209 W. Wilken Way
TYPE OF PERMIT C'ITY
Reroof .
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153 .
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 89
BUILDING PERMIT NO. BLD2005-01329
DATE: 5/9/2005
JOBADDRESS: 209 VIi WILKEN WAY
LEGAL DESCRIPTION: N TR 2520 LOT 100
CONTRACTOR INFORMATION:
CERTIFIED ONE ROOFING CO
16809 BELLFLOWER BLVD #545
BELLFLOWER, CA 907060000
BUSINESS PHONE' 800 757-6353
JOB DESCRIPTION: Tear off existing and re-roof 23 squares of 30 year composition shingles.
VALUATION: 3,000.00 '. . i;'ROCESSED BY: SAM
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
Profession.s Code: any city or county which requires a permit to construct, alte~ improve, demolish or repair any str~cture, prior to its i$Suance, also
requires the applicant for such permit to file a signed statement that heis licenood pursuant to-the provisions of the Contractor's License Law {Chapter
9)(commencing with Section 7000 of Division 301. the Business and Professiohs Code) orthat he is exempt therefrom and the ~asisfor the alleged .
exemption. Any violation of Section 7031.5 by any applicant for a permit subjetts,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 solecompe~satiOJ:1, will: do the work, and the structure is not intended or offered for'
s~\e {Sec. 7044 Business and Professions Code: The Contractor's License La~v 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, ho~ever, the building or improvement is sold with one year pf completion, the owner-builder will have the burden of proving that he
did not build or improve for the purpose qf sale]. ' ' . ..
.0 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). .
o I am exel1)pt under Sec. " B & P.C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pe~ury' one of the following, declaratio'ns:
D, I have and will maintain. a certificate of consent to selHnsure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance Qf the VlOrk for which
this permit is Issued. " 1
IXT11'ave and will maintain worker's compensation insurance, as required by Section 37QO of 5/9/2005
Aile"bwor Code, for the performanc~ of the work for.which this permit is issued.' Myworker's Date:
Compensation insurance .carrier and policy are:
Carrier: NO EMPLOYEES . Policy Number. EXEMPT
APPLICANT: LARRY MARKS
OWNER .INFORMATION:
MERRILL LANG
209W WilKen Way'
Anaheim, CA 92802
ARCHiTECT/ENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I ar:n
licensed under provisiof chapter 9 (commencing
with Section 7000) i ~ ion 3 of the Business and.
Professions Code.
Contractor
This section need not be completed,if the pennit is for one hundred dollars ($1 GO} 01' less.
dl'certify that in the perforrnance of the work f rwh'ich this,permit is issued; I shaU not
~ploy any person in any manner so as to beco subject to the workers compensation laws
of CaUfomia, and agree that if .1 should 'bBGdme lect to the workeris compensation
provisions of Section 3700 of the Labor Cod I all forthwith comply with those provisions.
Date: 51912005 . ' Applicant:
WARNING:FAIWRE TO SE EWORKER' C MPENSATION COVE RAG!, IS
UNLAWFUL, AND SHALL SUBJECT ANEMPl ER 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 370601' 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 for the
performance .00he work for which this permit is issued (Sec.3097.Ci'{.C):
Lender's Information:
NUMBER
540424
TYPE
. EXPIRATION DATE
.9/30/2005
C39
Construcion Types:
V N,
read. this application and sti3.te that the above information is correct. I
agree to mp with all city ordinances and state laws relatrng to building construction, and
hereby a hor' e epresentives of this city to enter upon the abpve mentioned property for
inspection r s.' .
Date: 519/2005
Fees paid for Permit:
Total:
235,33
Si nature of ApplJcant or Agent
The permit sha/ xpire by limitation and become null and void .ifthe building or
work has not passed final inspection 365 .days from the date of permit issuooce. A
new perMit is required to commence or continue work.
INSPECTION RECORD
, ' INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)' ,
Electrical Ground Electrode/lifer
SelbacklFormsrrrenches (Footings) , ,
Do not install subfloor or pour floor slab until the
following appiicable items have been signed: '
Plumbing (Water Plpe.Sprinkler Valves) ,
Mechanical (GrOUndwork) ,
Electrical (Underground Conduit) ,
Pre-slab (~ompaction/Membrane.Reinf.
Underpinning (Floor Joist/Girders) " '
Do not cover or conceal the woo< below untuthe
following appiicable items have been signed: "
1 st ,Floor Shear , ,
Firesprinkler (Rough) , . " , I
2nd Floor Shear ' , ' ~ . .n
Roof (Sheathing/Diaphragm/Frame) 5-//4'" ""'J'/ .J
Masonry (RelnfJBond BeamlPre-Grout)
Rough Plumbinll(Top Out) ,
Rough Mechanical" ,
Rough Electrical, (Dry Wall) , ,
Rough Electrical '
Framing . (Only after J:llbg:; Elec.. t,,'1ech.. and-Fire! ,
Insulation (SoundlE~rgy) , I
Do not tape or plaster until the following applicable
items have been signed: , ,- ,
Drywall ',' ,
Penetrations (Fire Rated) Electrical " , I
Penetrations (Fire Rated) Mechanical
Penetrations (1'1re Rated) Pl"mblng
Interior Lath ' ,
Exterior Lath
, " , GENERAL ITEMS
Exterior Piaster (Bl'l7Nn Coat) ,
T -Bar Electrical " ,
T-Bar Mechanical "
T -Bar Structural ,
,
Sewer
Water Engineering Backflow
Water Service . ,
FINAL INSPECTIONS,
Electrical Final
Plumbil)g Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040 '
Water Engineerin'g 765-5268
Sub ListlBusiness License 765.519
Zoning 765.5139
Building Final (Last Inspection. Only
After Above Complete)
PARTIAL INSPECTIONS
BuildinQ Inspections
Date
Inspector '
Mechanical Inspections
PJumbina Inspections
EJectricallnspectiol1s