6623 Leafwood Dr.
BUILDING PERMIT NO. BLD200S-00918
TYPE OF PERMIT CITY
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BUILDING DIVISION
200 S. ANAHEIM BLVD,
(714)765-5153
INSPECTION' REQUEST LINE:.
(714) 765,- 4626
CENSUS CODE: 555
QUARTER SECTION: 287
.
DATE: 4/5/2005
JOB ADDRESS: 6623 E LEAFWOOD DR
LEGAL DESCRIPTION: N TR 9136 LOT 17
APPLICANT: BRIAN HOYT
OWNER INFORMATION:
William D Cooper
6623 E LeafWood Dr
Anaheim, CA 92807
CONTRACTOR INFORMATION:
HOYT ROOFS
1899 N ORANGETHORPE PARK
ANAHEIM, CA 92801 0000
BUSINESS PHONE: 714713-1820
JOB DESCRIPTJON:Tear off existing roof and replace with 28 squares of Monier Ufetite ICBO# 2656.
ARCHITECT/ENGINEER INFORMATION:
VALUATION: 11,000.00
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contracto~'s License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, aller, improve, demolish or repair any structure, pr!or to its issuance, also
requires the applicant for such-permit to file a.sign~d statement that.he is 1ic't1n3ed pursuant. to the provisions of.the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professbns Code) or that he is exempt therefrom and the basis for the.alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit sut-jects the spplicant to a civil penalty of not more. than five hundred dollars
~~ '..
o I, as-owner of property, or my employees with wages as their sole ccmpensation:will do the work. and the structure is not intended or offered for
. sale (Sec. 7044 Business and Professions Code: The Contre.ctor.s Ucel1'5-G l:dw does not apply to an owner of property wh.o builds or improves
thereon, and who .does such work himself or herself or through his or hel OW:1 ~mp!oyees. provided that such improvements are not intended or
offered for sale: If, how.ever, .the building or improvement is sold with one Yf:ar of completion, the owner":bui_!der will have the burden of proving that he
did not build,or improve for the purpose of sale). .
D- I, as the owner ~fthe property, am exdusively contracting with license6'oontmctcrs to cons'truet the project (See. 7044 B.usineSs and Professions
Code: _ The Contractor's License Law does not apply to an owner of p::operty:.who builds or improves thereon, and who contractS for slJch projects with
Fl4ontractor(s) li_censeo pursuant. to the Contractor's License Law).
U I am exempt under Sec. - ., B & P.C. for this reason. -J
Date: Owner:
r--'. WORKER'S COMPENSATION DECLARATION '_
I hereby affirm under penalty of perjury one of the following declarations: ,
o I have- and will maintain a certificate of oonsent to self-insure for worker's compensation,
as provi(jed for by Sect'ion 3700 of the labor Code, for the performanteofthewl)rk for whidl
~syennit is. issued. .. . [ .
. ~ I havean~ will maintain worker's compensation insurance, as required'by Section 3700 of
the 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. 170047:(02
i
This section .need not be 'COITIpleted if the pennit is for one hundred dollars ($1 oel 01 less.
o .1 certify that in the- performance of the work for which this permit is.issued. I shali not
employ any person in any manner so as to become subject to the worker::; cemp"ensation laws
of Cal,ifomia, and agree th?!t if J should become subject to the worker's corrp.~nsat:un
provisions of'Section 3700 ofth7labor Code, I shall fOlthwith omply With tt-~e provisions.
PROCESSED BY: MSM
I
.- LICENSED CONTRACTORS DECLARATION!
I hereby affirm under penalty of perjury that I am
Hcensed under provisions of cttapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
~/:~e;;~ons Code. ~
Date: Contractor
. NUMBER
606111
TYPE
EXPIRATION DATE
12/31,/2006
C39
Date: 4/5/2005 Applicant:
WARNING: FAiLURE TO SECURE WORKER'S COMPENSATION COVE>1AGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENJ\I.T/ES AND CIVIL
FINES UPTO ONE HUNDREiJTHOUSAND DOLLARS ($100,000);. IN A[;[>,T10N TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN S::CT!O~! 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY
I herebyafflrri1 under penalty of perjury that there is a construction lending a~encyfor the
performance of the work for which this permit is issued (See. 3097 .Civ .C): ,.
Lender's Information:
ConstrLicion Types:
'IN, ,
Fire Sprinktered?
o NO
I certify that I have read this appli~ation and state that the above information is correct. I
agree to oomply with all city ordinances and state laws relating bbuilding construction, and
hereby authorize repre$entives_of this city fo enter upon the above mentioned property for
inspection purposes. .
S.'t'fA~I' A'
19na ure 0 pp lcant or gent .
The permit shall expire by Iimitati()n and become null and v()id if the building or
. work has not passed final Inspection 365 days fr()l11 the date of permit issuance. A
new perr.nit is required to commence or continue work.
Dat&: 4/5/2005
Fees paid for Permit:
Total:
235.93
".,
INSPECTION RECORD
. INSPECTION .' DATE INSPECTOR.
Temporary Power Pole
Plumbing (DrainlW"ste Pipe)
Electrical Ground Eiectrod"'Ufer
. SelbacklFormsfTrenches (Footings)
Do. not install subfloor or pour floor slab until the'
following applicable items have been. signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork) .'
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane.Reinf.
Underpinning (Floor Joist/Girders) ..' .
Do not cover or conceal the work below until the
following applicable items h"ye .been signed: .
.1st Floor Shear' .
Firesprinkler (Rough) . .
2nd Fioor Shear' . .'
Roof (Sheathing/Diaphragm'Frane) . -'-f-.()<, 7~Yp-n 4J..
Masonry (ReinfJBond BeanlPre-Grout) . . If
Rough Plumbing (Top Out) .
Rough Mechanical
Rough electrICal all)
Rough Electrical . .
Framing (Only after Plbg" Elec..: r...1ecl1.. and Fire) .
Insulation (SoundlEnergy) .
po not tape or. pla~ter until the following applicable
Items. have been .slgned: .
Drywall .
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical .'
Penetrations (Fire Rated) Plumbing
Interior Lath . . .
Exterior Lath '.
. GENERAL ITEMS
Exterior Plaster (Brown Coat) .
T -Bar Electrical .
T-Bar Mechanical
T-Bilr Structural
Sewer. . .
Water Engineering Backflow .
Water Service
FINAL INSPECTIONS . Date 'Inspector
Electrical Final
,Plumbing Final .
Mechanica!' Final .
Gas Test . . .
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040 . .
Water Engineering 765-5268
Sub List/Business License 765-519
Zoning 765-5139 ',' "
'.
Building Final \}ast Inspection- Onl~\ t ~/IJ-oi? ' t1. ,,,,.
. fter Above Complete)
PARTIAL INSPECTIONS !2A //::1
OU
Buildina InsDections
MechanicallnSDections
Plumbina InsDections .
ElectricallnSDections