8130 Woodsboro Ave.
~~;O~~F PERMIT . CITY
DATE: 4/1412005 \.
JOB ADD'RESS: 8130 E WOODSBORO AVE
LEGAL DESCRIPTiON: N TR 9169 LOT 32
ElM
BUILDING DIVISION ,
200 S, ANAHEIM BLVD,
(714) 765 - 5153
INSPECTION REOUEST LINE:
(714) 765 - 4626
CENsus CODE: 555
QUARTER SECTION: 206
,51
BUILOING PERMIT NO. BLD2005-01033
APPLICANT: MITCH ATCHLEY
OWNER INFORMATION:
Judith L Enlow '
8130 E Woodsboro Ave
'Anahl"im, CA 92807
, CONTRACTOR INFORMATION:
YORBA LINDA ROOR NG "
3924 E MIRALOMA AVE #A
,ANAHEIM, CA 928060000
BUSINESS PHONE: 714985-1307
JOB DESCRIPTION: Tear off existing and re-root 22 squares of composition shin9les,
VALUATION: ' 6,000,00
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: SAM
OWNER-BUILDER DECLARATION
I hereby affirm ul1der pena of'perjurythat am exempt from the Contractor'sLicense LaW fbrthe following reason (Sec. 7031.5 Business and.
Professions Code: any city or county whiCh-requ;res a permit to construct, alter, improve, demolish or repair any structure"prior to its'.isSuance,-"arso
requires the applicant for such permit to file a signed statement that he is licen'~d purs'uant to the p.lOvisions of the Confractor's license Law (Chapter..
9)(commencing w(th Section 7000 of Division 3 of the Business and. Professioos Code} or that he is exempt therefrom and the baSis for the alleged.
exemption. . Any vlolat.ion ,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). .
o .1, as owner of property. or my employees with w~ges as their sole compsDsation, will do the work, and. the structure'is not intended or offered for
sale (sec, 7044 Business and Professions Code: The Contractor's Wcense La;W does not apply to an owner of propertY who builds,orimproves
thereon, and whodoes.such work himself or herself or through his or her ownemployees,provided that such.improvements are not. intended.or,
offered for sale, If, however, the building or imp~ovement is sold with one yew', of oompletion,.the'owner-builder will have the burdenof provin!;j, that.l1e
did not build orfmprove for the purpose of sale). i ... ..
o I, as the owner of the property, am exclusively contracting,with .licensed contractors to construct th~'project (Sec. 7044 Business.and Professions
Code: The Cbntra~tor's License Law ~C?es 'not apply to an owner of propertyw;lho builds or improves thereon, and who contracts f~r sLich projects with
~ontractor(s) licensed pursua~t to the Contractor's License Law), .'_ .... . .!
U I am ,exempt un~erSec; ._. ,B & P.C. for this reason:' , .' .
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I herebyaffi.rm under penalty of perjury one of the following declarations:
o 'have and will maintain a certificate of consent to self-insure- for worker'scompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work. for which
this permh is issued, ' " , I, ,
S. have and Will, malntainworker'.s compensation insurance,- ~s, required b, Y Section.3700 of
bor Code, for the performance of lhe work for which this permit is issued; My worker's
Compensation insurance carner and policy are: . . i
Carrier: EXEMPT " ' ' , Policy Number. NO EMPLOYEES
This section need not be Completed if the pennit.is for one hundred dOllar~ ($100) Or less.
o I certify that in the perfonnance-of the work for which this permit is iSsued,', shall'not
employ any persoh in aDY manner so as to beCome subject to the worker's compensation laws
of Califomia, and agree-that if I should- become Subject to the worker's compensation. .
provisions of Section 3700 of the Labor Code, I shaH forthwi.th comply with those provjsions.
LICENSED CONTRACTORS DECLARATION
I hereby a _ irm undeT-penalty of perjury that I am
licensed under provislonsof chapter 9 (comn:aencing
with Section 7000) of Divslon 3 of the Business and
Prof~ssiOnS~D<!e~-- ,..
4/1412005 '
Date: . ... -.- , . C~ntT.actor
NUMBER EXPIRATiON DATE
549263 1113012006
TYPE C39
Construcion Types:
V N" '
Date: 4/1412005 Appile 0
,WARNING, F'AILURE TOSECURE KER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND.8HALLSUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDREDTI-fOUSAND DOLLAR,S ($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 agefl{:yfor the
performance of the work for which this permit is issued (Sec, 3097 .Civ.C):
Lender's Information:
I certify t.hat I have read this appHcation. and state that the above, information is correct. I
a9re.eto comply with all city ordinances and state laws relating to building construction, and
hereby authorize representives of this city to enter upon ihe above. mentioned property for
. inspection pur 0
\
Date: 411412005
Fees paid for Permit:
Total: .
235.43
Signatu Icant orAgent
Thl! permit shall expire by limitation, and become null and void if 1he building or
work has nOt passed fi 001 i nspectiOl1 365 days from the date of permit issuance. A
new permit is reqUired to commence or continue work.
INSPECTION RECORD
, INSPECTION , DATE INSPECTOR
Temporary Power Pole " ,
Plumbing (DrainlWaste Pipe) ,
Electrical Ground Electrode/Uter
SelbacklFormsrrrenches (Footings I
Do not install subfloor Of pour floor slab until the
fOllowing applicable items have been signed: ' ,
Plumbing (Water Plpe.Sprlnkler Valves)
Mechanical (Groundwork) ,
'I electrical (Underground Conduit)
I pre-slab (COWPaction/Membrane.RelOf. ' "
Underpinning (Roar Joist/Girders) , ,
Do not, cover or concea,1 the \Nom'bel,ow unt/l the
following applicable items haye been signed: ' '
1 st Floor Shear, ,
Firesprinkler (Rough) ,
2nd FloQt.S!1ear ': ' ' ' ' I', /.
~atHioblDlaPhragmlFram!>) , -//~irll'tS ' I~ Iow<A: _ IIA
Masonry (RelnfJBond BeamlPre-Grout) ~.
Rough Plumbing (Top Out) "
Rough Mechanical ,
KOugh l:IectrlC.. all)
Rough Electrical ,
Framing (Only after Plbg:. Elec.. t...lech. a~d Fire) ,
Insulali,on (SoundiEnergy) ,
po not tape or pla~ter until ,the lollowing applicable '
.tems have been sIgned: " ' ' ,
Drywall ,
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing' '
Interior Lath ' ' , ,
Exterior Lath ' ' .
GENERAL ITEMS
Ext4!rior Plaster (Brown Coat) ,
T -Bar Electrical ,
T'BarMechanical , "
T -Bar Structural "
Sewer ' -
Watar Engineering Backflow
Water Service
FINAL INSPECTIONS Date Inspector
Electrical Final , , ' , I
Plumbing Final , , ,
Mechanical Final "
,
Gas Test ,
,
EnginoorlnglGradinQ Final 765-5126 " , '
Fire Depl.' Final 765-4040 , "
Water Engineering 765-5268 , ,
Sub List/Business License 765-519 "
Zoning 765.5139 " , ,
,
Building Final *ast'lnspection. Only AjtlJOs' ~M" ,
fter Above Complete)' I
PARTIAL INSPECTIONS ~~,
. Buildina Inspections
MechanicallnSDections
Plumbina Inspections
Electrical Inspections