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109 S. Plantation Pl. BUILDING PERMIT NO. BLD200S-00728 TYPE OF PERMIT CITY Reroof DATE: 3/16/2005 JOB ADDRESS: 109 S PLANTATION PL LEGAL DESCRIPTION: NTR 6752 LOT 43 APPLICANT: SCOTT JOHNSON OWNER INFORMATION: . Way ne Walsh 109 S Plantation PI Anaheim, CA 92806 BUILDING DIVISION .200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE: . (714)765-4626 CENSUS CODE: 555 QUARTER SECTION: 122 CONTRACTOR INFORMATION: WESTERN ROOFING SYSTEMS 2031 E CERRITOS AVE #7E. '. ANAHEIM. CA 92806-0000 BUSINESS PHONE: 714/710-$294 JOB DESCRIPTION: Tear off,existing and re-roof 15 squares of metro metal shingles and 7 squares of BUR on flat area. . ARCHITECT/ENGINEER INFORMATION: VALUATION: . 4,000.00 I OWNER-BUILDER 'DECLARATION 1 hereby affirm under'penalty of perjury that I am exemptfrom the Contract.o?tiUcense Law for the following reason (Sec'. 7031.5 Business and Professions Code: any city or countYWhich requires a permit to construct, alter, improve. demolish or repair any structure, prior to'its issuance, also . requires"the applic:antforsuch permit to file a signed s.tatement that he islicierised pursuant to the provisions of the Contractor's,Ucense law (Chapter 9)(commencing with Section 7000 of Division 3 of the Business and Professio(ls Code) or that he is exempt therefrom and the .basis forthe alleged exemption. Any violation 9fSecUon 7031.5 by any applicant for a permit sutje.cts the applicant to ~ civil penalty of not more than five hundred dollars ($500). o I, as owner of property, orniy employees with wages as their sole complmsation, will do'thework, and the structure is not intended or offered for sale'(Sec, 7044 Business and Professions Code: The Contractor's license L;~w does not apply to an owner of property who builds or improves thereon, aDd ,who does such work' hi mself or herself or through his or her ovh:employees, provided that such improvementsare not intended or offered for sale. If, however, the building or improvement is sold w:ith one ye'a"t of ,completion, the. owner-builder will ryave the burden of proving that ~e 'did n'ot bu_ild or improve for the purpose of Sale). " " .: . D I, as the owner of the property, am exdusively contracting with licensed .~ntractors-to construct the projec~.(Sec. 7044 Business and Professions Code: The Contractor's l(cense law does not apply ,to an owner of property\vho builds or improves thereon, and who o:mtracts for such projects with ~cintractor(s) licensed pursuant to theCorrtractor's License law). . U lamexemptl,mderSec..' ~B&P.C.forthisreason:' Date: Owner: I WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of pe~ury one of the following deClarations: o ,I have and will ni~intain a certificate of consent to self-insure for workel"'t:icom'pensatlon, as provided for by Section 3700 of the labor Code, for the performance ofth~-work-for which ~i rmit is issued. ' ", .1 have a rid will maintain wol:ker's compensation insurance, as required bj Section 3700 of 313012005 he bor Code, for the performance of the work for.which this permit is iSSllEd. Myworker's Date: Compensation insurance carrier and policy are:,. . '~ Carrier: STATE FUND . . Policy Number. 1579948-:.1003. This section need not be completed if the pennit is for one hundred dollars ($10C)'prless. '0 I certify that in the perfonnance of the work for which this permit is iSSl)~C::'lshall not 'employ- any person in any manner so as to become subject to the worker's crJr'i1pensation laws of California, and agree.that if I should become subje to the worker's compb-I~sation provisions of Section 3700 of the la~r Code I sh com ith th.JSe provisioQs, PROCESSED BY: SAM. LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed underprovisiOns of chapter 9 (commencjng with Section 7000) of Divs' "3 of the B . ess-and Professions C e. NUMBER 675902 TYPE TYPE ConstriJcion Types: VN, , Date: 3/30/2005 Applicant: WARNING: FAILURE TO SEC REWORKER'S CO PENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN. EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO 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. CONSTRUCTION LENDING AGENCY I h~reby affirm l-Inder penalty of perfury that there is a construction lending agmt;yfor the performance of the work forwhidl this permit is issued (Sec.3097.Civ.C): Lender!s Informatioil: , . I certify that I have read this'a pplication and state that tlie above infonnation is correct. I agree to comply with ,all city ordinances and state laws r~lafing to bu~ding construction, and hereby authorize rep .ves of this city to enter upon the abovementioned property for i pection purpo -' Date: .3/30/2005 Sign e of Applicant or Agent 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 requirE~d to commence or continue work. ContraCtor EXPIRATION DATE 8/31/2005 HIC C39 Fees paid for Permit: Total: 160.61 INSPECTION RECORD INSPECTION DATE INSPECTOR Temporary Power Pole . Plumbing (Drain/Waste Pipe) Electrical Ground Electrode/uter setbacklFormsrrrenches (Footings) Do not install subfloor or pour floor slab until the fOllowing appiicabl<:> items have been signed: . Plumbing (Water Pipe.Sprinkler Valves) Mechanical (Groundwork) , Electrical (Underground Conduit) .' ' . Pre-slab (Compaction/Membrane.Rei nt. Underpinning (Roor Joist/Girders) , Do not cover or conceal ~ne work below until the " following appiicable items have been signed: - 1st Floor Shear ' - Firesprinkler (Rough) - 2nd Floor Shear '/I Roof (Sheathing/Diaphragm/Frame) '3 J-g I!f)~ Ullh Y~n Masonry (RelnfJBond BeamlPre-Grout) 1/1 Rough Plumbing (Top Out) Rough Mechanical Rough 6ectr Rough Electrical Framing '(Only after Plbg.., Elec.. Mech. and Fire) Insulation (SoundlEnergy) . po. not tape or plaster until the f<)lIowing applicable Items have been signed: ' . Drywall Penetrations (Fire Rated) Electrical -- Penetrations (Fire Rated) Mechanical Penetrations (Fire Rated) Plumbing Inlerior Lath . . Exterior Lath .. I. . GENERAL ITEMS Exterior Piaster (Brav,," Coat) . T -Bar Electrical - . T-Bar Mechan\cal T -Bar Structural - Sewer Water Engineering Backflow Water Service - FINAL INSPECTIONS '. . Date Inspector .' Electrical Fin,!1 : . Plumbing Final .. . - Mechanical Final . Gas Test _ - -- Engineering/Grading Final 765-5126 . . Fire Dept. Final 765-4040 Water Engineering 765-5268 Sub List/Business License 765-519 I. . - Zoning 765.5139 _ ^. '. Building Fin"al ~ast Inspection. Only '-'f)7)-s( ri; 1.'U. - fW Above Complete) . PARTIAL INSPECTIONS () Buildina Inspections Mechanical Inspections Plumbina Inspections Electrical Inspections "