316 N. West St. (2)
TYPE OF PERMIT CITY
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 62
BUILDING PERMIT NO.' BLD2005-01679
DATE: 6/6/2005
JOB ADDRESS: 316 N WEST ST
. .
LEGAL DESCRIPTION: VINEYARD LOTS LOT C-7 SLY 120 FT
CONTRACTOR INFORMATION:,
J W ROOFING
12892 FIELDSTONE DR
SANTA ANA, CA 92705 0000
BUSINESS PHONE: 714536-4577
JQB DESCRIPTION:Tear off existing material, install 30 squara. of composition shingles.
VALUATION: 7,000,00
APPLICANT: JOHN WHITE
OWNER INFORMATION:
Wiiliam e Koenig
316 N West St
Anaheim, CA 92801
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: ENO
OWNER-BUILDER DECLARATION
I herebyaffirm,uhder penalty of perjury that I am 'exemptfrom the Contractor'sUcense Law for the following reason eo. 7031,.5 Business and
Professlons "qode; any City 6r county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also
requires the applica:nUor such permit to file a signed statement that he is Iicen~d pursuant to the provisions of thEr Contractor's' License Law (Chapter
.9)(commencing with Section 7000 of Division-3,ot the Business and Profession's Code) or that he is exempt the_refrom and the basis for the alleged
exemption." Arr.j 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
-~., . ..' . .
o I, as owner,otproperty, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for
sale (Se~~ 7044 _ Busi~ess and Professions Code: The Contractor's License La~v does not apply to an owner of property who build~or iri1prov"es
thereon, and who does such work himself or helSelf 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-buader Will have "the burden of proving that he
did not build or improve for thepulpose of. sale). .
o I, as the owner ofthe 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 property wnobuilds or improves thereon, and who contracts for such projects with
a contractor(s) licensed pursuant to the Contractor's License Law).
.0. I am exempt under Sec; . .., S' & P.C. tor this reason:
Date: Owner:
I' . WORKER'S COMPENSATION DECLARATION'
I hereby affirm under penalty of perjury cine of the following declarations:
o I have and wiJ/. maintain a certificate of consent to self~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. . .
K). I have and will maintain worker's compensation insurance,'as required by Section 3700'of
'~bor Gode, fQr the performance of the work for which this permit is issued1 My worker's
Compensation insurance carrier and policy are:
Carrier: STATE FUND Policy Number. 285-02 UNIT 0001651
This section need not be oornple!ed if the penni! is lor one hundred dollars ($1 00) or less,
~certify that in the' performance of the work for which this permit- is issued, t shaH 'not
m oy any person in any manner gO as to become subject to the worker's compensation laws
of Ca ifomia, and agree that if I 'should become subject to the worker's compensation
provi~ions, o1:_Section ~700 of th Labor ode, I shan fo. w' . those provisions.
LICENSED CONTRACTORS DECLARATION
I hereby a irm under penalty of perjury that I am
lic-emsed nder provisions of c ter 9 (commencing
with Sect. n 700 ,of Divsio 3 of the' Business and
Profession C e.
6/6/2005
Date:
Contractor
NUMBE
436187 .
TYPE
TYPE
EXPiRATION DATE
3/3112007
C39
HIC
Date: 6/612005 Applicant:
WARNING: FAILURE TO SECU E. KER'S ENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUB CT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE.HUNDR , THOUSAND DQLLARS ($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
Iherebyaffirm ul1der penalty of perj~ry.that there is a construction lending agei1Cy.forthe_
performance of the work for which this permit is i.ssued (Sec. 3097 .Civ..C):
Lender's Information:
Construcion Types:
VN, ,
Fire Sprinklered?
NO
I certify that' have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to building construction, and
. hereby authorize repl;'esenti of this city to enter upon the above mentioned property for
in ection rposes.
Date: 6/6/~005
Fees paid for Permit:
.T01al:
. 235.53 .
Signa of Applicant or Agent
mi . pire by limitation and become' nun and void if the building or
work . s not passed Ii 001 i nsj>ection 365 days from the date of permit issuance. A
new permit'is required to lXimmence or continue work.
. INSPECTION INSPECTOR Electrical Final
. DATE . .
Temporary Power .Poie . , Plumbing Final
Plumbing (DrainlWaste Pipe) Mechanical Final
Electrical Ground Electrode/uter
Selbac:klForlt1lllTrenches (Footings) Gas Test,
.
Do not install subtloor Or pour floor slab until the Engineer1ng/Gradiog Final
following applicable ilems have been signed:
Plumbing (Water Plpe.Sprinkler Valves) Fire Dept. Final 765-4040
Mechanical (Groundwork) . Water Engineering 765-526
Electrical (Underground Conduit) Sub List/Business Lice~se
. Pre-slab (Co!llPactionlMembrane.Reinf.
Underpinning (Roor Joist/Girders) . . Zoning 765-5139,'
Do not cover or conceal the work be.low until the Building Final *ast Inspecl; "
following applicable items have been signed:
. ' fter Above C
1st Floor Shear . . PARTIAL
Firesprinkler (Rough) ........... Buildina Insoections
2nd Flo~eak . I I II\. &
Ro~ . aphragmlFrame) 11'1..1(1\ 1 VI .:..J..J L---
Masonry (RelnfJBcmd BeamlPre-Gcout) \' -I .
Rough Plumbing '(Top Out)
Rough Mechanical
Rough BectrlCaI (ory Wall) ,
Rough Electrical .
Framing (Only after Plbg" E!ec.. Mech. and Fire) ,
Insulation ISoundlEnergy) . . , MechanicallnSDectio
po no\.tape or pla\'ter until the following applic"ble
Items have been Signed: .
Drywall .
.
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
,Penetrations (Fire Rated) PI!Jmbing .
Interior Lath .,
Exterior Lath , . Plumbina Inspection
GENERAL ITEMS
Exterior Plaster 1Brown Coat)
T -Bar Electrical ,
T-Bar Mechanical .
T-Bar Stnuctural ,
Sewer .
Water Engineering Backflow . Electricallnsoections
Water Service
INSPECTION RECORD
FINAL INSPECTIONS
Date
Inspector
765~126
8
765-519
on-Only ,
omple!e)
INSPECTIONS.
ns
s