1731 W. Lincoln Ave.
APPLICANT: MICHELLE MCKINNON
OWNER INFORMATION: . CONTRACTOR INFOHI0,ATION:
HenlY B Wesseln L1NNERT ROOFING IN(: ..
9382 Thistle Rd 715 GROVE AVE ,
, Anaheim, CA 92804 ORANGE, CA 92865000:; ,
, , BUSINESS'PHONE: 7149~'4-5059
JOB DESCRIPTION;Tear off BUR and install 20 squares of BUR,
VALUATION: 3,000,00
L OWNER.BUILDE1~ DECLARATiON
I hereby affirm under penalty of perjury that I am exempt from the Contract~~"s License taW for the following reason (Sec. 703"1.5 Business and
Professj'c;msCode: any city-or county which requires"a permit to constrl.lc.t,'i;i":tt~r, improve,demolish or repair anys~ructure;priOr toi~ issuance;~\So
"requires the applicant for su.ch. perniit to file a signed statement that he is lic~nsed .pursuant to the provisions eftha. Contractor's License Law (Chapter
9)(c'ommencing with Section 7000 of Division 3 of the Business and.Profes~7ons Code} or-that he is eX19mpttherefrom and the basis for the alleged
exemption. Any violation of Section 7031.5.by any applicant for a permit su~ects' the applicant to a dvB penalty of not moi'e.than five hundred dollars.
($500), ,',' , , " j '. " , " "
o I, as owner of property, or my emPloyees- with wages as tneir sole Cf)n~~~nsatiOfl, will do the work, ,and the structure is not intended or offered for
sale.(Sec. 7044 Business and. Professions Code: The Contractor'sL;cem:~-\..a'.rJ dces riot apply to an,ownet of property who builds or improves, ..
thereon. and ~ho doe~ such work himself or helSelfor through his or !ler =-':.~ 'employe$s, provided that,soch irnprovementsare not intended or
offered for. sale. If, however, the building or improvement is sold Vvith.')ne y~,IC!.rofoomph)tion, the owner-builder w~l.h~v9 the b,urden of proving that t4
did notbuna or improve for the pUrPoseofsale).. . -l. " . .,. , '. .., _ "
01, as the owner of the.prope.rty,,~m exdusively contracting with Ijc~nS:E'~':o)ritractcrs; to conslructtl1e project (Sec. 7044 Business and Profeesions
Code: ,The Contractor's License law does. not apply to an owne~ cf:prope:t/Nl1o- l1_u:!ds or improves thereon, and who contracts for such projects with
~ontrad..or($),l~ensed.pursuant to the Contra?tor's LiC9nse Law). r
U I am exempt under Sec. ., S, & P;C. for this ~ea~on:
Date: Owner: __...J...
I WORKER'S COMPENSATION DECLARATIOrl '''--r
I hereby affirm un,der penalty of perjury one of the following declarations:
o _, have and will ma,intain a certi.ficate of consent to setf-insu,re for worke,' ,:. compensation,
as 'provided for by Section 3700 of the-labor Code, for the performance ct t~,e WO!K for which-
~hJ rmit is issued.. ',i .-:
, I have and will maintain worker's compens, alion insurance, as req'Jirod 't~, Sect10n 3700 of
. t Labor Code, for the performance of the wprk for which this permit is jss~l:~d. My.worker's
mpensation insurance carrier and policY are: ' ',... ; .
,Carrier: STATE COMPEN:sATION FUND poncy Number. 044-0~u~rr 0020874
. This section_need not be comple'tedifthe pennit is for one hundred doll~(S.~Qq()flf!:;s.;
. 0 I certify that in the performance oftha work for Which, this pennit ~ i~Jt;'J,_(~an -not
employ any person in any manne(so as to become subject to the wc~ker'G.~')O'.lpens'ation laws
of Califomia, and agree that if I should become subject to the WOri<.~r'$ corrJt:nsatioh
ProvisiQnsofSeclion3700ofthe L~ shali ,rthwil c mply with~\,t pro~isions,
Date: ,12/1512003 Applicant:, ' ' ..' .,.' "
WARNING: FAILURE TO. SECUR aRKER'S Co.MPENSA Jo.N COY~~'\GEII3, '
UNLAWFUL, AND SHALL SUBJEC1AN, EMPLOYER TO CRIM'INAL peoNi,:rtESAND'CIVIL
FINES UP TO. ONE HUNDREOlHOUSAND Do.LLARS, ($1~0,000), INlAti:;:iT!.oNfO THE
COST OF COMPENSATION, DAMAGES AS PRaVIDED FOR IN SECTIO:<J ;3706.oF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES' ',', ""
I ,', , '. CONSTRUCTIONLENDINGAG!'lIICY.., "\~:,./:.,,,
1'hereby_affirrn ur'}der penalty Clf perjury thatJ!'ere ;s a_~~3Wu~tion leDdJr:H;t'~E~'.-~Y;l':Yfor th:e .
