636 S. Westhaven Cir.
~~O~~FPERMIT . CITY
DATE: 1/19/2005
JOB ADDRESS: 636 S WESTHAVEN CIR
LEGAL DESCRIPTION: N TR 7241 LOT 37
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BUILDING DIVISION
200 S. ANAHEIM BLVD,
(714) 765 - 5153
INSPECTION REQUES,TLINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 10
BUILDING PERMIT NO. . BLD2005-00159
,
CONTRACTOR INFORMATION:
CARSON ROOFING AND WINDOWS
141 N LOHRUM LN
ANAHEIM, CA 928070000 I
BUSINESS PHONE: 71463f.4912
JOB DESCRIPTION:Tear off existing roof and replace wilh 22 squares of 30 year composition shingles.
, . I
VALUATION: 5,200,00
.1 OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor'f.Ucense Law for the following reason (Sec. 7031.5 Business and
Professipns Code:" any city or county which requires a pei-mit to construd, 8It4", improve, demolish or'repair any structure, prior to its issuance, also '
requires the applicqnt f<>r such permit to file a signed statement that he is lice,'1sed pursuant to the provisions" of the -Contractar;g, Llcens.e Law (Chapter
'9)(cammencing with SectiOn 7000 of Division 3 of the Business and ProfessichsCode) or that he is exempt therefrom and the basis for the alleged
exemption. Any violatlon of Section 7031.5 by any applic~nt fora permit sl!bj~ts the' applicant to a civil penalty of not more than five hundred doUars
($$00). '.," .
o I, as owner of property, or my employees with ~ages as their sole comri4nsation, will do the work, and the structur~,iS not intended?, offered for
sale (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 does suCh work himSelf or herself or through his or her owrl,employees, provided that such imp'lOvementsare- not intended or '
offered for sale, If, however, ,the building or improvement is sold with one ye~r' of oompletlon, the owner.bullder will have the burden of proving that he
did not bujfd or improve; for the purpose of sale), , :J.' - ",
o I" as the owner of the property, am exdusivetYcontracting with licensed" ;ontract'ors to construct the prC?ject (See, 7044 Business and Professions
Cod~: The Contractor's license Law does not apply to an_owner of propertY,\Vhobujlds or improves thereon, and who oontracts-for such projects with
~ontrador(s) licensed pursuant ,to the ContraGta~s License Law), \ ,j
U I am exempt under Sec. ,8 & P.C. for this reason:
Date: ' ,Owner: -:-;
I WORKER'S COMPENSATION DECLARATION ' !
, hrreby affinn under Penalty O:fperjury: one of the following declarati0n~: _ r 1, '
o ',h,ave.i'3nd wHl_mainJain,a certificate -of oonsent to' self-insure far wor~er's!c:ompensatjon,
as . provided for by.sectian 3700 ,of the Labor Code, for the perfdrmance of th~ work for whim' ,
'-' '. ' .. 1
jhi permit is issued. :', '
, " , I have and w, ill maintain-worker's compensation insurance, ,as required b),.':sectio~.3700,bf
labor Code, for the performance of the work for whjch this. permit is iSSU~'?, My worker's
Compensation insurance carrier and policy are:; "I .
,Carrier: ' Pohcy Number. EXEMPT.
.. ' , \..
.~' is section need notbe com~leted if the pennit is for one hundred dollars ($100};or less.
I certify that in the performance ofth~, :work for which this permi~ isissue(:, I shall not
mp\oy any_ person' in any manner so as to' become sUbjecfto the workets ~o:npengatlon ,laws
of Gafifomia, and agree that if I shOUld become subject. to worker's cornp.e;lsation
provisions of Section 3700 of the Labor Code,.' shallJort ith comply with th0sej:;>[oviSions.
APPLICANT: MIKE. CARSON
OWNER INFORMATION:
Rachel C. Blemker
636 S Westhaven eir
Anaheim;CA 92804
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: MSM
I
LICENSED CONTRACTORS DECLARATION
Ihereby affirm under penalty 0 perjury that I am
licensed under provis-ionsof chapter 9 (camT(lencing
with Se~tion 7000}~f pivsion 3 . the Bu,slness an,d
Prof~slons Cfode. e.' ~, .
1/19/200~--/;' .
Date: , T- . ., ,Contractor -, ., .',
NUMBER EXPIRATION DATE
661526 1213112006
TYPE C39
Oate: 1/1 9/2005 Applicant:
WARNING: FAILURE TO SECURE ORKER'S COMPENSATIONCOVERAGE;JS .
UNLAWFUL, AND SHALL SUBJECTe,N EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN AOQITION 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 agency far the
, performance of the work forwhid1 thispermltisissueQ (Sec.3097i9iv.C): '
LoGdai"s !nforrr.at:on:' ~' i
Construcion Types:
VN, ,
Fire Sprinklered?
NO
) certify that I have read this application and state that the abOVe information 13 corre~t. I
agree to oom'p1y withal! city ordinances and state laws relating to building construction, and
hereby authorize representlves of this' enter upon th . perty for
![}fpection purposes, '
A. Date: 1/19/2005
Signature of Applicant or Agent
, The permit shall expire by limitation and become null and void if the building or
work has.not passedfin;ll inspection ;165 days from the date of permit issuance. A
new permit is required to commence or continue work.
Fees paid for Permit:
Total:
235.35
INSPECTION RECORD
INSPECTION DATE INSPECTOR
T,mporary Power Pole . .
Plumbing (OrainlWaste Pipe)
Electrical Groond.ElectrodelUfer' .' ... .
Setbackl.FormslTrenches (Footings)
Do not install subfloor or po.urfloor "Iabuntilthe .'
.following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (GrOUndwork)
Electrical (Underground Condu it)
. pre-SIaD (CDI1IpactlonlMembrane.Reinf.
Underpinning (Roor Joist/Girders) . .
Do not cover or conceal'the work below untlltne
following applicable items have been signed: . .
1 st Floor Shear
Fhesprinkler (Rough) . ,
2nd Floor Shear ~ ,
Roof (Sheathing/DiaJ)hragm'Frame) .- '/ .
Masonry (RelnfJBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Me'chanical r
Rough f1ectrlCaI (ory wall'
,Roulih Electrical
Framirig (Only after Plbg" Elec., Mech" and Fire! .
bisulation (SOlIndlEnergy) . .
Do not tape or plaster until the following applicabli,
items have been.signed:. '.
Drywall '. . . .
Penetrations (Fire Rated) Electrical '.,
Penetrations (Fire Rated) Mechanical'
Pen.e1rations (Fire Rated) Plumbing
Interior Lath . . . . .
Exterior Lath.
GENERAl'ITEMS .
exterior Plaster (Brown Coal)
T .Bar Electrical
T-Bar Mecl)anlcal . , . . .'
T .BarStructural [. .
Sewer
Water Engineering Backflow .
Water "'ervice .
FINAL INSPECTIONS Date , Inspector
Electrical Final '.
Plumbing Final I .
I:
Mechanical Final .
Gas Test .
.
EnghieerlnglGrading Final 165,5126 .
Fire Dept. Final 765-4040 .
Water Engineering 165,5268 .
Sub List/Business License 765.519 .
Zoning 765-5139'
Building Final ~Last Inspection- Only 111tlo( 1-1';".. // -,-
Iter Above COl11plete) J'(fV'Io/ .
. .' PARTIAL INSPECTI()NS. ~i~
BUildin; Ins;ections . ~.' !j~ .
~1// f !;y'?~ ----1, 'I P . '.
. . .' I . .
MeehanicallnsDections
PlumbinQ Inspections
. Eleetricallnspectioris