1071 S. Spinnaker St.
BUILDING PER~IT NO. BL1;l2005-(12569
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TYPE OF PERMIT CITY
Reroof
DATE: 8/1 6/2005
JOB ADDRESS: 2071 S SPINNAKER ST
LEGAL DESCRIPTION: N TR 3017 LOT 3
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 98
APPLICANT: TIM OUTZEN
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
JAMES E RHODES OUTZEN ROOF CO INC i
PO BOX 2082 591 E BONITA AVE # A
PALM DESERT, CA 92261 SAN DIMAS, CA 917730000
JOB DESCRIPTION:Tear off existing roof and replace with 25 squares of hot mop over apartments and attached laundry room.
VALUATION:
4,000.00
PROCESSED BY: MSM
OWNER-BUILDER DECLARATION
1 hereby a irm under penalty 0 perjury that I am exempt rom t e ontractors Icense w or t e 0 OWing reason ec. 7031.5 BusIness and
Professions Code: any city or county which requires a permit to construct, alte;. 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 (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.7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars
~~. , .
o I, as owner of property, or my ~fPloyees with wages as ~heir sole compensation, will do the work,_ 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 does-such work himself or herself or through his or her own employees, provided that such 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 build or improve for the purposeof sale).
o I, as the owner of the property, am exclusively contracting with licensed (X>ntractors to construct the project (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 contracts for such projects with ~
p....qontractor(s) licensed pursuant to the Contractor's License Law).
U 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 have and will maintain a certificate of consent to self-insure for work~r's compensation,
as provided for by Section 3700 ofAhe Labor Code, for the pertormance of the !Nork for which
~'s permit is issued.:
I have and will maintain worker's compensation insurance, as required by Section 3..700 of
e Labor Code, for the performance of the work for which t\:lis permit is issue~ Myworker's
ompensation insurance carrier and policy are: I
Carrier: STATE FUND Policy Number. 285-02 UNIT 0001695
This section need not be completed if the pennit is for one hundred dollars ($100) Or less.
o I certify that in the perfonnance of the work for which this permit is issued~ I shall not
employ any person in any manner so as to become subject to the worke~s corrlpensation laws
of Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I shall forthw'th co wit hmje provisions,
Date: 8/16/2005 Applican .
WARNING: FAILURE TO SECUR WO KER'S COM NSATIO C ERAGE IS
UNLAWFUL, AND SHALLSUBJE T AN EMPLOYER TO CRIMI AL PENAL1IES AND CIVIL
FINES UPTO ONE HUNDRED OUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, D AGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AN ATTORNEY'S FEES.
C STRUCTION LENDING AGENCY
I hereby affirm under pena of perjury that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec.3097 .Civ.C): '
Lender's Information:
I certify that.1 have read this appl;ca~ion and state that the above informatio';1 is correct. I
agree to comply with all citv ordinAnces and statAJaW$l relating to_bllHrlil'1g CI)J"I,:,.~r'J':'tjon, and
hereby authorize representives of this city to enter upon the above mentioned property for
i ion purposes.
Date: 8/16/2005
Signature Applicant or ge
The p it shall expire by limitation and become null and void ifthe building or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
LICENSED CONTRACTORS DECLARATION
ere ya Irm un er pena ty perjury t at am
J icensed under provisions of chapter 9 (commencin g
with Section 7000) of Divsion 3 of the Bu . ess and
Professi n
8/16/20
Date:
Construcion Tvpes:
V N, ,
Fire Sprinklered?
EXPIRATION DATE
4/30/2007
C39
NO
Fees paid for Permit:
Total:
226.77
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormslTrenches (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 have been signed:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame) Sh, I. jA>JQ ": .
Masonry (Reinf./Bond Beam/Pre-Grout) II /
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable
items have been signed:
Drywall
Penetrations (Fire Rated) Electricat-
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-Bar Structural
Sewer
Water Engineering Backflow
Water Service .
.,. \.,.,
,
FINAL INSPECTIONS DATE
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-5194
Zoning 765-5139
Building Final (Last Inspection - Only "'"
After Above Complete)
INSPECTOR
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections
Plumbina InsDections
Electrical InsDections