2650 W. Winston St.
CONTRACTOR INFORMATiON:
THE ROOF GUY
9781 EASTWOOD CIRCLE,
VILLA PARK, CA 92861 O((JO'
BUSINESS PHONE: 714921-1500
JOB DESCRIPTfONReroof. remove existing rock roof.and ins!aU 30 yr camp.;Z2 squares
", I
VALUATION: . 3,000.00. '. . . ..i . . . PROCESSED BY: KBT .
: .
I . '. '. '. OWNER-BUILDEfi'OECLARATION. . .
I hereby affirm under pen.alty of perjury that l am exempt from the Contractot~s License law for the f.ollqwing reas9n' (Sec~ 7031.5 Bu~iness and
Pro~ssions Code: any city or county which requires a permit to construct. at;ur, improve,' demolish or repair any structure, prior to its, iss'uance. also
requires the appncant for such permit to file a signed statement that he is lic',insed pursuant to the proVisions o.f-the Contfactor's License Law (Chapter
9)(commenci':l9 with S_ection 7000 of Division 3: of the Business and Professions Code)'Or that he is,exempt. therefrom and the basis for the,alleged
exemption. Any viblation of Section 7031.S'by any applicant for a permitsu~jects the appH6antto a civil pena.ltyof not more tha-n five hundred dollars
($500). . . i'.. . ....
o I. as owner of property. or my employees, with 'wages as their sole cor;:,~'er:sati~ri, will do the work, and the stro~ture -is not intend~or offered f~r
sal~(Sec. 7044 Business and Professions Code: The Contractor's-license \aw does notapp{yto a'1owner of property who builds or Improves
thereon. and who does sum work himsetf or heiself or through his,or her Oy;t; employees,provided that'such improvements are not inten(jed_or
9ffered for sale:; If, however, the ,building or improvement is sQld with onE y~~~ of'oompletion, the'owner-builder wHlhave the burden of tiroving fhat he'
did not buUd or improve far the purPose of 'sale). ,;, , < _ : .
o :', as the owner of the' property,_ am exdusiVely contracting with Iicensed"v:mtractors to construct the project (See. 7044 8usines~f arid Professions
Code: The Contractor's license taw daes natapply ta:an owner af property,:who builds OJ i'mpraves thereon. and who contract&for suCh projects with
~ontra.ctor{s) licensed p~rsuant to the C,?litractor's License 'law). C . ' .
U I am exempt.under Sec. , B &_ P.C. for this reason: I
Date: Owner: !'
I WORKER'S COMPENSATION DECLARATION; .
I hereb.y affirm under penalty of perjury_one of the following declarations: ~ .
. 0 J hi::lVe and will, maintain a certificate _of consent to Self~insure!a r worker'f' compel1sa~ion. .
as provided for by Section 3700 of the labor Code, for the performance of th'>~ w~rk for .....'hidl
~i permit/S issued; . . ,- . " t
, . I have and will maintain wori<er's compensation !ns~rance. asre,q~i~a~? ~ection 3700 of
e. abor: Code, for the ~rformance of the work for which this permit IS 1$S~'~d. ,My worker's
Campen'sationinsurance 'earrier and policy are: . i'
Carrier: STATE COMPENSATION FUND POli"" Number. 1713793,
. . . ' i '
.This section need not be ooinpleted If lhe permit Is for one hundred d~lIars ($10(;.<r less.
o I certify that in the pertonnance ofthe work for which this permit is jss~f:''l~'l~shaU.nOt
employ any pers;on in aoy man ner so as to become subject to the workel"s- c"Jinperrsation laws'
of Califomia, and agree that if t"should becoine 'subject to. the worker's' com~r~atlon
. provisions of Section ~7oq ofth!~a.OOI':Cvtre. , sh~ '.. co with ~m$e.'provi~ons.
Date: 2/6/2004 . Applicant:.~ .... "'''
WARNING: FAILURE TO SECURE ORKER'S COMPENSATION COVER~.GE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEtJAcTIES AND CIVIL
FINES.UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADD,TION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTI01: 3706 OF THE
LABOR CODE,INTEREST AND ATTORNEY'S FEES.'
