2126 W. Willow
TYPE OF PERMIT
Reroof
.
CITY
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714)"165 -4626
CENSUS CODE: 555
QUARTER SECTION: 40
BUILDING PERMIT NO.
BLD2005-03844
.
DATE: 12/2/2005
JOB ADDRESS: 2126 W WILLOW AVE
LEGAL DESCRIPTION: N TR 2369 LOT 52
APPLICANT: SHARON CARTER
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
SHARON LPIERCE
2126 W WILLOW AVE
ANAHEIM. CA 92604
JOB DESCRIPTION:Tear off existing roof, resheath with 1/2~ OX and replace with 22 squares of 30 year composition shingles over house and attached
VALUATION: garaf!esoo 00 PROCESSED BY: MSM
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's, License Law for e falowing 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 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 5ubj(cts the applicant to a civil penalty of not more than five hundred dollars
($500).
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 (Sec. 7044 Business and Professions Code: The Contractor's Ucense Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or helSelf 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 purpose of sale). .
o I, as the owner of the property, am exclusively contracting with licensed ojntractors 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
,aQontractor(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
this permit is issued,
o I have and will maintain worker's compensation insurance, as required by Section 3700 of
the labor Code, for the performance of the work for which this permit is issued. My worker's
Compensation insurance carrier and poUcy are:
Carrier: Policy Number.
This section need not be completed il 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 shan not
employ any person in any manner $0 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 Labor Code, I shaH forthwith comply with those provisions.
LICENSED CONTRACTORS DECLARATION I
I hereoy affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
Professions Code.
12/2/2005
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Date: 12/212005 Applicant:
WARNING: FAILURE TO SECURE 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 ADDIllON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I 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 (S€lc.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 building construction, and
hereby authorize representives of this city to enter upon the above mentioned property for
inspection purposes.
Fees paid for Permit:
Total:
244.87
Date: 12/2/2005
Signature of Applicant or Agent
The permit shall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuooce. A
new Dermit is reauired to commence or continue work.
...:' - _....
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
Setback/FormslTrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water PipelSprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
Underpinning (Floor JoistlGirders)
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 iI
Roof (SheathinglDiaphragm/Frame) ) ~~"'r: i-'f' ,IY I kJ
Masonrv (Reinf.JBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., EJe., Mec. And Fire)
Insulation (SoundJEnergy)
Do not 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
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
Cross Connection Control (T14j7&5-4280
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765.5268
Sub ListlBusiness License 765-5194
Zoning 765-5139
Building Final (Last Inspection. Only /~,~ y /)
After Above Complete) ./ "
, /
PARTIAL INSPECTIONS
.bUA5~
Buildina Inspections
illd1//-f/~e;. .
"
Mechanical Inspections
Plumbina Inspections
Electrical Inspections
PERMIT APPLICATION ..JOB ADDRESS
,;L\dto I {rllOLO PV-e
NUMBER ~ .) .'" .--
~~~~IU~;J.~ -D3 ~lf L( ~~:~W'
PART 2
STREET
P,(UldA~
To obtain this permit. the undersigned hereby files this application and agrees, certilies and declares:
That notice has been given me that this pelm\! may be used only in compliance willllhe Anaheim
Municipal Code, and all othe(apPlicab\eortlinanc:&sand laws.
That this palmit does not ..Mow occupancy. and thllt no OCClJp(l.ncy is permitted, 01 the cOl\$truc1\on
tor which this pelmit is issued unt)) il has been approved in writing by tills offioo lor occupancy
after final inspection.
ThaI this petmit does nof aflow. and separate permits are required fOI. any plumbing,electrical,heal-
ingarldaircondillorlingwork.
Thai a double tee wlU b0 paid {or any permit issued Ilffer any work thereby allowed has been oom-
menced.
I agree that the City may enter UpOrl the job premises atarly reasonable time to il\$pect any work
Il\$talled under Ihis permil, and 10 olherwise act as and when required by the Anaheim Municipal
Code.
LICENSED CONTRACTORS DECLARATION
, hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000} of
Division 3 at thQ Business and Professions Code. and my license is irl full force and !:!tteet.
UcenseClass
lic.Number
Exp.Date
Contractor
OWNER-BUilDING DECLARATION
r hereby affirm tllat I am 91(8mpt from the Contractor's Ucense Law for the following reason (Se<:.7031.5
Business and Professions C<Xie: any city or county which requires a permit to construct, alter, improve,
demolish or repair any structule, prior 10 its issuance, elso requirss the applicant for such permit to tile a
signed statement ttlat tw is licensed pursuant to the provisions ollhe Conlractor's License law (Chapter
9) (commerlcing with Section 7000 of Division 3 01 the Business and Professions Codel or tIlat he is
exempt lIlere/rom and the baSis lor the aWeged exemplion. Any viOlation 01 Section 7031.5 by any appli-
cant for a permit subjects ttw applicant to a civil penally 01 nOI more Ihan five hundred dollars ($500}.
o I, as owner of the property. or my tlmployees with wages as Iheir sole oompellsation, will dothe well<,
and the structure is not intended or offered for sale (Sec. 7044 Business and Prolessions Code: The
Contfactor's license law does not appJy 10 an owner of property who ouilds or imprlrn;ls themon, ..nd
who does such work himsell or through his own employees, provided that such implovemenlS are not
intended or oflered for sale. II, however, the building or Improvement i$ sok! within 0Il8 y&ar ol completioJ:!.
the owner-bl.lilder will have the bUrden of proving Illat he did notl:luild or improve for the pUlpose ot Sllle).
o I. as the owner of the property, am e):clu$.lvelycOl'ltlac:1ing wilh licensed conlfactors to construct the
project (Sec. 7044 Business and Protessions Code: Th9"Con1rator's License Law does not apply to an
owner 01 property who builds Ot improves thel"eor.. and who contracts tor such projects with a contrac-
lor(s) licensed pursuant to the Contractor's license Law).
o I am eXempt under Sec. B & PC tor this reason
liON ECLARATION
If-Insure, or a certificate 'Of Worio:.ers' Compensation
C) Policy No. Company_
Certihed copy furnished. Exp. Dale AppIica.nt
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE
(Thil'> section ne-ad not be'completed if the permit is for one hundred dollars {$100} or less). 1 certity
that in the per!ormance of Ihe work lor which t . mif Is issued, I ot e person in
any n r as to come subject to leer iOn ytS {Car
\.Ja.te Ap
tr:tOTJCE T APPUCANT: Ii, aft&!" maki 0 Exemption, you should baeo e wb' to
the Workers' Compensation Plovisions 01 e Labor de, you must forthwith comply wi i-
sions or tIlis permit shall be (leerned rev ed.
CONSTR LENDING AGENCY
r hereby affirm Ihat there is a COMtruct!on lending agency lor the perlormance of the work for which
Ihls permit is issued (Sec. 3097. Civ. C):
Lendar'sNama
Lender's Address
I certify that J have read this application and state that the above \rn,)Jrnallon is correct. I agree to comply
with an city ordinances and slate laws relating to building construction, and heret:ly aulhorize represen-
tatives ot this cily to enler upon Ihe above mentioned prOPerty lor inspection purposes.
TtIE PERMIT SHALL EXPIRE BV LIMITATION A.NO BECOME NULL AND VOID IF THIS WORK
IS NOT COMMENCED OR COMMENCED A.ND SUSPENDED AFTER A PeRIOD OF 180 DAYS,
NEW PERMIT IS REQUIRED TO COMMENCE WOfIK.
~ ~NT NAME
~y