123 W. Wilken Way
TYPE OF PERMIT CITY
Reroof.
DATE: 6/1412005
JOB ADDRESS: 123 W WILKEN WAY
LEGAL DESCRIPTION: N TR 1965 LOT 56.
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
'(714) 765 - 5153
. INSPECTiON REQUEST. LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 89
BUILDING PERMIT NO: BLD2005-018111
APPLICANT: BUDDY SILVERSMITH'
OWNER INFORMATION:
RubyM Weber
123 W Wilken Way
Anaheim, .<:A 92802
'. CONTRACTOR INFORMATION:
WHITEHAwK ROOFING
'10391 LA BALLENA CIR
FOUNTAIN VALLEY, CA 927;080000
BUSINESS PHONE: 714963-4070
JOB DESCRIPTION:Tear off exis~ng roof and replace with 25 squares of 30 year compositionshingles.
VALUATION: 7,000.00 PROCESSED BY: .MSM
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjl,Jry that I am exempt from the Contractor's icense Law fort e.fo lowing reason (Sec. 7031.5 usiness 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 i$licensed pursuant to the prOvi~orrs '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 subj,ects the applicaht to a civil 'penalty.of 'not more than five hundred dol/a'rs
($500). . . , . . . .'
o I, as owner of property, or my _employees with wages as their sole comp'ei'isation" will do the work, and the structure is not intended-or offered for
sale '(Sec. 7044'SUsinessand Professions Code: The Contractor's Ucense Law does nOt apply to an Owner of property Vl(hobuildsor improves
thereon, and who does such work himself or helSelf or through his or her own employees. providedthat.Sl,ICh improvements,qre riot intended.or
offered for sale. If, however, the building 'or improvement is sold with one year:of completion, the owner-builder will nave the burden-of proving that he
did not build or jmprove forUie purpose of sale)~ . . " . ,
o I, -as the owner of the prop~rty, am exclusively contracting with licensed cOntractors to construct the project (Sec. 7044 Business and Professi9ns
90de: The Contractor's licenSe Law ~~not apply to ,an owner of, prope rty who builds or improves thereon, and who contracts for s'uch projects with
~ontractor(s) licensed pursuant to the Contractor's License Law). .
U I am exempt under Sec. . -, B & P.C. ~or this reason:
Date: . Owner:
ARCHiTECT/ENGINEER INFORMATION:'
WORKER'S COMPENSATION DECLARATION I
I hereby affirm under penalty of perjury oneot thetollbwing declarations: .
o I have and will maintain a certificate of C9nsent to self~insure for worker's~mpensation,
as provided for by Section 3700 Of the labor Code, for the performance ,of the work for which
~hi permit is issued. " .' .
. I have andWiII.main. taiil worker's.compensation. iris~ranc.e,a5 re,q~i~d bY ~ection 3700 o. f
. e Labor Code, for the performance of the work for whICh thIS permit IS 'Issued. My worker's
ompensation insurance carrier and poUcy are: . _ .
J:;arrier: EXEMPT. . . Policy Number. EXEMPT
~hi section need not be'completed if the pennit is for one hundred dollars ($100) ~ less. ,
I certify that in the perfor:mance of the work for which this permit is issued, I shall not"-,
e ploy any ,person hi any manner so as to become subject to the worker's compensation raws
of Caiifomia, and agree that ifl should become ject to th worker's compen,sation
provisions of ~ctiQn 3700 of the Labor , I fort Ii comply with thoSe provisions.
LICENSED CONTRACTORS DECLARATION
I here ya ;rm under penalty of perjury _that I am
licensed under provisions of chapter (comm'encing
with Section ,7000) of Divsio f t siness and
Professi C
i
EXPIRATION DATE
8/31/2005
C39
Dale: 6/14/2005 Applicant: .
WARNING: FAILURE TO SECURE ORKER'S PENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED ll-i USAND DOLLARS ($100,000), IN ADDITION TO THE.
COST OF COMPENSATION, DAMAGES' AS PROVIDED FOR IN SECTION 3706 OF THE .
LABOR CODE, INTEREST-AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm -under penalty of perjury that there ~ a construction lending agency for th~
performance. of the work for which this permit is issued (Sec.3097,Civ.C):
Lender's Information:
ConstruCion Types:
VN, "
Fire Sprinklered?
NO
I certify that I have -read this application and state that the above information is correct. I
agree_ to comply with all city ordinances and state laws relating to bUilQing construction, and
here ,r authorize r ntiv :thi$.city to enter upon t~e above mentioned property for
'nsp io
Dale: 6/14/2005
Fee~ paid for Permit:
TQtal:
235.53
. SI atu of Appli nt or Agent
The permit shaH expire by limitation aQd become null and void if the building or
work hasnol passed final inspection 365 (lays from the date of permit issuance. A
new permit is required to commence or continue work. .
INSPECTION RECORD
INSPECTION .' , DATE INSPECTOR.
Temporary Power Pole .
Plumbing (DrainIWaste Pipe)
Electrical Ground Electrode/lifer
SetbacklFormsfTrenches (Footings) .... .
Do not install subfloor or pour floor slab until the
. folloWing applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valve~) .
Mechanical (Groundwork)
,ElectriCal (Underground Conduit)
. Pre-slao(\.OompactiOl1/Membrane.Reinf.
Underpinning (FlOOr Joist/Girders) .' . .
Do not cover or conceal the work below until the
following applicable items have been signed; .
1st Floor Shear
Firespnnkler (Rough) .
2nd .Flo .
Roltf (Sheathi hragm'Frame) ;.../1.... ...:F L._ .10""-'
Masonry lReinfJBond BeamlPre-Grout) . /
Rough.Plumbing (Top Out) .
Rough Mechanical . .
Rough BectrlClll (DrY Wall) . .
Rough Electrical
Framing: (Only after Plbg., t:lec.. Meet'!.. and Fire'
.Insulation (SollndlEnergy) . .
po not tape or pla~ter until the following applicable
Items have been signed: .
Drywall . . '. .
Penetrations (Fire Rated) Electrical, ,
Penetrations (Fire Rated) Mechanic;al
Penetrations (Fire Rated) Plllmbing
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 Inspector
Electrical Final , ,
Plumbing Final . ,
Mechanical Final "
Gas Test , ..
, '.
Engineering/Grading Final .765-9126 '. "
FireDepl. Final 765-4040
Water Engineering 765.5268 .'
Sub List/Business License 765.519
Zoriing 765.5139
Building Final ' ~Last InspectioJl- Only b~/-{)r 'e~ .:1
. fter Above Complete)
PARTIAL INSPECTIONS
Buildina Inspections.
Mechanical Inspections
. Plumbina Inspections
Electrical Inspections