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608 S. Sylvan St. ',. ElM BUILDING DIVISiON 200 S, ANAHEIM BLVD, , (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 . CENSUS CODE: 555 QUARTER SECTION: 21 I( BUILDING PERMIT NO. BlD2005-01344 TYPE OF PERMIT CIT'Y Reroof DATE: 5/10/2005 JOB ADDRESS: 608 S SYLVAN ST LEGAL DESCRIPTION: N TR 2874 LOT 41 APPLICANT: KIM MC CLAIN OWNER INFORMATION: Jerry L Witham 608 S Sylvan St Anaheim, CA 92804 JOB DESCRIPTION: VALUATION: CONTRACTOR INFORMATION: MC CLAIN ROOFING INC 12812 VALLEYVIEW'ST' #33 GARDEN GROVE, CA 926450000 , Tear off existing and re-roof 23 _squf!.res' of 30 year composition shingles. ARCHITECT/ENGINEER INFORMATION: 7,000.00 ' PROCESSED BY: SAM OWNER-BUILDER DECLARATION erebya .irm under penalty 0 ,perjury that I am exempt. rom the on tractor's pcense Law or t e oJ lowing reason ec.7031.5. USlness and Profes~ions Code: any city 'or COuritywhich requires a permit. to construct, altel1 improve, deiTlOlish or repair anystructllre, prior to its issuanc,e, 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 gj(commencing with Section 7000 01 Division 301 the Business and Professio'n's Code) or that he,is exetnpt 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, ($500). . o I, as owner of property, or my employees with wages as their sole comper:l~ati..on, will do, the work, and ~he sfructure is not intended~or offered for sale (Sec. 7044 Business and Professions Code: The Contractor's Ucense Law does not apply to an owner of property who builds"or improves thereon; and who does such work himself or herself or through his or her own ~h1ployees, provided that such 'improvements are not 'intended or offered for sale. If, however, the building or improvement is-sold .with one year:Ofcompletion, the owner-builder will have the burden of proving that he . did not build or imprOve for the purpose of sale). " o I, as the owner of the property, am exclusively contracting with licensed cctttractors to construct the project (Sec. 7044 Business an~ Professions Code: The Contractor's Ucense Law doeS not apply to an owner of-property who builds or improves thereon, and who contr~cts for such projects with fiJ(,ontractor(s) licensed pursua~t to the Contractor'sUcenseLaw). U I am exempt under Sec. . , S & P.C. for this reason: Dam:' Owne~' I. WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: o .'.have and will maintain a certificate of Cbnsent to selt.insure for worker's compensation, as provided for by Section 3700 of the Labor Code, for the performance of the-work for which tis mit is issued,' ' . ': have and wfll maintain worker's compensation insurance, as required bY$~ction 3700 01 t e Labor Code, for the performance of the work for which this permit is issued.), Myworker's ompen~tion insUrance carrier and policy are: ' Carrier: STATE FUND PoliCVlllumber. 285-02 UNIT 0001873 This section need not be completed if the pennit is for one hundred dollars($100} or less. o , 'certify thatin the performance of the work for which this permit is issue"d, I shall not employ any'person in any mann~r so as to become subject to the Worker'~ compensation laws of Califomia, and agree that if l- shoold become 'subject to the'worker's compensation provisions of Section -3700 of the 4bor Code, I s~all forthwith comply wit~ those provisio~. Date: 5/10/2005 Ap Ileant: 1. ~ WARNING: FAILURE TO SECUREWOR ER'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 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 I hereby affirm under penalty of perjIJry that there is a construction lending age~pyfor the performance of the work for which this permit is issued (See.30g7.Civ.C): L_ Lender's lnfonnation: LICENSED CONTRACTORS DECLARATION ere ya Irm un er pena yo perjury t at am licensed under provi,sionsof chapter 9 (commencing 'with Section 7000) of Divsion 3 of the Business and Professions Gode, tJ"h ...-"'-- 5/10/2005 (31'\ 1'- , Date: .. . Contractor NUMBER' EXPIRATION DATE 625013, 8/31/2005 TYPE C39 TYPE , Hie Construcion Types: VN, , I certify that I have read this application and state that the above information is correct. I agree to oomp!y with all city ordinances and state laws relating to buUding construction, and hereby authorize representives of this city to enter upon the above mentioned property for in~ect{-i'!n p,u~~ . ' " ' , ;<: V - ~ / Date: 5/10/2005 . ,Signature of Applicant or Agent " The permit shall expire by Iimmilionand become null and void if the building or work has not passed fi 001 inspection 365 days from the date of permit issuance. A new permit is required to commence or continue work. Fees paid for Permit: Total: 235.53 INSPECTION RECORD INSPECTION DATE INSPECTbR Temporary Power Pole . Plumbing (DrainlWaste Pipe) .. . EleCtrical. Ground Electrode/uter . SelbacklFormslTrenches (Footings) 00 not install subflocr or pour floor slab unti I the. following applicable. items have been signed:. Plumbing (Water Pipe.Sprlnkler Valves) . , Mechanical (Groundwork) : ,Electrical (Underground Conduit) Pre-slab.(CompactionlMembrane.Reinf. , Underpinning (Floor JoistJGlrders) . 00 not cover or CQnceal thework below until the following applicable items have been signed: . 1, st Floor Shear ' . ' , . . Firesprinkl8f (Rough) , ' 2nd Floor Shear, /) I ;}/ Roc{(SheattiragmlFrame) 1'lVr3/6'S'" -i!::r. ~, Mas n JBood BeamJPre..Grout) '.. Rough Plumbing (TopOl/t) , Rough Mechanical Rough !:Iectrle31 (ury wau) , ,,' Rough Electrical, Framing (On~ after Plbg.. Elec.. Mech, and Fire) . , Insulation (SoundlE",rgy) 00 not tape or plaster untillhe following applicable items have been, signed: . '. Drywall . Penetrations (Fire Rated) Electrical Penetrations (File 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 BackfJow , , Water Service ~ FINAL INSPECTIONS .. Date Inspector Electrical Final ,L' ;. .-- ' , Plumbing Final . Mechanical Final , .. , , Gas Test' " Engineering/Grading Final 765-5126 . . , Fire Oepl. Final 7,65-4040., .. " Water Engineering 765-5268 Sub list/Business License 765-519 Zoning 765-5139 ' " ., BUilding Final ~ast Inspection. Only tflVr~ M~ fter Above Complete) " ' vvvv, PARTIAL INSPECTIONS Buildina Inspections Mechanical Inspections PlumbinQ Inspections Eh~ctricallnsi:lections '