114 E. Wilken Way
.
ElM
BUILDING DIVISION
.200 S. ANAHEIM BLVD.
. (714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 99
BUILDING PERMIT NO. BLD2005.01555
TYPE OF PERMIT CITY
Reroof
DATE: 5/24/2005
JOB ADDRESS: 114 E WILKEN WAY
LEGAL DESCRIPTION: N TR 2683 LOT 16
APPLICANT: RANDY CARTER
OWNER INFORMATION:
SaUyT ~ruber
3606 Catamaran Dr
Corona Del Mar, CA. 92625
CONTRACTOR INFORMATION:
PETERSEN & DEAN, INC..
2191 S DUPONT DR
ANAHEIM, CA 928060600
BUSINESS PHONE: 714628-9670
JOB DESCRIPTION:Tear off existing root and replace with 37 squares of 30 year composition shingl.es and 1 square of torch down.
. , .
10,724.00 PROCESSED BY: MSM
ARCHITECT/ENGINEER INFORMATION:
VALUATiON:
OWNER-BUILDER DECLARATION
I hereby affIrm under penalty of perjury tha.t I am exempt from the Co.ntractor's,~icense Law for tt)e foHowing reason Sec. 7031.5 Business and
ProfesSions Code: any city or county which requires; a permit to construct, after, improve, demolish or repair any structure, prior to its iSsuance', also
requires the applicant for such permit to fjle a signed statement ~hat he IS liCen~d.pursuant to the pro.visions of the Contractor's License law (Chapter
9)(commencing with Section 7000 of Divisi,on 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 do{lars
~~. I... .. .
o I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for
sale (s6c, 7044 Business and Professions Code: The Contractor's Ucense Law does not applyt'o 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 owne.r-buil<;:fer will havethe burden of proving ,that he.
did not build or irnprovefor the purpose of sale), ~
0' I, as the owner o.f the, property, am exclusively contracting with licensed contractors to construct the project (See, 7044 Business and. Professions
Code: The Contractor's ,License Law does not apply' to' an owher of .property w)1o builds or improves thereon, and who contracts for such projects with
~ontractor(s) 'Ii~ensed pursuant to the Contractor's License Law).. f .'
U I am exempt under Sec. , B & P.C, for this reason: \
Date: Owner: .
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 forby Section 3700'of the Labor Code, for the performance of the work for which
~iS ermit is issued. : . '
I have and will maint. ain worker's compens. atiQn inSuran?e, as required by Section 3700 of.
lab,or Code, for the performance of the work for which this permit is issued. My worker's
ompensation 'insurance carrier and policy are: : '
Carrier: ZURICH AMERICAN INS.CO PolicyNumber. WC0399213602
This sectiOn need not be Completed if 1he pennll is for one hundred dollars ($1 00) or less.
o I certify t~at in the- perfOITl'H!OCe of the work for which thi,~ permit is issued;1 shall 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 e ~bject to the worker's.compe~ation .
provisions of Section 3700 'of the Lab .Cod, r U forthwith comply with those provisions.
LICENSED CONTRACTORS DECLARATION
t hereby affirm under penalty of perjury ,that I am
licensed under provisions of chapter. 9 (commenq-i!1g
with Section 7~". 0 VS'P3 of tI1e Business and
Professio s Me. \/~ .
5/24/2005 '. .'
Date: Contractor
NUMBER
468117
TYPE
EXPiRATION'DATE'
113112007
C39
Date: 5/24/2005 Applicant:
WARNING: FAiLURE TO SECUR WORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND 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 Sprihklered?
-NO'
I certify that I have read this application and stat~ thafthe above information is correct. 1
agree to comply' with all city ordin"ances and state laws relating to building construction, and
~ereb 7auth '.e representives of this city to enter upon the abovementioned prop. erty for
In . purses,._. . , .
'. Date: 5/24/2005
Signature of Applicant or Age.nt "
The permit shall expire by limitation and become null and void if the building or
work has not passed Ii nal inspection 365 days Irom. the date of permit issuance. A
new permit is required to commence or continue work.
Fees paid for Permit:
Total:
310.62
INSPECTION RECORD
" "
... INSPECTION DATE INSPECTOR
Temporary Power Pole
,Plumbing (DrainIWaste Pipe)
Electrical Ground Electrode/Ufer . '. .
SelbacklFormsfTrenches (FootingS) .
Do not install sublloor or pour Iloor slab until the
following applicable items, have been signed:
Plumbing (Water Plpe.Sprinkler Valves)
Mechanical (Groui1dwork) .
Electrical. (Underground Condu it)
Pre:slab.(CompactionlMembrane.Reinf.
Underpinning (F100r.Joist/~irders)
uo not cover or conceal th<l worn below until th<l ,.
following applicable items have been signed:
1, st .Floor Shear
Firesprinkier (Rough) .'
2nd Floor Shear
Roof (ShlIathiIllllDiaphmgmlFrame), b'-" '....r(A IA. (J,.n
., Masonry (ReinfJBondBeamlPre-Giout) ( 1/1/ ' .
Rough Plumbina (Top Out) ,
Rough Mellhanical .
Rougn ~ectrlClII H) .
Rough Electrical
Framing (Only after P,lbg:, Elec.: Mech.. and Fire;
Insulation (SoundlEnergy)
Donot.tape or plaster until the following applicable
items have been. signed: .' ..'
Drywall .
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing .
Interior Lath ' . . .
Exterior Lath
GENERAL ITEMS
Elderlor Plaster (Brown Coat)
T .Bar Electrical ..
T.Bar Mechanical
T .Bar Structural .
Sewer
Water Engineering Backflow ..
Water Servic.. .
FINAL INSPECTIONS . qate )l)spector ' '
Electrical Final . ."\
Plumbing Fjnal
Mechanical Final , .
Gas Test
Enginllering/Grading Final 765-5126
Fire Oept. Final.765-4040 ,
Water Engineering 765-5268
SU;b List/Business Licens.. 765-519' .
Zoning 765.5139 .
Blli\ding Final ' ~ast Inspection' Only ~4CJ5 /.~ ,~
Iter A~ov. Complete)
PARTIAL INSPECTIONS
,- "
Building Inspections
Mechanical Inspections
Plumbina Insoections
Electrical Inspections