520 W. South
TYPE OF PERMIT CITY
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REOUESTLlNE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 74
BUILDING PERMIT NO. BLD2005-02447
DATE: 8/4/2005
JOB ADDRESS: 520 W SOUTH ST
LEGAL DESCRIPTION: ORCHARD PARK TR LOT 4 EL Y1/2 -EX E
APPLICANT: JAY MOREAU
OWNER INFORMATION:
FIRST C CH URCH
520 W SOUTH ST
ANAHEIM, CA 92805
CONTRACTOR INFORMATION:
GREAT WESTERN ROOFING
205 S BERKELEY CIR
FULLERTON, CA 92831-0000
BUSINESS PHONE: 714738.5848
JOB DESCRIPTJON:Tear off existing roof and replace with 12 squares of 20 year composition shingles.
ARCHITECT/ENGINEER INFORMATION:
VALUATION:
3,000.00
PROCESSED BY: MSM
OWNER-BUILDER DECLARATION
I hereby a irm under penalty of perjury that I am exempt from the Contractor'~ License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, alte,f, improve, demolish or repair any structure, priorto its issuance, also
requires the applicant for such permit to file a signed statement that he is licen'sed 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 exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a perma subjects 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 compe;1sation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License ldw does not apply to an owner of property who buildsor 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, the oWner-builder will have the burden of proving that he
did not build or improve for the pUlpose of sale).
o I, as the owner of the property, am exclusively contracting with licensed C'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 lathe Contractor's License Law). .
o 1 am exempt under Sec. , B & P,C. 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 will maintain a certificate of consent to selHnsure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the wa rk for which
ii permit is issued.
i I have and will maintain worker's compensation insurance, as required by Section 3700 of
e Labor Code, for the performance of the work for which this permit is issued. Myworker's
Compensation insurance carrier and policy are:
Carrier: INDEPENDENT STAFFING SOLUTIONSPoficy Number. ISS100010301
LICENSED CONTRACTORS DECLARATION
r hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Di .a~n 3 of the Business and
Professions e.
8/4/2005
Date: Contractor
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
o I certify that in the performance of the work 10r 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 Califomia, and agree that if I should become ubject to the worker's compensation
provisions of Section 3700 of the LZ:od shal o~~mply with th~ provisions.
Date: 8/412005 Applicant: .~ ~
WARNING: FAILURE TO SECUR WOR 'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITlON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
1 hereby affirm under penalty of perjury that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
NUMBER
361389
TYPE
EXPIRATION DATE
8/3112006
C39
Construcion Types:
VN. ,
Fire Sprinklered?
NO
1 certify that I have read this application and state that the above information is correct. I
agres to comply with all city ordinances and &ate laws reJating to building construction, and
hereb authorize re sentiVes 01 this city to enter upon the above mentioned property tor
in ion purpo s
Date: 8/4/2005
Fees paid for Permit:
Total:
160.74
ignature of Applicant or Agent
The permit s I 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 issull'lce. A
new permit is required to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
Setback/FormsfTrenches (Footings)
Do not install sublloor or pour 1I00r 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:
1st Floor Shear
Firesprlnkler (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame) ~.'t-M" fl. f).a,.4/J
Masonry (Reinf./Bond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., E!e., 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 I
Zoning 765-5139 I
Building Final (Last Inspection - Only ts'j'l.'6t r<. fJ;~ If I
After Above Complete) I
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbin9 Inspections
Electrical Insoections