2550 Ward Terrace
TYPE OF PERMIT CITY
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 123
BUILDING PERMIT N9: ' BLEl2005-01646
DATE: 6/2/2005
,JOB ADDRESS: 2550 E WARD TER
LEGAL DESCRIPTION: SEC 12 T 4 R,10 POR NW1/4 SE1/4 AS
APPLICANT: J ERRY BOLT
OWNER INFORMATION: CONTRACTOR INFORMAT:ON:
Hampshire Square CELOSEAL ROOFING, INC
PO Box 19528 2323 N BAT A VIA'
Irvine, CA 92623 ORANGE, CA 928650000
. BUSINESS PHONE: 714998 ;:990 .
JOB DESCRIPTION:Tear off existing roof and replace with 1,60 squares of bUilt-"p roof over carports 11-88: 58-82 and 10-18.
VALUATION: 60,000.00 I PROCESSED BY: MSM
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Ucense Law for the following reason (Sec. 7031.5 Business and .
Professions Code: any city or county which requires a permit tocQnstruct, alte~ improve, demolish or repair any structure, prior to its isSuance, also
requires the applicant for such permit to file asigned statement that he is licen~d pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7:000 of Division 3 of the .susinessand Profession's Code) or that he is exempt therefrom ~nd the basis for the,alleged
exemption. Any vi0lation of Section 7031.5 by"any applicant for a permit subjeCts the applicant to a civil penalty of ribthlore than five hundred dollars
-~', " . ' , ;' ,
o I, _as owner of property,' or my e'mployees with wages as their sole comper\sation, will do the work, and the structure is' not intended or offered for
sale (Sec. 7044' Busin~ss and Professions Code: The Contractor's ~icense laiN' does not apply to an owne,r of property who builds or im.proves
thereon, and who does such work himself or herself or through h.is or her own 6lmployees; provided that such improvements~re not intended-gr_
offered for sale. If; however, the building or improvement is sold with one yearhf,completibn, the owner-builder will have the burden of proving that he-
did not build or improve for the purpose of sale). j - .
o I, as the owner of the property, am !9xclusively contracting' with licens:ed cdntractors 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
a contractor(s) licensed pursuant to the Contractor's License 19.w):~, _' .'
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 pe~ury one of the following declarations:
D I have and will maintain" a certificate of consent to self-insure for worker's c'ompensation,
as provided for by Section 3700 of the Labor Code, lor the pertormanoe of the war!< for which
~hi permit is issued.' . 1
I have. and w, i1('maintain workE!r's compensation insurance, as required by Sec.tion 3700 of
labor Code, for the performance of the work for which this permit is issued, Myworker's
orT!penSation insurance carrier and policy are: ' " ,
arrier: STATE FUND' Policy Number. 467-0000614
This section need not b:e" completed if the pennit isfor one hundred dollars ($100) Qr less.
o I certify that in the performance of the work forwhich this permit, ~s issued;'1 shall not
employ any person in any manner so ~ to become subject to the worker's compensation laws
of California, and agree th?t if I should beco e subject to the worker's compensation
provisions of Section 3700 01 the Labor C , I shall forthwithcomp ith those provisions.
ARCHITECT/ENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 70 . ) of Divsion 3 of the Business and
Professions e
6/212005
Date:-
NUMBER
263519
TYPE
TYPE
, EXPIRATION DATE
11130/2005
C39
B
Date: 6/2/2005 Applicant:
WARNING: FAILURE TO SEcLiREVv
UNLAWFUL, AND SHALL SUBJECT EMPLOYE TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TOTHE'
COST OF COMPENSATION, DAMAGES AS P'ROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTERESTAND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec. 3097 .Civ .C):
lender's Information: .
Construcion Tvpes:
V N, ,
Fire Sprinklered?
NO
I certify that I have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to building construction, and
hereby authorize r sentives of this city td.enter pon-the above mentioned property for
insp ion purpo s . ~ L1 .
r::9(J)' Date: 6/2/2005
Fees paid for Permit:
Total:
913.29
ignature of Applicant or Agent
The ermit shall expire by limitation and becoine null and void if the building or
work has not passed final inspecti!!n 365 day.. from the date of permit issuMce. A
new permitJs required to commence or continue work. ' ,
, INSPECTION RECORD
INSPECTION .
, . .. DATE INSPECTOR
Temporary Power Pole .
Plumbing (PrainlWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormsfTre.nches (Footings)
Do not install subfloor or pourfloor slab untilthe . .
following. applicable items have been signed:
Plumbing (Water Pipe$prinkler Valves)
Mechanical (Groundwork) . . .
Electrical (Underground Conduit) .
Pre-slab (Coll1PactionlMembrane.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 (SheaihinglDiaphragm/Frame) . l./14/0 I. AiL. n
Masonry (ReinfJBond BeamlPre-Grout) I. /111
Rough Plumbing (TopOut)
Rough Mechanical. .
Rough 8ectrical (Dry Wau)
Rough Electrical
Framing (Only after Plbg.', Elec.. M~ch..,and Fire)
Insulation (SoundlEnergy)
po not tape or pla~ter until the following applicable
Items have be~m'slgned:, .
Drywall ., ~. .
