560 S. Paseo Lucero
.CONTRACTOR INFORMNrION:
HOYT ROOFS
1809 N ORANGETHORPE pARK.
.ANAHEIM, CA 92801000e,
BUSINESS PHONE: 71477:l-1820
JOB DESCRIPTION; Remove existing tile and use existing sheathi'ng. Install 2'layers of 30 year felt and. re-install 25 squares of Eaglite--TiJe (7lbs, ICBO
VALUATION: #4669!ooo.00 PROCESSED BY: SAM
I OWNER-BUILDER:OECLARATlON
I h.ereby affirm t:mder penalty of perjury t~at I am exempt from the Contractor::; License Law for the following reason (Sec. J:031.5 Business and
Professions Code: any city or county"which requires a permit to cOrts"truet; ar.er, improve, demqlish or repair any structure, prior ~o its issuance, also
requires the applicant for such 'permit to file a signed statement that he islJce'Dsed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Pl'ofes's;h;,~'Code) or that he is,exempt therefrom andthe basis for the alleged
exemption. Any violation of Section 7031,5 by any applicant for a permit sub~tic!.s the applicant to a dvil penalty of not more tha'n five hundred dollars
($500). ..;.... ..
D I, as owner of property.-or my employees with wages as, their sole comp'.:'n~ation, will do the work. and the structure is not intended or offered for
sale (Sec. 7044, Business and Professions Code: The Contractor's license l~vl does not apply to an o,,!,ner of property who buildsor improves
thereon, and who does such work himself or helSelf or through his or her owj1;-~mployees. provided that such improvements are not hitended or
offered for-sale~ If, however, -the building or improvement is sold with one ye'::-lfofccmpletion, the owner-builder wi!1 have the, burden of proving that he '
did not build or improve for the purpose ofsale).i . .
o ,I. as the owner of the property, am exdusiv~ly contracting with Iic,ensed!c...,ntraCtors to construct the project (See: 7044 Business and ProfesSions
Code: The Contractor's License Law does not apply to an owner of property'who buiids or Improves thereon, and who,oontracts. for such projects with.
fU(ontractor(snicensect~ursuant tothe.Contractor's Uce~se Law).
LJ I am exempt urlder 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 have and willrnaintain a certificate onxmSent to self-insure for worker';)compensation,
as provided for by Section 3700 of 'the labor Code, for the performance_ of thi:> .NOrk for which
~hi rmit is issued. ' .' ';,' ,
. ." i"have and will maintain wOrker.'s compensation insurance, as required b:,.,.:,section 3700 of 2128/2005
labor Code. for the perforrhance of the work for which this permit is iSSUEd. Myworker's Date:
ompensation insurance carrier and Policy are: : .. .
arrier: STATE FUND Policy Number. 1700471 c02
,
This section neeel no! be oompleted if the penni! is for one hundred dollars ($100), or less.
D I certify that in the perforrnance,ofthe work for which thiS permit.is.iS5'uaa,ls~a.1I not
~mploy any person,in any manner so as to become subject to the worker's CC:ln-pensation laws
of Califomia, and agree that if I should become subject to the worker'S: comp€'Dsation
provisions of Section 3700 of the labor t:;;ode, .I.shall forthwith'comply with those provision1i.
BUILDING{K:"MiT NO. . BLD2005,00511
.....
TYPE OF PERMIT C.ITY
Reroof
DATE: 2/28/2005
JOB ADDRESS: 560 S PAS EO LUCERO
LEGAL DESCRIPTION: N TR 8455 LOT 7
APPLICANT: BRIAN HOYT.
OWNER INFORMATION:
MARY MOTAKEF
570 S PASEO LUCERO
Anaheim, CA 92807
BUILDING DIVISION
200S. ANAHEfM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626 .
