6761 Leafwood Dr.
BUILDING PERMIT NO.. BLD2004-03973
TYPE OF PERMIT
Reroof
li:i;::;;!~~~\
CITY aiSt~ji~HEIM
. \~l~l~t~t~/.
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REQUEST LINE: .
(7.14) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 287
DATE: 10/28/2004
JOB ADDRESS: 6761 E LEAFWOOD DR
LEGAL DESCRIPTION: N TR 9133 LOT 16
CONTRACTOR INFORMATION: . .
WESTERN ROOFING SYSTEMS
2031 E CERRITOS AVE #7E
ANAHEIM, CA 92806-000r,
BUSINESS PHONE: 800. 7€5 3000
JOB DESCRIPTION: Tear of shakes, add a layer of.30 pounds felt and metro-it"1~ta] shingle ICBO 5626
APPLICANT: SCOTT JOHNSON
OWNER INFORMATION:
Cha rles Strongo
6761 E.Leafwood Dr
Anaheim, CA 92807
ARCHITECT/ENGINEER INFORMATION:
VALUATION: 3;000.00
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contracta;'; License Law for the following reason (Sec. 7031.5 Business and
Professi<.:ms Code: any dty .or countywhich.requires a permit to construct,'al:'3}. improve, demolish or repair any structure; prior to i!5 issuance, also
requires the" applicant for sl!ch permitto file a signed'statement that he is Ijc~nsed pursuant to the provisions-of the Contractor's License Law (Chapter.
9)(commencing .with Section 7000 of D'ivision 3 of the Business and Professi;?ns Co~e) or that he is exempt th~refrom ar'ldthe basis for the alleged
exemption. Any violation of SectIon 7031.5 by any applicant for a permit suhiects the applicant to a dvil_penalty of not more than five. hundred dollars
~~. ... .
D I.-as owner of property, or my employees with wages as their. sole compensation, will do the.work, and the ~trl.lctl.l~e is not intended or offered for
sale (Sec. 7044 Business and Profes~iQns Cod~: The Contractor's License Law does not apply to an owner of property who builds or improves
therepn, and who does such work himself or herself or through his or her oW.1emp!oy'ees, provided that such improvements are not intended or
offered for sale. If, howeveJ, the building or improvement is sold with oileye3, 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 exdusively contracting with license.j"wntractors to Gonstruct th'eproject (Sec, 7044 Business and Professions
Code: The Contractor'f;" License Law does not apply to an owner of property v/ho build~ or improves thereon, and who contracts for such projects with
~ontractor(s)licensed pursuant to the CO'nt.ract9r's License La.w), .
U I am exempt under Sec. , B & P .C. for this reason:
Date:' Owner:
I
PROCESSED BY: JNJ
WORKER'S COMPENSATiON DECLARATION
I hereby affirm under penalty of perjury one oHhe following declarations:
o .1 have and will maintain a certifjc~.te of consent to self-insure for worker:$ corr.perisation,
as provided for by Section 3700. of the Labor Code, for the performance oftl~'eworK for-wllich
this permit is issued.
J:d.-i have and will maintain worker's compensation insurance, as required Oi Sedion 3700,of
thE:t l~bor Code, for tlie performance of the work for which this perin it !s i$Su:~..J. 'Myworker's I
Compensation insurance carrier and policY are: '
Carrier:. STATE FUND' . Policy Number. 157994B.2003
This section need not be' completed if the pennit is for one hundred dollars ($~GOj Or less.,
o I certify,that in the performance of the work for which this permit is _isS:U~d, j shallllot
employ any person in any manner so as to become subject to the worker-s c'JlOpensationlaws
of Califomia, and agree that if I should become su ct to the rker's' comk-..;.nsatidn
provisions of Section 3700 of the Labor Code, I all rth comply with those provisions.
LICENSED CONTRACTORS DECLARATION
I hereby. affirm under penalty of perjury that lam
licensed under provisions of chapter 9 (commencing
with Section 7000) of Di 3 Of the Business and
Professions Code.
10/28/2004
Date~
Contractor
NUMBER
675902
TYPE
TYPE
EXPI RATION DATE .
8/31/2005
HIC
C39
Date: 10/28/2004 . . Applicant: .
WARNING:. FAILURE TO SE<;UREWORKER'S OMPENSATION GOV"i'~"'GE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENA.LTIES.AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITlON TO THE
COST OF COMPENSATION, DAMAGES' AS PROVIDED FOR IN SECTION 3706 OFTHE
, LABOR CODE, INTEREST AND AITORNEY'S FEES.
J CONSTRUCTION LENDING AGENCY
: I hereby affirm.lJnderpenalty of perjury that there is a cpnstruCtion lendingP'J~ir:cy for the
:.~rf9r!-'-:~~~"0~ th~":.::~-k-f::,.~--.>-..:h~C"':-t~~i:;?<;:-:"~~ is i!':~ed {S:.c.30S? .c;;;.C~:
Lender's Injormation:
Construcion Types:
VN, ,
~:#.,
I certifY that I.have read thjs application' and state that the above information'is correct. I
agree to comply with 'all city ordinances and state laws relating to bu itding construction, and
hereby authoriZe r ntiv f this dty to enter upon the above mentioned proPerty for
ins ection pur . .
Fees paid for Permit:
Total:
160.61
Date: 10/28/2004
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 issuance. A
new permit is required to commence or continue work. .
INSPECTION RECORD
." . INSPECTION ".DATE' INSPECTOR
Temporary Power Pole . . .
Plumbing (OrainlWaste Pipe) '.
EleCtrical Ground Electrode/uter . .
SetbacklFormsrrrenches (Footings).
Do not install subf1ooror pour floor slab until the . .
following applicable it~ms have been signed:. .
Plumbing (Water Pipe.Sprinkler ValVes)
Mechanical (Groundwork)
Eledrical(Underground Conduit) .' .
Pre'slab (Compaction/Membrane.Reinf.
Underpinning (Floor Joist/Girders) .
Do not cover or. conceal the work below until the
fol!owina app'I!,t_~ble items have been signed:". .
1st Floor Shear . . .
FiieSprinkler. (Rough) ".
2nd Floor Shear'
~heathidalDiaph~gmlFrame) . WJ~\'S'
Masonry 1r<B.infJBond BeamlPr....Gl'O\It) .' .
Rough Plumbing (Top Out)
Rough Mechallical ". . .
. KOugh .E1eclrlCalIDry wall) .
Rough Electrical
Framing' (Only after Plbg.. Elee.. Meeh and Fire! In\l<.le( ,\"
Insulation (SoundlEnergy) . ,
Do not tape or plaster' until the following applicable
items have been sign'rd:', . .
Drywall . . .
Penetrations (Fire Rated) Electrical . .
Penetrations (Fire Rated) Mechanical .
Penetrations (Fire Rated) P1umbill9
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 . ,
M'echilnical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Cept. Final 7654040 .
Water Engineering 765-5268 , .'
Sub List/Business License 7i;5.519 .
Zoning 765-5139 . "
.
Bl,Iilding Final Itast Inspection. Only . ~t~'OY'" f ME.. J
fter Above Complete)' ..' IV 1.1. , .
. PARTIAL INSPECTIONS
Buildinq Ihsoections
Mechanical Inspections
Plumbinqlrispections
. Electrical Inspections