128 W. Simmons Ave.
CONTRACTOR INFORMATION:
llLL ROOFING
5791 SANTA CAT All NA
GARD EN GROVE, CA 928450000
BUSINESS PHONE: 714423-9228
JOB DESCRIPTION:Tear off ex~s_ting, sheet 1/2 osb plywood, and install 19.75 squares of lifetime shingles and .25 squares of BUR
VALUATION: 8,000.00 PROCESSED BY: JNJ
I OWNER-BUILDER tlECLARATION
I hereby affirm under penalty of perjury that J 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, altel, 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 licen';sd pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professior,s Code) or that he is exempt therefrom and the basis forthe alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subje:;ts the applicant to a civil penalty of not more than five hundred dollars
~~. .
D 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
sale (Sec. 7044 Business and Professions Code: The Contractor's License La'w doeis not applytq 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, thel 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 Cl;lntractors 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).
,,0 I am exempt under Sec. ,B & P.C. for this reason:
Date: Owner:
I
BUILDINQi f'ERMIT NO. BlD2005-Q3349
TYPE OF PERMIT CITY
Reroof
DATE: 10/18/2005
JOB ADDRESS: 128 W SIMMONS AVE
LEGAL DESCRIPTION: N TR 6184 LOT 7
APPLICANT: BRANDON TILL
OWNER INFORMATION:
CHARLES E CH IAPELLO NE
128 W SIMMONS AVE
ANAHEIM, CA 92802
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 89
ARCHITECT/ENGINEER INFORMATION:
WORKER'S COMPENSATION DECLARATION
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'sGompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
r:7 I have and will maintain worker's compensation insurance, as required by Section 3700 of
the Labor Code, for the periormance of the work for which this permit is issued. Myworker's
Compensation insurance carlier and policy are:
Carrier: STATE FU ND
Policy Number. 285-05-0002494
This section need not be completed If the penn It is for one hundred dollars ($100) or less.
o I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subjec! to the worker's compensation laws
of Califomia, and agree that if 1 should become subject to the worker's compensation
provisions of Section 3700 of the Labor all forthwith co~ provisions.
Date: 10/18/2005 Applicant: =-l- ~
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 ADDIllON 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 hereby affirm under penalty of perjury that there is a construction lending arlH1cyfor the
periormance 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 representi this city to enter upon the above mentioned property for
'in 00 Ion poses.
Date: 10/18/2005
Signature of Applicant or Agent
The permit shall expire by limitation and becorre null and void if the building or
work has not passed fi nal inspection 365 days from the date of permit issuooce. A
new permit is required to commence or continue work.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury th.;d I am
licensed under provisions of chapter 9 (comme'ncing
with Section 7 of Divsion 3 of usiness and
Professions ode
10/18/2005
Date:
Contractor
NUMBER
833820
TYPE
EXPIRATION DATE
3/31/2006
C39
- ~....
Construcion Types:
VN, ,
Fees paid for Permit:
Total:
170.50
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 (Last Inspection - Only ~ ,
After Above Complete) ~.r........~~>
/ '/
City of Anaheim
Building Division
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INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormslTrenches (Footings)
Do not install sublloor or pour Iloor 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 until the
following applicable items have been signed:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame)
Masonry (Reinl.lBond Beam/Pre-Grout)
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:
PARTIAL INSPECTIONS
Building Inspections
Mechanical InsDections
Plumbina InSDections
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
Electrical Inspections
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