2042 W. Willow
BUILDING PERMIT NO. BLD200S,01300
TYPE OF PERMIT CITY
Reroof
DATE: 5/5/2005
JOB ADDRESS: 2042 W WILLOW AVE
LEGAL DESCRIPTION: N TR 2369 LOT 41
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 40
APPLICANT: KAREN NICHOLS
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
Micheal Nichols
2042W Willow Ave
Anaheim, CA 92804
JOB DESCRIPTION:yhange pitch of roof to existing garage and re-~oof existing ~ouse total of 28 squares of class B asphalt shingles
,
VALUATION: 6,000.00 ,
I OWNER-BUILDER DECLARATION
l.hereby affirm onder penalty of perjury that I am ex.empt from the Contractor's J..icense Law tor the following r~ason (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 fire a signed statement that he is licen~d pursuant to-the provisions of the Contractor's License law (Chapter
9){commencing with Section 7000 of Division 3 of the Business and Profession~ Code) or that he is exempUherefrom and the basis forthe alleged
exemption. Ar)y violation- of Section 7031.5 by any applicant for a permit Subjec;ts the applicant to a civil penaltyof not more than five hundred dollars
($500). . J , , ' ,
5ZL I, as owner of property, or my employees with 'wages as their sole compe~ation,.wiU do the work, and ,the structure is not intendedor offered for
sale (Sec. 7044 "Business'and Prof~ssions COde: The Contractor's License La\y does not apply to an owner of property who builds or improves
thereon, and who does such work himself or belSelf or through his or her own'El)1ployees, provided that such improvements,a-re not intended or
offered for sale. If, however, the building or improvement is sold with one year of colJ1pJetion, the 'owner'~builder will have the burden 01 proving that'tie
did not buUd oi'improve for the purpose of sale). ' .
o " I; as the owner of the property, am exclusively contracting wnh licensed contraGtors to construct the project (Sec. 7044 Business and-Professions
Code:. The Contractor's License Law does not apply to an owner of property w~o builds or improves ther.eon, and who contracts for suqh projects with
.~ontract.or{s) licensed pursu~nt. to the Contractor's License La\y). . . .
U . ex P1. nder Sec. . B & P.C. f r .s reas n: ')
e: 0
WOR 'S COMPENSATION DECLARATION'
.1 hereby affirm under pen ty of p~~ury one of the following declarations: . ~
o I have and will maintain a certificate of consent to self-insLJre for worker's compensation,
as provided for by section 3700 of the Labor Code, for the periormance of fheVror1< for which
this permit is issued. , ,". i'
o I have. and will maintain wO-rker's compensation insurance, as required byS.ection 3700 of
the Labor-code, for.the performance of the work for which this permit is issued.!Myworker's
Compensatiof) insurance carner and po~cy are: ~
Carrier: Policy Number: I,:
This section need not be .completed if the pennit is for one hundred dollars ($100) ~.Iess. ,
I2t I' certify that"i~ ~he, pertol111ance oftha, work for wh~h. this permit is'issued, t shall ~dt
employ any person In any manner so as to become subject to the worker's compensatIon laws
of Califomia, and agree that if I should ,become subject to the worker's compensation
provisions of Section 3700 of the L or Co , shan forthwith comply with.~hose provisions.
Date: 515/2005 ,Applicant:
WARNING: FAILURE TO SECUR OR COMPENSATION COVERAGE 'fS
UNLAWFUL, AND SHALLSUBJ TAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTQ ONE HUNDRE OUSAND DQLLARS ($'100,000), INADDll1bN TO THE
COST OF COMPENSATIO DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST. ;/\NDATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I' hereby affirm under enalty of perjury that there is a con~ruction lending agency for the
pel:tonnaOGe._QUI'le_~o(kJQtwh)cttthis_permit isissued (Sec.3097-.Giv.C):, }.:: ,
Lender's Infonnation:
J certify that I have react 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
hereb uthor.ize representiVes of this city to enterupon t~e above mentioned property for
I ion" ~~. Dale: 515/2005
Signature of Applicant or, Agent
mit shall eXpire by limltation and become null and void if the building or
work as not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
PROCESSED BY: ENO
LICENSED CONTRACTORS DECLARATION ,
" I hereby affirm under penalty 0 perjury .that ! am
licensed under provisions of Chapter 9 (commencing
with Section 7000) of Divsion 3- of the Business arid
Professions Code.
515/2005
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Construcion Tvpes:
VN, ,
Fire Sprinklered?
NO
. 'Fees paid for Permit:
Total:
437.17
INSPECTION RECORD
I
FINAL INSPECTIONS
Date
Inspector
. INSPECTION . DATE INSPECTOR . Electrical Final
I
Temporary Power Pole '. ,
.. Plumbing Final
Plumbing (DrainiWa$te Pipe) Mech~nical Final.
. Electrical Ground Electrode/ute,
setbacklFormsrrrenches (Footings) . Gas Test
I
00 not ins taU subf/oOr or pour floor slab until the EngiJ\eering/Grading Final 765-5126 . .
following applicable items have been signed: . , .
I '.'
Plumbing (Water Pipe.Sprinkler Valves) Fire Oept. Final 765-4040 . .
,
Mechanical (Groundwork) Wate'r Engineering 765-5268 . .' .
Electrical (Underground Conduit) .'
Sub List/Business Ucense 765-519 ."
Pre-slab (Compaction/Membrane.Rei m.. . . ,
Underpinning (Floor Joist/Girders) .'. Zoni~g 765-5139
00 not cover or conceal the war!< below until too BUilcl;ng Final ~ast Inspection- Only II)(..()( x:'/M '. L .
following applicable items have been signed- . . . i fie( Above Complete~
1st Floor Shear . I PARTIAL INSPECTIONS
Firesprinkler (Rough) . Buildina InSDections
2nd Floor Shear '.
Roof /Sheathlng/Diaphragm/.Frane) . "fi'/Jdt>$ V,..L ~ /V~r h: ~. of- ~r'" .>L..;:. ~"L...r .
Masoriry.(RelnfJBond BeamlPre-Grout) . ./ ..--!", .~. .~ /'"x....-,:;
Rough, Plumbing (Top Out) +.1<=. f)/Jl I~ ., ~O\ K <6-/(.05 ffJ(tf
Rough Mechanical . .
I KOugn ~ectrlC8Ilury vvaU)
Rough Electrical . , ! .
Framing (Only afterPlbg.. flec.. Mech. and~ . . . . '.
Insulation (SoundlEnergy) ,
.,
MechanicallnSDections . .
po not tape or plaster until the following applicable
Items have b~en Signed: '. . . , . . ..
Drywall . . . , . ".
Penetrations(Fine Rated) Electrical . ,
Penetrations (Fine Rated) Mechanical . . .
Penetrations (Fine Rated) Plumbing . '. .'
Interior Lath .
Exterior Lath )"'_~O-t'l'l" fL. .U " Plulnbina Inspections .
GENERAL ITEMS ,
Exterior PJaster(Brown Coat) , ,
T -Bar Electrical /' . . . .
.
T -Bar Mechanical . . , .
. . .' -
T -Bar Structural . .
Sewer . . . , .
Water Engineering Backflow . ,
ElectricallnsDections ~
Water Service' ,