2447 Powhaten
CONTRACTOR INFORMATION:
BERRY ROOFING
3165 CENTER ST
RIVERSIDE, CA 92501 0000
BUSINESS PHONE: 909905-5116
JOB DESCRIPTION:Remove existing material, install 33 squares of Owens Coming composition shingles to house and attached garage.
VALUATION: 7,735.00 PROCESSED BY: ENO
I OWNER-BUILDER OECLARATION
I hereby affirm under penalty of perjury that I 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, altfr, 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 licerlsed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professio;1s 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 subj(!cts the applicant to a civil penalty of not more than five hundred dollars
($500).
o 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
sare (Sec. 7044 Business and Professions Code: The Contractor's License u!w 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 yea" of completion, the owner-builder will have the burden of proving that he
did not build or improve for the purpose of sale).
o I, as the owner of the property, am exclusively contmcting with licensed c;>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
a contractor(s) licensed pursuant to the Contractor's License Law).
o I am exempt under Sec. , B & P.C. lor this reason:
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 maintain a certificate of consent to self-insure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
~ 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 Myworker's
Compensation insurance carrier and policy are:
Carrier: STATE FUND COMPENSATION
BUILDING PERMIT NO. BLD200S-02124
TYPE OF PERMIT CITY
Reroof
DATE: 7/11/2005
JOB ADDRESS: 2447 E POWHATAN AVE
LEGAL DESCRIPTION: N TR 4717 LOT 3
APPLICANT: LISA GOODMAN
OWNER INFORMATION:
BILLY KHUU
2447 E POWHATEN AVE
ANAHEIM, CA 92806
ElM
BUILDING DIVISION
2QO S. ANAHEIM BLVD.
(714) 765 ~ 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 113
ARCHITECT/ENGINEER INFORMATION:
Policy Number. 1509405-o.~
This section need not be completed II the pennil is for one hundred dollars ($1 00) cr 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 California, and agree that if I should become subject to the worker's compemation
provisions 01 Section 370001 the Labor ~ode, I all lo'!.hwith com y ith those provisions.
Date: 7/11/2005 Applicant:
WARNING: FAILURE TO SECURE WORKER'S COMPE TION 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 COD E, I NTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending ap'7n.r:y 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
reby authorize representives of this city to enter upon the above mentioned property for
ecti ur ses.
Date: 7/11/2005
ign t of Applicant or Agent
The permit shall expire by limitation and becorre null and void if the building or
work has not passed final inspection 365 days from the date of permit issumce. A
new Dermit is reauired to commence or continue work.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of 'vsion 3 of the Busin ss and
Professio
7/111
Date:
NUMBER
691947
TYPE
TYPE
TYPE
Construcion Types:
VN, ,
Fire Sprinklered?
EXPIRATION DATE
11130/2005
C43
C39
HIC
NO
Fees paid for Permit:
Total:
310.32
. .
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
SetbackIFormsrrrenches (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 (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 Flo
Ro Sh laphragm/Frame)
Masonry (ReinfJBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
INSPECTOR
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 765-5139
Building Final (Lasllnspecllon - Only y~{ 1/ lL.n~
After Above Complete)
'I
PARTIAL INSPECTIONS
Building Inspections
Mechanicallnsoections
Plumbing Inspections
Electricallnsoections