580 S. Scout Trail
TYPE oF' PERMITC ITY
Reroof.
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 186
BUILDING PERMIT NO. BLD2005-01681
DATE: 6/6/2005
JOB ADDRESS: .580 S SCOUT TRL
LEGAL DESCRIPTION: N TR 9750 LOT 64
CONTRACTOR INFORMATION:
WESTERN ROOFING SYSTEMS
2031 E CERRITOS AVE #7E
ANAHE.IM, GA 92806-0000
BUSINESS PHONE: 714f778-6294
JOB DESCRIPTION:Tear off existing material, install 20 squares Of metro metal \,hingles ICBO #5626.
VALUATION: . 4,000.00 PROCESSED BY: ENO
APPLICANT: SCOTT JOH'NSON
OWNER INFORMATION:
Angela M Wangyal
580 S ScoutTrl
Anaheim, CA92807.
ARCIfITECT/ENGINEER INFORMATION:
OWNER-BUILDER DECLARATION
I hereby affirm. underpenalty of perjury that I am exempt from the Contractor's'Ucense Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city orcour)tywhichrequires a permit to construct, after;, 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 Divfsion 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged
exemption. Arry violation of Section 7031.5'by,any applicant for a permit subjec~ts the applicant to a civil penalty of net mere than five hundred dollars
-~. '.
D .1, as owner of prop~rty, or my employees with wa,ges as their sole comper$ation, will do the work, and the.structure is not intended-o~ offered-for
~aJe (sec. 7044 Businessand'Professions Cod~: The Cl?ntractor's License La~it does nota'pplyto an owner of property who builds orimprbves
thereon._ and who does such work himself or herself or through his or her own e)nployees, provided that such imp-rovementsare n'at intended or ,
offered for sale. If, however,' the building or improvem,ent is sold with one year'oOf completion, the- owner-builder will have the burden of p~oving that he
dld not build or'improVe for the purpose of sale). '1,- ~ "
D' I, as the owner of the property, am exclusively contra-cting with licensed 'cof1tractors to constructthe project (Sec. 7044 Business and Professions,
Code: The Contractor's License Law does not apply to an owner of prope!ty w~o buHd~ or improves thereon, and who contr~cts for such projectswith
~ontractor(s) licensed pursuant to the Contractor's Licen~ ~w). f' '
U I am exempt uhder Sec. , B & P.C. for this reason: I
Date: owner: \
I WORKER'S COMPENSATION DECLARATION
I hereby affirm u'nder penalty,of perjury on~ of-the following_ declarations:
0' I haVe and will ma'inta:!n a certificate of conSent to Self-insure for worker's compensation,
as provided for by Sectioll 3700' of the Labor COde, for the performance' of the work for which
thfs' permit is issued. , ,\
~..Jhave and will mafntain worker's compensation ihsurance, as required by &ection 3700 of
the Labor GOde, for the periormance of the work for which this permit _is, issued, I, Myworker's<
Compensation insurance carrier and policy are:' '
Carrier: STATE FUND Polity Number. 1579948-2003
This section need noibe completed if the pennit is for one hundred dollars ($1 00) Or less.
~ertifythat in the perie~ancE? of the work for whi~h this permit is issued, I shall not
employ any person in any manner so as to become ~ubject to the worker's compensation laws
of California, and agree that if I should,become subj to the worker's compensation
provisions of Section 3700 of the'Labor Code', I s rthwl c with th~eprovisions.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licansed under provisions 0 hapter 9 (c'ommencing
with Section 7000) of on 3 f B sifless and
Professions
6/6/2005
Date:'
HIC
C39
NUMBER
675902
TYPE
TYPE
Date: 6/612005 . Applicant
WARNING: FAILURE TO SECURE R R'S'Co ENSATloN COVERAGE. IS
UNLAWFUL, ANDSHALLSUBJ AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDR OUSAND DOLLARS ($100;000), IN ADDI1l0N TO THE
COST OF COMPENSATI9 ,DAMAGES AS PROVIDED FOR IN SECTION 3706 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 agertcyfor the
periormance of-the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
Construcion Tvpes:
VN, ,
Fire Sprinklered?
NO
Date: 6/6/2005
Fees paid for Permit:
Total:
t60.61
Signature of A lcant or Agent
The permit shall expire by limitation and become null and void if the building or
work has not pasSed fi nill inspection 365 days from the date of permit issuance. A
new permit is r~quired to ~inmence or continue work.
INSPECTION RECORD
INSPECTION .' DATE INSPECTOR
Temporary Power Pole .
Plumbing (DrainlWaste Pipe)' '. . I
Electrical Ground Electrode/lifer
SEitbacklForinsfTrenches (Footings) .
Do not install subfloor or pour floor slab unlillhe
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves)
MechaniCal (Groun<lwork) .
Electrical (Underground Conduit) .
Pre-slab.(CompactionlMembrane.R8I rn. .
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed: .
1st Floor Shear . '.' . '.
Firesprinkler (Rough) . .
2nd Floor Shear . . I .
Roof (Sheathing/Diaphraam/Frame) -'6-0.7
Masonry (ReinfJBond BeamlPre-Grout) . .
Rough Plumbing (Top Out)
Rougl1 Mechanical '. . . . .
Rough Electrical (Dry wall)
Rough electrlcal
.Framing (0.nly after Plbg..Elec.. Mech.. and Fire)
Insulalion (SoundlEnergy)
po not tape orpla~.ter until the following applicable
Items have been signed:. '. . .
Drywall . . .
Penelrallons (Fire Rated)Electncal . .'
Penelratlons (Fire Raled) lIIIechanical . . .
Penetralions (Fire Rated) Plumbing
Interior Lath' . . .
Exterior Lath
GENERAL ITEMS .
Exterior Plaster (Brown Coat)
T -Bar Electrical .
T -Bar Mechanical . . .
T -8ar Structural
Sewer
Water Engineering Backflow .
Water Service . .
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Date' Inspector
EngineeringlGr<lding Final 7fi5~126
Fire Dept. Final 765-4040
Water Engineering 765-5268'
Sub List/Business License 765-519
Zoning 765c5139
Building Final (Last Inspection. Only
. ". After Above Complele)
i PARTJALINSP
I .
Buildina Inspections
Mechanicallnsoections
Plumbina Ihsoections'
Electrical Insoections