350 S. Smokeridge Ter.
~~~O~~F PERMIT . C ITV .
DATE: 61612005 .
JOB ADDRESS: 350 S SMOKERIDGE TER
LEGAL DESCRIPTION: N TR 8783 LOT 27
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST.L1NE:
(714)765.4626
. CENSUS CODE: 434
QUARTER SECTION: 180
32
BUILDING PERMIT NO. BLD2005-01682
CONTRACTOR INFORMATION:
WESTERN ROOFING SYSTEMS
2031 E CERRITOS AVE.#7E
ANAHEIM, CA 92806-0000
. BUSINESS PHONE: 7141778-6294
JOB DESCRIPTION: Tear 6ff existing material, install 20 squares of metro metal shingles ICBO #5626.
VALUATION: 4,000.00 PROCESSED BY: ENO
APPLICANT: SCOTT JOHNSON
OWNER INFORMATION:
John R Rodriguez
350 S Smokeridge T er
Anaheim, CA 92807
ARCHITECTIENGINEER INFORMATION:
OWNER-BUILDER DECLARATION
I hereby' affirm under penalty of perjury that I am exempt from the Contractor's Ucense Law for the following reason ( ec. 7031.5 Business and
Professions Code: any city or county which 'requires a permit to construct, alter, improve, c::femoiish or repair any structure, prror to its issuance, also
requires the applicant for such permit to 'file a signed statement that he islicenr,ed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division ,3 of the Business and Professions Code) or that he is t?xempt therefrom and the basis for the alleged "
exemption. Any violation of Sectio(17031.5 by any applicant for a"permit subjects the applicant to a civil penalty-of not more than five hundred dollars
(j~i.)~s ow~er of property"; ~r my employees with w~~es as their'soi~ comper":sat;on, will do-the ~ork, and the strllctur~" is ~t i~tended or offered f~r "
sale (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 does such work himself orhel5elf or through his or her own employees, provided tllat such improvements a"re not intended or
offered for sale. If; however, the ,building or improvement is sold with one year of completion, the owner.builder will have the burden of proving that he
did not puild or improve -for the purpose of sare). _," , "
o I, as the owner of the property, am exclusively contracting with licensed.qcntractors to construct t~e pr9ject (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
~ontractor(s) licensed pursuant to the Contractor's License Law). " ,
1..) I am exempt under Sec. ,B & P.O. for 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 win maintain a certificate of consent to seff-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.
RJ have and will mai"ntain worker's compensation insurance, as required by Section 3700-of
the Labor Code, for the performance of the work fqr which this permit is issued. Myworker's
Compensation inwra-nce carner and policy are: "
Carrier: STATE FUND . . Policy Number. 1579948-2003
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that am
licensed'under provisions 0 er g"(co encing
with Section 7000) of Divsi of he B ness and
Professions e. .
This section need not be completed if the penni-t is for one hundred dollars ($100) or less.
~"certjfy.that in the performance of the work for which this permit is iss~ed.' sh~1l 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 . auld become sub' 0 the wo r's compenSation
provisions of Section 3700 of the aboT Code, I I fort c ply with those rovisiol1S.
Date: 5/6/2005 Applicant:
WARNiNG: FAIl,URE TO SECUR ORKER:S COMPENSATION COVERAGE is
UNLAWFUL, AND SHALL SUBJ T AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDR THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF c;OMPENSATI9 ,DAMAGES AS PROVIDED FOR IN SECTION 3,706 OF THE
LA130R CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby afHrfr} under penalty of perjury that there~a construc!ion_1er"lding.ager1Y fpr the
performance of the work for which this permit is-issued (Sec.3097.Civ.C):
Lender's Information:
NUMBER
675902
TYPE
TYPE
6/612005
Date:
HIC
C39
EXPIRATION DATE
813112006
Construcion Tvpes:
VN, ,
Fire Sprinklered? >
NO
,,'p--~"~~
Date: 61612005
Fees paid for Permit:
Total:
. 160.61
Signature of ppllcant or Agent
it shall expire by limitation and become null and void if the building or
s not passed final inspection 365 days from the date of permit issuance. A
miUs required to ~mmence or continue work.
INS!>ECTION RECORD
INSPECTION DATE , INSPECTOR
Temporary Power Pole, ,
Plumbing (Orain/Waste Pipe)
Electrical GroundE/ectlQdeluter ' ,
SetbacklFormslTrenches (Footings)
,00 not install subfloor or p,our floor slab until the
following applicable items have been signed: '
Plumbing (Water Plpe.Sprinkler Valves)
Mechanical (GroundWork)
Electrical (Underground Condu il)
l>re-slab (Compaction/Membrane.Reinf.
Underpinning (Floor Joist/Girders) ,
00 not cover or conceal the work below unfifthe
following applicable items have been -signed:'
1 st Floor Shear , ,
FiresprinkJer (Rough)
2nd Floor Shear ' ' , 7! ,
Roof (SheathinOlDlaphragm'Frame) JfL{jt'.. FI,
Masonry (ReinfJBond BeamlPre-Groutl /
Rough Plumbing (Top Out) 'c-
Rough Mechanical -
lROugh 8ectrICaI '(Di'Y"Wallf
Rough Electrical
Framing ': (Only after Plbg., Elec.."rAech.. a'nd Fire! .
Insulation (Sourid'l;nergy)
po not tape or plaster until the foHowing 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 Backffow , ,
Water ServIce .,--c
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 765-519 ,
Zoning 765-5139 C' I I
,
Building Final *ast Inspection. Only o/z:~ /'00 ~A).)bUfllL
fter Above Completel .
PARTIAL INSPECtioNs
Buildina Inspections.
Mechanical Inspections
Plumbina hlsp&ctions
Electrical Inspections