1658 Mells Ln.
BUILDING PERMIT NO. BLD2005-02321
TYPE OF PERMIT CITY
Reroof
DATE: 7/25/2005
JOB ADDRESS: 1658 W MELLS LN
LEGAL DESCRIPTION: N TR 3446 LOT 6
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 57
APPLICANT: KIM MCCLAIN
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
JEROMETCORNELlUS MC CLAIN ROOFING INC
, 658 W MELLS LN 12812 V ALLEY VI EW ST #33
ANAHEIM, CA 92802 GARDEN GROVE, CA 926450000
JOB DESCRIPTION:Tear off existing and reroof 37 squares with 40-year composition shingles
OWNER-BUILDER DECLARATION
I here ya irm un er pena yo perjUry that am exempt rom the ontractar s L.icense w for t e allOWing reason ec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, aher, 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 lice.nsed pursuant to the provisionsot 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 penattyof not more than five hundred dollars
($500).
D I, as owner of property, or my employees with wages as their sole compansation, 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 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 proving that he
did not build or improve for the purpose of sale).
D I, as the owner of the property, am exclusively contracting with licensed A>ntractors 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
fUtontractor(s) licensed pursuant to the Contractor's License Law).
U I am exempt under Sec. , B & P .C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION OECLARATION
I hereby 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'~,compensation,
as provided for by Section 3700 of the labor Code, for the performance of the work. for which
this permit is issued.
S 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 issuej, Myworker's
Compensation insurance carrier and policy are:
Carrier: STATE FU NO
VALUATION:
9,000.00
PROCESSED BY: JNJ
Policy Number. 285-02UNIT0001873
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
o J 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 California, 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: 7/25/2005 Applicant'lQ I<~
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 ADDI110N 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 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
in~ectio.ln ~~~ses/
E. E!V '--'" Date: 7/25/2005
Signature of Applicant or Agent
The permit shall expire by limitation and become null and void if the building or
work has not passed Ii nal inspection 365 days Irom the date 01 permit issuance. A
new permit is required to commence or continue work.
LICENSED CONTRA"CTORS DECLARATION I
I hereby affirm unde'r penany at perjury that I am
licensed under proviSions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
Professions codeKlh-.....
7/25/2005r:::
Date: Contractor
NUMBER
625013
TYPE
TYPE
EXPIRATION DATE
8/31/2005
C39
HIC
Construcion Types:
VN, ,
Fees paid for Permit:
Total:
310.45
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
SetbacklForms/Trenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane Reinf.)
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below unlilthe
following applicable items have been signed:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear / /
Roof (Sheathing/Diaphragm/Frame) 7/Z#nS .l"'NO,,\~1
Masonry (Reinf./Bond Beam/Pre-Grout) II I
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 S1ructural
Sewer
Water Engineering Back1low
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 4
Zoning 765-5139 . I/J 1/1 /
Building Final (Lastlnspsction - Only ty. ~:r I'--'~
After Above Complete) C,
PARTIAL INSPECTIONS
BUiI;n;-sections ~ -% 1\ W . I
1( r{, ~fl v~\I" . '" lA.G<. ~.
Mechanical Insoections
Plumbing Inspections
Electrical Inspections