656 So. Westford
~~~o~tPERMIT CITY.
DATE: 5/6/2005
JOB ADDRESS: 656 S WESTFORD ST
LEGAL DESCRIPTION: N TR 8116 LOT 33
ElM
BUILDING DIVISION
2005. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 169
BUILDING PERMIT NO. BLD2005-01318
APPLICANT: JONATHAN ACOSTA
OWNER .INFORMATION:
Rajesh Patel
656 S West/ord St
Anaheim Hills,' CA 92807
CONTRACTOR INFORMATION:
. HOYT ROOFS
1809 N ORANGETHORPE PARK
ANAHEIM, CA 928010000
BUSINESS PHONE: 714773-1820
JOB DESCRIPTION: Tear off existing and re-roof 24 squares of "Eagle Ponderosa' tile; ICBO Ii 4600; 6.5Ibs.
VALUATION: 9,000.00 PROCESSED BY: ENO
ARCHITECT/ENGINEER INFORMATION:
OWNER-BUILDER DECLARATION
I hereby affirm unde.r penalty of perjury.that lam exempt1rom the Contractor's Ucense Law for the following reason ( ec. 7031.5 Business and
Professions Code: any city or county which requires a perm it, \0 construct., a Ite r. improve, demolish or repair any structure; prior to its issuance, .also
requires the applicant for such permit to 'file a signed statement that he' is licensed pursuant to the provisions of the Contractor's License Law (Ch?pter
9)(cOrT'.lmencing with Section 7000 of Division 3 of. the Business and Professions-Code) or that he is exempt therefrom.and the basis for' the alleged' ,
ex~mpti9n. Any violation of 'Section 7031.5 by any applicant for a permit subjects the applicant to a dv" penalty of not more than'five hundred dollars
($500). . . .. . .
o I, as owner of property, or my er:nployees with wages as their sole compensation, will do. the wOr'k, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: ,The Contractor's License Law does not apply to an owner of property who_ builds or improves
thereon, and who d<>:eS: such work himself or hersel-f or through his.or her own employees, provided that suc,h improVements are not' intended or..
offered for sale. If, however, the building or improvement Is sold. with one year of completion, the owner-builder will have the burden,of proving that he
did not buil,d or.imp'rove for the purpose of sale). . .
o I, as the owner of the property, am exclUSively contracting with licensed CQ,ltractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply,to an owner of propertywi'lO builds' or improves thereon, and who' contracts for such projects with
a cpntractor(s) licensed -pursuant to the Contractor's License Law).
o 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:
o I hav~and will maintain a'certificate of consent to self-insure for worker's cpmpensation;
as provided for by Section 3700 Of the Labor Code, for the performance of thevloik for which
~~; is issued . . ..
and will maintain worker's compensation insurarice,.as required by ~ection 3700 of
. e .. Code, for the performance of the work for which this permit is issued.. My worker's
Compensation insuranCe carrier and policy are:
Carrjer: STATE R.JND
LICENSED CONTRACTORS DECLARATION
.1 hereby affirm under penally of perjury that I am
liCensed u'nder provisions of chapter 9 -(commencing
with Section 7000) Divsion 3 of the Business and
Professions Code
)
5/6/2005 .
Date:
Policy Number. 1700471-0.2
NUMBER
606111
TYPE
C39
EXPIRATION DATE
12/31/2006
This section need not be completed if the permit isfQr one hundred dollars ($100} or less.
o _I certify that in the performance 6ft~e work forwhich.this-permit is issued,: shaU not
employ any person in any manner so as to become subject to the worker's compensation laws
of Califomia'-'and agree that if I should b me subject to the worker's compensation
provisions of Section 3700 of the Labor , I shall fo hwith comply with those provisions.
-..._-
,
Construcion Tvpes:
VN, ,
Date: 5/6/2005 Applicant:
WARNING: FAILURE TO SECURE
UNLAWFUL, AND SHALL SUBJECT AN LOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDI11DN TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE .
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agen:;y for tQe
;Jo:fcrlT'.ance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information: .
-'"
1 certify that 1 have read this application and state that the above information is'correct. I
agree to comply wit all city ordinances and state laws relating to buJlding construction, and
hereby authorize resentives of this city to enter upon the above mentioned property for
i nspection p~rpo
. \. Date: 5/6/2005
_ " ignature of Applicant or Agent'
The ermit shall expire by limitation and become null and void if the building or
work has..not passed Ii 001 inspection 365 days Irom the date of permit issuance. A
new permit is required to. commence or continue work.
Fees paid for Permit:
Total:
490.59
INSPECTION RECORD
FINAL INSPECTIONS
Date .Inspector
. '. INSPECTION DATE' INSPECTO~ Electrical Final .
'.
Temporary Power Pole . : Plumbing Final - .
Plumbing (DrainlWaste Pipe) Mechan!cal Final
Electrical Ground Electrode/Ufer '.
Gas Test ,
SelbacklFormslTrencheS (Footings) '.
Do not install subfloor or pour floor slab until Ihe Engineering/Grading Final 765-5126 . .
following applicable items have,been sign~d: .
. Plumbing (Water Pipe.5"prinkler Valves) Fire Dept. Final 7654040 '.' .
Mechanical (GroundWork) Water Engineering 765;5268 I
Electrical (Underground Conduit) . . . .
Pre-slab (Compaction/Mernbrane.Reint. Sub List/Business Licen"e 765-519
Underpinning (Floor Joist/Girders) . . Zoning 765.5139 '. .
Do not cover or concealth<1 work below. unW.Ill!> Building Final ~ast Ihspectioh' Only s;) \1\0')' 1'~\~ ."Q
following applicable,items have been signed: ' fter Above Complele) ,
1 st Floor She,ar , , , PARTIAL INSPECTIONS .
Firesprinkler (Rough) Buildina Ins"ections
2nd Floo'r Sbaar , /)'u'1
Roof (She.hilllllbiaphragm'Frane) , S-.~, ~Lc\...,.~ , . .
Masonry (Reinf./Sond BeamJPr~rout) :' / "
Rough Plumbing .(TOD Out) ,
Rough Mechanical , ' '
i KOugn ,l:IectrlCaI all)
Rough Electrical " , I ,
Framing' (On~ a~er Plbg.. Elec.. Mech.. and Fire) . ,
Insulation (SoundlEnergy) I Mechanical.lnspections
po noHape or pla~teruntil the following applicable .
Itemshave been Signed: - '. . , ,
Drywall ,
Penelr;llions (Fire Rated) Electrical " .
"
Penetrations (Fire, Rated) Mechanical
Penetrations (Fire Rated) Plilmbing .
Interior Lath , , ,
Exterior Lath , , . PlumbinQ Inspections
. ' GENERAL ITEMS
Exterior Plaster (Brown Coat)
T.Bar Electrical' , , .
,T .Bar Mechanical,
T .Bar ,Structural' , , ':
Sewer . ,
Water Engineering Backflow , ' Electrical Inspections "
Water Service , ' ,
, ,