I CONSTRUCTION LENDING AGENCY _
I hereby affirm under penalty of perju'ry that there is a construction lending af.~ncy felr the
. perlor(r>..ance ofthe'l1ork f~rwhicn th!!!",~P.'mit i':ld~~j~d (~~_-~_1.~7r:>':c;: ...:. -~--- ..
. lender's Information: - ~. '.'
BUILDING PERMIT NO. BLD2004-00350
TYPE OF PERMIT CITY
Reroof
DATE: 2/6/2004
. JOB ADDRESS: 2650 W WINSTON ST
LEGAL DESCRIPTION: N TR 3124 LOT 59
APPLICANT: JOHN SHEAn
OWNER INFORMATION:'
. Thomas Johnson
2650 W Winston Rd
Anaheim; CA 92804
BUILDING DIVISION
. 200 S. ANAHEIM BLVD.
(714) 765.5153
INSPECTION REQUEST LINE:
(714) 765 . 4626
CENSUS CODE: .434
QUARTER SECTION: .22
ARCHITECT/ENGINEER INFORMATION: .
~
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury lhat I am
licensed u.nderprovlsions of chapter 9 (commencing-
with Section 7000) of Oivsion 3 of the Business and
P!Ofessio'b . .
~:i::004' . -. ~~.
NUMBER
638593
TYPE.
TYPE
C39
HIC
ExpiRATION DATE
2/28/2004
Construc:ion Types:
VN, ,
Fi~ Sprinklered?
I cel:1ify that I have read' this a pplication and state that the above informa tion'is correct I
agree to comply with all city ordinances and state laws relating to building construction. and
hereby authorize representives of this city benter upon the above mentioned. property for
in~~rpo~~ . .' DaI6:2/6I2oo4
, "\ - i --; O!J\PPlicant or Agent
, The permit shall expire by limitation and become nun and void if the building or
work has not passed final InSpection 365 days from the dale of permit issuance.. A
new permit _is reqUiredlo commence or continue work. .
NO
"
Fees paid for Permi~:
Total;
1.1.0.77
. INSPECTION RECORD
. INSPECTION. . .
. DATE. INSPECTOR
T empor~ry Power Poie. .
Plumbing (DrainlWaste pipe) ..
. Electrical Ground Electrode/Ufer . .
SetbacklFormsfTrenChes (Footings) . .
00 not instaUsubfloor or pourfloor slab until the ..
following applicable items have been signed:
Phlmbing (Water Pipe.Sprink"'r Valves)
Nlechanical (Groundwork).. . [. . .
..1 Electrical (Underground Conduit)
Pre-slab ("ompactiOnlMembrane.Reinf.
Underpinning (Floor Joist/Girders)
. .1 !J<:l. not cover or conceal the work below until tne I.
following applicable items have been signed: .
1 sf Floor Shear .
Firesplinkler(Rough) . I . .
2nd Floor Shear ,
Roof (Sheathing/Diaphragm/Frane) .7'..tS"g-t- \.Ifi.>.V.
Masonry (ReinfJBond BeamlPrlfoG/'OUt) I ' .
Rough Plumbing (Top Out)
Rough Mechanical ... .. .
I ROugh 6llCtrICalII ,IlL..
Rough Electlical .
Framing (Only after Plbg.. Elec.. Mech.. ahd Fire)
Insulallon.(SoundlEnergy) I
po not tape or pla~ter until the following applicable
.tems have been sIgned: .. .. . . . ,.
. Drywall . . . . .
Penetrations (Fire Rated) Electlical
Penetrations (Fire Rated) Mechanical .
. Penetrations (Fire Rated) Plumbing
Interior Lath . .. . . . .
Exterior Lath. ... . .
GENERAL ITEMS .
exterior Plaster (Brown Coat). .
T -Bar Electrical
T-Bar Mechariical .
T-Bar Structural... . .
Sewer .
Water El)glneering 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 Lis.tlBUsiness License 765.519 . ..
Zoning 765,5139 .
..
Building Final ~ast Inspection. Only H'HJ<cr j,-Lfj ..--
Iter Above Comple1e) . r .v
PARTIAL INSPECTIONS
Bui/dinq InsDections
MechanicallnSDections
. ,
Plumbina Inspections
ElectricallnSDections