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121 Midway Manor APPLICANT: ROSA CORTEZ OWNER INFORMATION: ROSA CORTEZ 121 W MIDWAY MNR ANAHEIM, CA 92805 JOB DESCRIPTION:Tear off existing and reroof 22 squares with composition shingles V ALUA TION: 2,500.00 I OWNER-BUILDER DECLARATION I hereby affirm under penalty of perjury thatl 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, 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)(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. 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). ~ 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 Ie (Sec. 7044 Business and Professions Code: The Contractor's Ucense Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or hersel1 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 pUl'pose of sale}. o I, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (See, 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner of property who bulJds or improves thereon, and who contracts for such projects with FLQontractor(s) licensed pursuant to the Contractor's License Law). U I am exempt under Sec. , & P.C. tor this reason: Dale: ./ -05 Owner: F\ elfr w r~G..- WORKER'S COMPENSATION DECLARATION !yreby affirm under penalty of perjury one of the following declarations: "D I have and will maintain a certificate of consent to self-insure for worker's compensation, as provided for by Section 3700 of the Labor Code, for the pertormance of the work for which this permit is issued. o I have and will maintain wocker's compensation insurance, as required by Section 3700 of the Labor Code, far the performance of the work for which this permit is issued. Myworker's Compensation insurance carrier and polley are: Carrier: BUILDING PERMIT NO. BLD2005.02922 TYPE OF PERMIT CITY Reroof DATE: 911412005 JOB ADDRESS: 121 W MIDWAY MNR LEGAL DESCRIPTION: N TR 1194 LOT 25 CONTRACTOR INFORMATION: POlicy Number: 'This section need not be oompleled if the pennil is for one hundred dollars ($1 00) or less. rOt I certify that in the perfonnance of the work for which this permit is issued, I shall not ~ploy any person in any manner so as to become subject to the worker's compensation laws of Callfomia, and agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Laborpade, I shall forthwith comply with those provisions. . ()5A COil<'- -C'L2 Dale: 911412005 Appiicant: 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 lHOUSAND DOLLARS ($100,000), IN ADDITlON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3700 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 agency 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 hereby authorize representives of this city to enter upon the above mentioned property for inspectiontRurposes. f"l_ r ~ ckr.!3f'1 'ltSCtr] VJf-7:t:.- 2-- Date: 9/1412005 ~ - Signature of Applicant or Agent The 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 permit is required to commence or continue work. ElM BUILDING DiViSION 200 S. ANAHEiM BLVD. (714) 765.5153 INSPECTION REQUEST LINE: (714) 765 - 4626 CENSUS CODE: 555 QUARTER SECTION: 85 ARCHITECT/ENGINEER INFORMATION: PROCESSED BY: JNJ LICENSED CONTRACTORS DECLARATION 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. 9114/2005 Date: Contractor NUMBER EXPIRATiON DATE TYPE Construcion Types: VN, , Fees paid for Permit: Total: 244.87 City of Anaheim Building Division INSPECTION RECORD INSPECTION DATE INSPECTOR Temporary Power Pole Plumbing (DrainlWaste Pipe) Electrical Ground Electrode/Ufer Setback/FormslTrenches (Footings) Do not install sublloor or pour 1I00r slab until the following applicable items have been signed: Plumbing (Water Pipe/Sprinkler Valves) Mechanical (Groundwork) Electrical (Underground Conduit) Pre-slab (Compaction/Membrane 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 Firesprinkler (Rough) 2nd Floor Shear /""l Roof (Sheathing/Diaphragm/Frame) (III ~1 .... II. -'-- Masonry (RelnfJBond 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 Backflow Water Service FINAL INSPECTIONS DATE INSPECTOR Electrical Final Plumbing Final Mechanical Final Gas Test Engineering/Grading Final 765-5126 Fire Dept. Final 765-4040 Water Engineering 765-5268 Sub List/Business License 765-5194 Zoning 785-5139 Building Final (Last Inspection. Only lo.fo g~( ,- After Above Complete) - -./Ur PARTIAL INSPECTIONS Building InsDections Mechanical Inspections Plumbing Inspections Electrical Inspections