CENSUS CODE: 555
QUARTER SECTION: 198
ARCHITECT/ENGINEERINFORMATION:
I
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (cornmencing
withSectio 7000) of DiVs:On. 3 of the BUl3inesS: and
Profession C .
NUMBER
606111
TYPE
Construcion Types:
VN, ,
Date: 2128/2005 Applicant:
WARNING: FAILURE TO SECURE
UNLAWFUL, AND SHALL SUBJECT EMPLOYER TO CRIMINAL PENAltiES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDISlON TO THE
COST OF COMPENSATION, DAMAGES ASPROVIDED FOR IN SECTiON ~706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES..
I CONSTRUCTION LENDING AGENCY
I h_ereby affirm under penalty ofperjur'l that ther~U~_ aconstn)ctjor.I€'r.din_qJ'i':1,~?'..cY.for the--.""c_.~~-l .
parf.:::!m=oO::! of-thc ;:,.OJ k for wiiial ,this p.ermit is issued (Sec.30g7 .Civ.C):
lender's Information:
I certify that I have read this application and state_ that the above information is correct. I
agre~ to oomply with all city ordinances and state laws relating to building con3truction. and,
hereby authorize representives 'of this city to'enter upon the above mentioned property for
in e .Ion purpo'ses.
Date: 2/28/2005
Signature of Applicant or Agent
The permit shall expire by lim.itation and become null and void if the building or
work ha.s not passed final inspection 365 days from the date of permit issuance. A
new permiHs required to commence or continue work.
EXPIRATION DATE.
12/31/2006
C39
Fees paid for Permit:
Total:
491.89
'INSPECTION RECORD
, '
INSPECTION DATE "INSPECTOR
T emporaryPower Pole
Plumbing (DrainlWastePlpe)
Electrical Ground I;lectrodelUfer '
SelbacklForinsfTrenChes (Footings)
Do not install subfloor or pour floor slab until the
following applicable'ilems have been signed;
, Plumbing (Water Pip!!.Sprinkler Valves) "
MeChanical (Groundwork)
I;lectrical (Underground Conduit)
Pre-$Iab (Compaction/Membrane.Rei m..
. Underpinning (Floor Joist/Girders) ,
Do, not cover or conceal the work below umil the
following applicable items have been signed: "
1st FlOor Shear , " , "
Firesprinkler (Rough) " "
2nd Floor Shear J
ROof (Shealhlng/DiaphragrnlFramel -;: ...11-tJ 7<1. ~
Masonry (~inf.JBond BeamlPre-Grout) "
Rough Plumbing (Top Out) , ' , ,
Rough Mechanica,l ,
ROugn l:Iectrical ,
Rough.Electrlcal
Framing (Only after Plbg.. Elec, Mech.. and Fire)
Insulalion (SoundlEnergy) . ','
Do not tape or plaster until the following applicable
items have been signed: ' " ,
Drywall ,
'Peneti'alions (Fire Rated) ElectriCl!' "
Penetrations (Fire Rated) MlIChanical " "
Penetrations (Fire Rated) Plumbing
Interlor Lath, , , .' ,
Exterior Lath
, ' GENERAL ITEMS
Exterior Plaster (Bl'O'i'in Coal) , ','
T -Bar I;lectrical ' "
T-Bar Mechanical
:r .Bar Structural
Sewer
Water Engineerlng Backflow '
Water Service
, " ,
FINAL INSPECTIONS Dale, ~n)~no'":tor .
Electrical Final , , ,
Plumbing Final ' "
Me,chanical Final ,
, , ,
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 7115-4040 ' "
" '
Water Engineering765-5268 , ' ,
Sub List/Business License 765.519
Zoning 765-5139
Building Final ~ast Inspection- Only, ItA~p,) 1~~
fter Above Complele)
PARTIAL INSPECTIONS , .}l, i
I
Buildina InsDections
~f,
"
, I
,
MechanicallnsDections
Plumbina InsDections
, i
1
ElectricallnsDections ,.
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