4890 Maychelle
TYPE OF PERMIT
Reroof
DATE: 6/27/2005
JOB ADDRESS: 4890 E MAYCHELLE DR
LEGAL DESCRIPTION: N TR 7911 LOT 8
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 173
BUILDING PERMIT NO. BLD2005-01966
CONTRACTOR INFORMATION:
ADAMS ROOFING AND CONTRACTING
1572 MARSHALL LN
CORONA, CA 91719 0000
BUSINESS PHONE: 951 279-0472
JOB DESCRIPTION:Tear off existing roof and replace with 25 squares of 40 year composition shingles and 30 lb. A.S.T.M. felt
APPLICANT: GLEN BRINAGH
OWNER INFORMATION:
Cindy A Leyns
4890 E Maychelle Dr
Anaheim, CA 928070000
ARCHITECT/ENGINEER INFORMATION:
VALUATION:
6,000.00
PROCESSED BY: MSM
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that r am exempt from the Contractor's License Law for the following 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. MY violation of Section 7031.5 by any applicant far a permit subjHcts the applicant ta a civil penalty of not more than five hundred dollars
($500).
D I, as owner of property, or my employees with wages as their sole compensation, will do the wark, 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 herself 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 provingtl1at he"
did not build or improve for the purpose of sale).
D 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
a contractor(s) licensed pursuant to the Contractor's License Law).
o I am exempt under Sec. , 8 & 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'scompensation,
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 policy are:
Carrier: STATE COMP INS. CO.
I
LICENSED CONTRACTORS DECLARATION I
I hereby 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.
6/29/2005
Date:
Contractor
Policy Number. 285-02 UNIT 0002071
NUMBER
652470
TYPE
TYPE
EXPIRATION DATE
8/31/2006
This section need not be completed if the pennit is for one hundred. dOl1ars{$100) or less.
o I certify that in the perfonnance 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 become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Date: 6/29/2005 Applicant:
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION 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 fending agency for the
performance of the work for which this permit is Issued (Sec.3097.Civ.C):
Lender's Information:
B
C39
Construcion Tvpes:
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:
235.43
Dale: 6129/2005
Signature of Applicant or Agent
1he permit shall expire by limitation and become null and void if the building or
work has not passed fi nal inspection 365 days from the date of permit issuance. A
new oarmit is reauired to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Uter
Setback/FormslTrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been sianed:
Plumbing (Water PipefSprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (CompactionfMembrane Reinf.)
Underpinning (Floor JoislfGirders)
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
Roof (SheathingfDiaphra!lmfFrame) (,/W/OS IYZiI tfi:.
Masonry (ReinfJBond Beam/Pre-Grout) .
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
Insulation (SoundfEnergy)
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
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
EngineeringfGrading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub LislfBusiness License 765-5194
Zoning 765-5139
Building Final (Last Inspection - Only
After Above Complete)
DATE
INSPECTOR
711~r- j)U?C0
PARTIAL INSPECTIONS
Buildina Insoections
Mechanicallnsoections
Plumbina Insoections
Electricallnsoections