPre-Grout) . . . . Rough Plumbing (Top Out) Rollgh Mechanical '. ROugh ElectrICal ,II) . Rough EleCtrIcal . -,- Framing (Orily,after.,Plbg., Elec.. Mech.. and Fire) . Insulation (SoundlEnergy) . Do not tape or plaster' 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." . ". Plu . . . . GENERAL ITEMS .' '. . Exterior Plaster (BI'OIII/n Coal) . T -Bar EleCtrical . T -Bar Mechanic.al . .' . . T -Bar Structllral . . Sewer . . Water Engineering Backflow Ele Water Service. . . , INSPECTION RECORD FINAL INSPE.CTIONS etrlcal Final mbing Final chanical Final s Test ngineering/Grading Final 765-5126 e Dept,- Final 765-4040 ter Engineering 765:5268 b List/Business .License 765-519 ning 765-5139 Idi,ng FinallLast Inspection- Only . After Above Complete) . PARTIAL INSPECtiONS Idina Inspections OC::e" .'Inspector ~ '\ chanical Inspections mbina Inspections ctrical'lnspections .