1290 N. Willet Cir.
BUILDING PERMIT NO. BLD2005-02155
TYPE OF PERMIT CITY
Reroof
DATE: 7/12/2005
JOB ADDRESS: 1290 N WILLET CIR
LEGAL DESCRIPTION: N TR 7417 LOT 13
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 200
APPLICANT: MI KE KLEI N
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
THOMAS KDENNIS BILTWELL ROOF & MATERIAL CO
1290 N WILLET CIR 3310 VERDUGO RD
ANAHEIM, CA 92807 LOS ANGELES, CA 900650)00
BUSINESS PHONE: 818986-4411
JOB DE,SCRIPTI9N:Tear off ~xisting and reroof 15 squares with 30-year composition shingles
VALUATION: 5,100.00
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 city or cQuntywhich requires a permit to construct, altel~ improve, demolish or repair any structure, prior to its issuance, also
requires the appUcant for such permit to file a signed statement that he is licenood pursuant to the provisions of the Contractor's license Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and ProfessfonsCode) 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).
D I, as owner of property, or my employees with wages as their sole 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 La.N 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 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 purpose of sale).
D 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 property who builds or improves thereon, and who contracts 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:
I
PROCESSED BY: JNJ
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
D I have and will maintain a certificate of consent to self~insure far warker'scampensatian,
as provided for by Section 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. Policy Number: 46-11751-02
This section need not be completed if the pennlt is for one hundred dollars ($100) or less.
D I certify that in the performance 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 b orne subject to the worker's compensation
provisions of Section 3700 of lhe Labor e, I sh forthwit mply with those provisions.
Dale: 7/12/2005 Applicant:
WARNING: FAILURE TO SECURE WORKER'S COMPENSA TlON COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO 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 perjury that there is a construction lending agen-cyfor the
performance of the work for whidl this permit is issued (Sec. 3097 .Civ .C):
Lender's Information:
I certify that I have react 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 a horize representives of this city to enter upon the above mentioned property for
insp "purpo
Date: 7/12/2005
Signature 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 issuMCe. A
new permit is required to commence or continue work.
LICENSED CONTRACTORS DECLARATION
I hereby a irm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000 of Divsion 3 of the Business and
Professions Cod
7/12/2005
Date:
NUMBER
458005
TYPE
TYPE
TYPE
Contractor
EXPIRATION DATE
6/30/2006
B
C10
C20 HT AC
Construcion Types:
VN, ,
Fees paid for Permit:
Total:
160.62
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
SetbacklForms/Trenches (Footings)
Do not Install subfloor or pour floor 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:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear I I /
Roof (SheathinglDiaphragm/Frame) I !>/!/d ,/\7 . If,,,.
Masonry (ReinfJBond Beam/Pre-Grout) , .
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ere., 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
Zoning 765-5139
Building Final (Last Inspection - Only 0-10-OS fM Jf...r:,r.j!
After Above Complete)
PARTIAL INSPECTIONS
Buildina InSDections
Mechanical Inspections
Plumbing Inspections
ElectricallnSDections