629 S. Lemon
;i~ . .".
~~O~OF PERMIT' . CITY
DATE' 2128/2005
JOB ADDRESS; 629 S LEMON ST
LEGAL DESCRIPTION;. VINEYARD LOTS LOT H-5 SLY 50FT NLY
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE; 434
QUARTER SECTION; 84
BUILDING PERMIT NO. e.LD200S-00490
CONTRACTOR INFORMArION:
J W ROOFING .
12892 FiElDSTONE DR
SANTA ANA, CA 92705 oDeD
BUSINESS PHONE: 7145384577
JOB DESCRIPTION:Re-roof over existing layerwith 17 squares of 30 year composition elk shingles, ICBO #ER-5444,
VALUATION: 3,000,00 PROCESSED BY: ENO
I OWNER-BUlLDEROECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor'J License law for the following reason (Sec. 7031.5 Business and
Professions Code: any oty or county which requires a p~rmit to cO!1struct, altdr, 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 Jicer)sed pursuant.to the p~vision~ofthe Contractor's license Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professichs Code) or that he is' exempnherefrom and the basis for the alleged
exef!lptian.. Any violation of Section 7031.5 by"any applicant for a. permit"subj;ects the applicant to a civil penalty"of not more than five hundred dollars
~~ " ,'1 ,'. " '
o I, as owner of property, or.r!lY employees with wages as their sole com~~nsation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License tAw does not apply to an owner of property who builds or improves "
thereon, and who does sudi work himself or herself or through his or her ow:-",:emp~yees, provided that such improvements' are-not 'lnte"nded,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 bu i1d or improve for the purpose of sale). "';. .
o I, as the ,owner of the property, am exdusively contracting with licensed (on tractors to construct th"e project (See. 7044 Busjnessand Professions
COde: The Contractor's License law does n()t apply to an owner of propertY\-Vho builds or improves thereon, and who contracts for sudl projects with
~o~tractor(s) licensed pl:lrsuant 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 h~reby affirm under penalty of perjury one of the following declara"tions: . . ..
0- '"have and will maitltain a certificate of consent to self-insure for worker'~"compensation,
as provided for by Sed ion 3700 of the labor Code, for the perlormance of thEi work forwhidl'
ihl permit is issued. " "
_ I have and will maintain" worker's compensation insurance, as required bY~Section 3700 of"
n labor Cod e, fo r tlie - performance of _ the work for which th is permit is issue.j. My wo r~er's
Compensation insurance carrierand policy are: "
Carrier: STATE FUND Policy Number. 285-02 umr 0001851
APPLICANT: JOHN WHITE
OWNER INFORMATION:
Betty L Canaday
629S Lemon St
Anaheim, 'CA 92805
ARCHITECT/ENGiNEER INFORMATION;
This section need not be completed if the pennit is for, one hundred dollars ($100) or less,
'f.i(1 I certify that in the perfonn"anceofthe work .for which this permit is issued, I shall not
'"'e~Joy any person in a ny manner so as to become subject to the worker's cGmpensation taws
of Califomia, "and agree that if! ould become ~ect to the worker's compensation
provisions of Section 3700 of the bor Code shall forthwith comply with tht::"se pro'llisjoos.
Date: 2/28/2005 Applicant:
WARNING: FAILURE TO SECUREW
UNLAWFUL, AND SHALL SUBJECT E OY TO CRIMINAL PENALTiES AND CIVIL
FINES UP TO ONE HUNDRED THO SAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAM ES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE,INTEREST AND A ORNEY'S FEES,
CON RUCTION LENDING AGENCY
Contractor
NUMB
,43618
TYPE
TYPE
EXPIRATION DATE
3/31/2005
C39
Hie
Construclon Types:
VN, ,
Fire $prinklered?
, NO
! hereby 2ffi.;~ llr:.der ~!?n3!t'l C per}!..'!"} tha.!. t.~!e is a CO:1S!fll';tion !erl':Hng 2C~~C-:,' f').!, tf>o?
performance of the work for idl this permit is issued (Sec.3097 .Civ.C):
Lender's Information:
I certify that I have read this appHcation and state that the above information is correct. I
agree to oomply with all city ordinances and state laws relating to building construction, and
hereby 8uth'orize repre~ntjvesof this city to enter upon the above mentioned property for
insp'ecti r .
Date: 212812005
Fees paid for Permit:
Total:
'160.61
19nature of Applicant or Agent
perml s all expire by'limitation and become null and void if the building or
ork has not passed final inspection 365 days from t~ date of permit issuance, A
w permit is required to commence or continue work.
INSPECTION RECORD'
FINAl- INSPECTIONS
ctrical Final
mbing,Final
chanical Final
s Test
,Date
Inspector
INSPECTION DATE INSPECTOR' Ele
Temporary Power Pole , Plu
Plumbing (DrainlWaste Pipe) , , Me
Eledrlclll Ground ElectrodellJfer
SetbacklFormsfTrenches (Footings) Qa
00 not install subfloor'or pourfloor slab until the En
following applicable items have been signed: .
Plumbing (Water Pipe.Sprinkler Valves) , , Fire
Mechanical, (GrOUndwork) , Wat
Eledrical (Underground Conduit) ,
Pre-$lab (Compaction/Membrane.Reim.) , , Su
Underpinning (Floor Joist/Girders) , ' Zon
00 nat cover,arcol}cea,1 the wark ,below untuthe Suil
followmg applicable Items have been signed:
1st Floor S"ear , , , "
Firesprinkler (Rough) ,
2nd Floor Shear '" ~d Sui
Roof (SheathIIl!llDiaphra!lnv'Frame) ~ ;"'<><;:' ---
Masonry (ReinfJaond BeamlPre-Grout)
Rough Plumbing (Top Out) , . ,
Rough Mechanical , "
Rougn t:IectrlC all) ,
Rough Electrical
Framing (Oniy aner Plbg.. Elec.. Mec/].. and Fire! '
Insulation (SoundlEnergy) Me
0.0 nat tape or plaster, until the following applicable ,
items have been signed: ' ,
DryWall , , '
Penetrations (Fire Rated) Electrical,
Penetratfons (Fire Rated), Mechanical ,
Penetrations (Fire Rated) Plumbirig
Interior Lath " ,
Exterior Lath " Plu
GENERAL ITEMS
exterior PIa$ter (BI'CM/n Coal) .
T -Bar Electrical ,
T -Bar Mechanical
T -Bar Structural
Sewer
'Water Engineering Back1iow. , Ele
Waler Serviee ' , "
'.
gineering/Grading Final 765-5126 '
Dept. Final 765-4040
er Engineering 765-5268
b list/Business License 765-519
ing 765-51,39
ding Final 'Last Inspection. Only ,
" After Above Completel
ehanieallnspections '
mbina Inspections
etrical Inspections