-performance .oftne work for which. tn-iS -permit is issued (Sec.309? .eiv.C): - .';->'f"
. Lender's Information: .
,
,.......... .-
BUlWjNG PERMIT NO., BLD2003-04783
TYPEOFPERMIT CITY,
Reroof
DATE: 12/1512003
JOB ADDRESS: 1.731 WLlNCOLNAVE.
LEGAL DESCRIPTION: TR 658 LOT 2 ALL-EX HWY- ,
BUILDING DIVISION
200 S,ANAHEIM BLVD:
(714) 765 - 5153
INSPECTION REQUEST liNE:
(714) 765 - 4626 '<
CENSUS CODE: .1137
QUARTER SECflON: 46
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: AEM
NUMBER
664319
TYPE
TYPE
EXPIRATlo.N DATE
2121\12005
C39
H,IC
Construcion Tvpen:
VN" "
Fire Sprinl<,lered?
"certify that I have read.this application and ~tate.that the above infurmationis correct. I.
. agree to -CQmply with all city ordlnanees,and state raws relating to bu ijding 'construction,a nd
~e\eby .authorize r presentives of this city. to enter upon the above mentioned property for
InSP . sa . .
~" .' " ' Dale: 12/15/2003
. Signature of fi\ Ii nt 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 requirl!d to comml!nCl! or continul! work.
NO.
- .............
'1 '.
Fees paid for Permit:
Total:
110.90
INSPECTION RECORD
INSPECTION DATE INSPECTOR .
Temporary Power Pole .
Plumbing (DminlWaste Pipe) . . . .
Electrical Ground Electrode/lifer
Selback/FormslTrimches (Footings) . .
00' not install S\lbfloor or pour floor slab unt.il the .
fOllowing applicable items have been signed:. . '.
Plumbing (Water. Plpe.Sprinkler Valves) .
.
Meehltnk:a1 (Groundwork) 1
Electrical (Underground Conduit) . . .
Pre-slab (CompactionlMembr;me.Reinf.
Underpinning (Floor Joist/Girders)
00 not cover .or conceal.the work below until the
following applicable .items have been signed:
1st Floor. Shear
Filllsprinkler (Rough) . .
2nd Floor Shear . .
Roof (SheathinglDiaphragm'Frame)
Masonry (ReinfJBond Beam/Pre-GroIJt) . .
Rough Plumbing (Top Out)
Rough Mechanical" '. .
ROugh 6ectrk:a1 ( II) .
Rough Ele<:trical
Fmmirtg (Only afterPIbg:: EIeC.. r,'lech.', and Fire)
Insulation (SourtdlEnergy) . .
. po not tape or pla~ter until the follOWing applicable .
.' Items have been 'slgned: .
Drywall .' .
Pen_ralions (Fire Rated) Electrical
Pen_ralions (Fire Rated) Mechanical .
Pen_rallons (File Raled) PlUmbing
Interior Lath . . . .' ". .
Exterior Lath . "
.. GENERAL ITEMS
Exterior Plaster (BlOWn Coat) . .
T $arElectrical . I. . .
T-Bar Mechanical .'. . '
T-Bar Structural
Sewer '.
Water Engineering Backflow . .
Water Service ... .
FINAL INSPEctiONS Date Inspeclor
. Electrical Final . ". . .
Plumbing Final . . . .' :
Mechanical Final '. .
Gas Test '. '.
. . ..'
Engineering/Grading Final 76$-5126
Fire Dept, Final 765-4040 ..
Water Engineering 765-5268 .
.
Sub List/Business License 765.519
Zoning 765-5139 . .
Building Final ~ast inspection, Only .
fler Above Complete). ..' . .
PARTIAL INSPECTIONS
BuildinQ Inspections
Mechanical Inspections
PlumbinQ Inspections
Electrical Inspections
PEHMlT EXPIRED
INSPECTION
NOT COMPLETED
OA TEt...l.k~~' . ..