6691 Smokewood Cir.
TYPE OF PERMIT CITY
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REOOESTLlNE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 287
BUILDING PERMIT NO. BLD200s-01879
DATE: 6/20/2005
JOB ADDRESS: 6691 E SMOKEWOOD CIR
LEGAL DESCRIPTION: N TR 9135 LOT 24
APPLICANT: BRANDON TILL
OWNER INFORMATION:
Evan Reynolds
7106 Wellington Point Rd
Mckinney, TX 75070
CONTRACTOR INFORMATION:
llLL ROOFING
5791 SANTA CATALINA
GARDEN GROVE, CA 928450000
BUSINESS PHONE: 714423.9228
JOB DESCRIPTION: Tear off existing and re.roof 25 squares of "Monier Duralite Tile"; ICBO# 2656: 5.9Ibs.
VALUATION: 9,000.00 PROCESSED BY; SAM
ARCHITECT/ENGINEER INFORMATION:
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that am exempt from the Contractors;Ucense Law for the fa lowing reason ( ee. 7031.5 BUSiness and
Professions Code: any city or county which requires 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 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 permit 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 soJe compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's Ucense Law 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 tor sale. If, however, the bulJding or improvement is sold with one year of completion, the owner-builder will have the burden of proving thatfteu
did not build or Improve for the pUlpose of sale).
o I, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's license Law does not apply to an owner of propertywi-Jo builds or improves thereon, and who oontracts for such projects with
a contractor(s) licensed pursuant to the Contractor's License Law).
D I am exempt under Sec. , B & P.C. for this reason:
Date: Owner:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certificate of consent to self.insure for worker's (.ompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
this rmit is issued.
ave and will maintain worker's compensation insurance, as required by.8ection 3700 of
bor Code, for the performance of the work for wh1ch this permit is issued. Myworker's
pensation insurance carrier and policy are:
ier: STATE FUND Policy Numbe" 285-05-0002494
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencIng
with Section 7000) of Divsion 3 of t usiness and
Professions Cod
6/2012005
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 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 worke(s compensation laws
of California, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I shan forthwit ith those provisions.
== (
NUMBER
833820
TYPE
EXPI RATION DATE
3/31/2006
C39
Date: 6/20/2005 Applicant:
WARNING: FAILURE TO SECUI'lE
UNLAWFUL, AND SHALLSUBJE MP YER TO CRIMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED 1l-\OUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PI'lOVfDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTP.UCT:ON LENDING AGENCY
I 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.S097 .Civ.C):
Lender's Information:
Construcion Types:
VN, ,
I certify that I have read this application and state that the above information is correct. J
agree to comply with all city ordinances and state laws relating to building construction, and
hereby authorize representives of thj~to enter upof\.the above mentioned property for
inspecti s.
. Date: 6/2012005
Signature of Applicant or Agent
permit shall 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 issuance. A
new Dermit is reauired 10 commence or continue work.
Fees paid for Permit:
Total:
235.73
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
Setback/Forms/Trenches (Footings)
Do not install subtloor or pour tloor 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
F1resprinkler (Rough)
2nd Floor Shllal'-..
Roof lSheathiltAl6iaphragm/Frame) 1/;,\1,Jd( 11.
Masollr\TtRelnfJBond 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:
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 Backllow
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 Engineerina 765-5268
Sub List/Business License 765-5194
Zoning 765-5139 I
Building Final (Last Inspection - Only j0js
After Above Complete) J AWD tJSi(.1
7
PARTIAL INSPECTIONS
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