Penetrations. (Fire Rated) Electrical
PenetratIons (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing .. I
Interior Lath .
Exterior Lath .
GENERAL ITEMS .
Exterior P.!aster (Bl!7Nn Coat)
T -Bar Electrical .
T -Bar Mechanical .
T -Bar Structural , I'
Sewer .. ..
Water Engineering Backflow
Water Service '.
FiNAL INSPECTIONS Date Inspector
Elec~rical 'Final . .. . .
Plumbing Final . .
,.
Mechanical Final . .
Gas Test .
Engineering/Grading Final 765'5126. . .. . .
.
. Fire Dep!. Final 765-4040 . .
Water Engineering 765-5268 . .
Sub List/Business License 765-519 . . ..
Zoning 765-5139 . ( '\
Building Final ~ast Inspection. Only ~U()C' -J.I'\L\'\ .___
Iter Above Completel
PARTIAL INSPECTIONS
w~~~O;jJ-681 'j)aA
Mechanicallhspections
Plum'binQ Inspections
Electricalli'ispections
TYPE OF PERMIT C ITV
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 123
BUILDING PERMIT NO. BLD2005-01832
DATE: 6114/2005
JOB ADDRESS: 2550 E WARD TER
LEGAL DESCRIPTION: SEC 12 T 4 R 10 POR NW1/4 SE1/4 AS
APPLICANT: JERRY BOLT
OWNER INFORMATION:
Hampshire Square
PO Box 19528
Irvine, CA 92623
CONTRACTOR INFORMATION:
CELOSEAL ROOFING, INC
2323 N BATAVIA
ORANGE, CA 92865 0000
BUSINESS PHONE: 71499112990
JOB DESCRIPTION:Tear off existing roof and replace with 190 squares of built-up roof over carports 43-138, 51-112, 7~59 and 31-85.
ARCHITECT/ENGINEER INFORMATION:
VALUATION: 72,000.00
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, alter, 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 licJ,nsed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business a nd 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 dvil penalty of not more than five hundred dollars
($500).
o I, as owner of property, or my employees with wages as their sole com~ensation, 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.aw 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 ow', 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 purpose of sale). I
D I, as the owner of the property, am exdusively contracting with licensed:rontract.ors 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
~ontractor{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 worker's compensation,
as provided for by Section 3700 of the labor Code, for the performance of the work for which
~hi permit is issued.
I have and will maintain worker's compensation insurance, as required by Section 3700 of
he Labor Code, for the performance of the work for which this permit is issu9d. Myworker's
ompensation insurance carrier and policy are:
Carrier: STATE FUND Policy Number. 467-0009614
PROCESSED BY: MSM
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) f Dlvsion 3 of the Busin sand
Profession
6/14/2005
Date:
This section need not be completed if the pennit is for one hundred dollars ($100) or less,
o I certify that in the performance of the work for which this permit is issued, I sha 11 not
employ any person in any manner so as to become subject to the worker's compensation laws
of California, and agree that if I should b me subject to the worker's comj:e sation
provisions of Section 3700 of the Labor 0 e, I shall forthwit wit tl se provisions.
NUMBE
263519
TYPE
TYPE
C39
B
Date: 6/14/2005 Applicant:
WARNING: FAILURE TO SECURE R' MP SATION COV GE IS
UNLAWFUL, AND SHALL SUBJE LOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED, OUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty 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:
Construcion Types:
VN, .
Fire Sprinklered?
NO
i ctlriiiy iilat I have rei;:lct ihi::; appiicaiion and stale that the above informatiotl is correct. I
agree to rom ply with all city ordinances and state laws relating to building construction, and
hereby horize representives of this ci to enter upon the above mentioned property for
insp: 0 purposes.
Date: 6/14/2005
Fees paid for Permit:
Total:
1,074.60
Si ature of Applica or Agent
The p mil shall e pire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new Dermit is reauired to commence or continue work.
City of Anaheim
Building Division
~~
r€~i'
~~.
"DED
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Wasle Pipe)
Eleclrical Ground Eleclrode/Ufer
Selback/Forms/Trenches (Foolings)
Do nol inslall subfloor or pour floor slab unlil the
following applicable items have been sianed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduitl
Pre-slab (Compaction/Membrane Reinf.)
Underpinning (Floor Joist'Girders)
, Do nol cover or conceal the work below until the
I following applicable items have been signed:
:1st Floor Shear
IFiresprinkler (Rough)
2nd Floor Shear
Roof (SheathinalDiaphragm/Frame)
Masonry (ReinfJBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only aft~r Plbg., E&e., Mec. And Fire)
Insulation (Sound/Energy)
Do nollape or plaster unlil the following applicable
items have been signed:
Drywall
Penetrations (Fire Rated) Electrical
Penelralions (Fire Rated) Mechanical ,
Penetralions (Fire Rated) Plumbing
Interior lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coal)
T -Bar Electrical
T-Bar Mechanical
T -Bar Structural
Sewer
Water Engineering Backflow
Water Service
FINAL INSPECTIONS DATE INSPECTOR
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) \ 6("
PARTIAL INSPECTIONS
-:::
.
Mechanical Inspections
Plumbina Inspections
Electrical Inspections