251 S. Summertree Rd.
CONTRACTOR INFORMATION:
WESTERN ROOFING SYSTEMS
2031 E CERRITOS AVE #7E
ANAHEIM, CA 92806-0000
BUSINESS PHONE: 714/778.6294
JOB DESCRIPTION: Tear of! existing and reroof 15 squares with metro metal shingle ICBO # 5626
VALUATION: 3,000.00
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the fOllowing reason (Sec. 7031.5 Business and
Professions Code: any dty or county which requires a permit to construct, alter, 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 wlth 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 dvU penalty of not more than five hundred dollars
($500),
o I, as owner of property, or my employees with wages as their sole compensation, win do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner of property who buik:lsor improves
thereon, and who does such work himself or helSeJf 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 comptetion, the owneT~builder will have the burden of proving that he
did not build or improve for the purpose of saJe).
o I, as the owner of the property, am exdusively contracting with licenseC contradors 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
~ontTad.or(s) licensed pursuant to the Contractor's License Law).
U I am exempt under Sec. , B & P .C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o J have and will maintain a certificate of ronsent to self-insure for worker's compensation,
as prOVided for by Sedion 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
~have and will maintain worker's compensation insurance, as required by Section 3700 of
the Labor Code, for the performance of the work for which this permit is issued. Myworker's
Compensation insurance carrier and policy are:
Carrier: STATE FUND
BUILDING PERMIT NO, BLD2005-01827
TYPE OF PERMIT
Reroof
DATE: 6115/2005
JOB ADDRESS: 251 S SUMMERTREE RD
LEGAL DESCRIPTION: TR 8905 LOT 6 AND paR LOT A
APPLICANT: SCOTT JOHNSON
OWNER INFORMATION:
Michael J Moore
251 S Summertree Rd
Anaheim, CA 92807
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765.4626
CENSUS CODE: 555
QUARTER SECTION: 191
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: JNJ
Policy Number. 1579948.2003
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 shan not
employ any person in a ny manner so as to become subject to the worker's compensation laws
of Califomia, and agree that if I should become su' 0 the worker's compensation
provisions of Section 3700 of the Labor Code, J all fa with comply with those provisions.
Date: 6/15/2005 Applicant.
WARNING: FAILURE TO SECURE ORKE
UNLAWFUL, AND SHALL SUBJECT AN EM OYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
J hereby affirm under penalty of perjury that there is a construction lending agency for the
performance 01 the work for which this perrp;t i:::; :se!..Jed (Sec. 3CS7 .Civ .C):
Lender's Information:
I certify that I have react this application and state that the above information is correct. I
agree to oompty with atl city ordinances and state laws relating to building construction, and
hereby authorize sentives of this city to enter upon the above mentioned property for
inspection pur ses.
::z:.
Date: 6/15/2005
nature of Applicant or Agent
The 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 permit is required to commence or continue work.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under proviso nsof chapter 9 (commencing
with Section 7000) of vs n 3 of the . S8 and
Professions Cod e.
6/15/
Date:
NUMBER
675902
TYPE
TYPE
Contractor
EXPIRATION DATE
8/31/2005
Hie
C39
Construcion Types:
VN, ,
Fees paid for Permit:
Total:
160.61
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
Setback/Forms/Trenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing IWater Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit) I
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:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (SheathlnalDiaphra!lmlFrame)
Masonry (ReinfJSond Seam/Pre-Groul) -
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only llfter 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-Sar 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 Depl. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-5194
Zoning 765-5139 I
Building Final (Last Inspection. Only III; 3,
After Above Complete) cO; J A I..lcwSV- \
I
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections
Plumbina Inspections
Electrical Inspections