4021 Maple Tree
BUILDING PERMIT NO. BLD2005-03119
TYPE OF PERMIT C TV
Miscellaneous I
DATE: 9/29/2005
JOB ADDRESS: 4021 E MAPLE TREE DR
LEGAL DESCRIPTION: N TR 4689 LOT 11
APPLICANT: KEN LARUE
OWNER INFORMATION:
ElM
BUILDING DIVISION
200 S. ANAHEIM BlVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765- 4626
CENSUS CODE: 555
QUARTER SECTION: 157
ARCHITECT/ENGINEER INFORMATION:
CONTRACTOR INFORMATION:
WEATHERLlNE ROOFING, INC.
1013 E WALNUT 8T
SANTA ANA. CA 92701 0000
BUSINESS PHONE; 714731-3425
JOB DESCRIPTION:Permil to finalize expired roofing permit issued 09/08/2000. Ref BLD2000-02822.
VALUATION:
PROCESSED BY: CAL
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt rom the Contractor's Ucense Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, atter, 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)(commenc-ing 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 subjects the applicant to a civil penalty of not more than five hundred dollars
($500).
o I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves
thereon, and who does suCh work himself or helSelf or through his or her own employees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one year of completion, the owner~builder will have the burden of proving that he
did not build or improve for the purpose of sale).
o I, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with
~ontractor(s) licensed pursuant to the ContraGtor's license Law).
U I am exempt under Sec. , B & P.C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certificate of oon$ent to self.insure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the petformance of the work for which
~hiS mit is issued.
I have and will maintain worker's compensation insurance, as required by Section 3700 of
bar Code, for the performance of the work for which this permit is issued. My worker's
Compensation insurance carrier and policy are:
Carrier: STATE FUND Policy Number. 1635961-02
Thlssecllan need not be completedil1hepennil is lor one hundred dollars ($100) or less.
o I certify that in the performance of the work for which this permit is issued, I shall not
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 beco je to the worker's compensation
provisions of Section 3700 of the Labor Co a rthwith comply with those provisions.
Date: 9/29/2005 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 ADDI1lON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending a~ency for the
performance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
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
herebyauth ize epresentives of this city to enter upon the above mentioned property for
Insp r s.
Date; 9/29/2005
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 issuance. A
new permit is required to commence or continue work.
LICENSED CONTRACTORS DECLARATION
I ereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 700 fin 3 of the Business and
Professions Cod
9/29/2005 .
Date:
NUMBER
729560
TYPE
Contractor
EXPIRATION DATE
11/30/2006
CS9
Construcion Tvpes:
VN, ,
Fire Sprinklered?
NO
Fees paid for PermIt:
Total:
113.63
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground ElectrodelUfer
SetbacklFormslTrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water PipefSprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane Reinf.)
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear
Flresprinlder (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (Reinf./Bond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
Insulation (Sound/Energy)
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 Back/low
Water Service
FINAL INSPECTIONS DATE INSPECTOR I
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765.5268 I
Sub List/Business License 765-5194 I
I
Zoning 765-5139 I , I
Building Final (L..I'''.pectlon. Only '0;, Ii~ I
I
Alter Above Complete) .\A-~tiU)~\Lr I
I
I
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbing Inspections
Electrical Inspections