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
"