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721 La Reina TYPE OF PERMIT CITY Reroof ElM BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765- 5153 INSPECTION REOUESTLlNE: (714) 765 - 4626 CENSUS CODE: 555 QUARTER SECTION: 18 BUILDING PERMIT NO. BLD2005-01776 DATE: 6/10/2005 JOB ADDRESS: 721 N LA REINA ST LEGAL DESCRIPTION: N TR 2332 LOT 147 CONTRACTOR INFORMATION: o C E IINC 10615 LAWSON RIVER AVE FOUNTAIN VALLEY, CA 927080000 BUSINESS PHONE: 714962-9nO JOB DESCRIPTION:Tear off existing, resheat as needed, and reroof 22 squares with 5O-year composition shingle APPLICANT: TOM KORSVALL OWNER INFORMATION: James P Thompson 721 N La Reina St Anaheim, CA 92801 ARCHITECT/ENGINEER INFORMATION: VALUATION: 5,000.00 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 county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9)(commencing with Section 7000 oi Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation oi Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred donars ($500). o 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 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 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 th~t he did not build or improve for the purpose of sale). o 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 ior such projects with ~ontractor(s) licensed pursuant to the Contractor's License Law). U I am exempt under Sec. , B & P .C. for this reason: Date: Owner: I WORKER'S COMPENSATION DECLARATION , hereby affirm under penalty of perjury one of the following declarations: o I have and will maintain a certificate of consent to setf~insure ior worker's compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which ~is 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 COMPENSATION INS FUND PROCESSED BY: JNJ LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9 (commencing with Section 7000) of Di' of the Bus' as and Professions e. 6/10/2005 Date: Policy Nu mber. 229-01 UN IT 0014911 NUMBER 431058 TYPE TYPE EXPIRATION DATE 5/3112006 This section need not be completed if the pennit is for one hundred dollars ($1 00) or less. o r 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 workers compensation laws of Califomia, and agree that if I should become subja 0 the work's compensation provisions of section 3700 of the Labor Code, I s ith 'th Iy with those provisions. 8 Hie Date: 6/10/2005 Applicant. WARNING: FAILURE TO SEC RE WO ER'S COMP SA TION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER 0 CRIMINAL PENALTIES AND CIVIL FINES UPTO ONE HUNDRED THOUSAND DOLL 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 agency for the performance of the work fot which this permit is issued (See.80S7 .Civ .C): Lender's Information: Construcion Tvpes: VN, , I certify that I have read this application and state that the above information is correct. I agree to comply with II city ordinances and state laws relating to building construction, and herebyauthoriz p sentives of's to enter upon the above mentioned property for inspectio p Dale: 6/1 0/2005 Fees paid for Permit: Total: 235.33 Applicant or Agent e permit shall expire y 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 Dermit is reauired to commence or continue work. City of Anaheim Building Division INSPECTION RECORD I INSPECTION DATE INSPECTOR iTemporary Power Pole :Plumbing /DrainlWaste Pipe) Iflectrical Ground Electrode/Ufer 'setbacklForms/Trenches (Footings) I Do not install subfloor or pour floor slab until the I following applicable items have been signed: IPlumbing /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 Roof (Sheathing/Diaphraam/Frame) &-13 -&J Masonry (Reinf J80nd 8eam/Pre-Grout) Rough Plumbing (Top Out) Rough Mechanical Rough Electrical (Dry Wall) Rough Electrical Framing (Only after Plbg., Ele., 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 Dep!. Final 765-4040 Water Engineering 765-5268 Sub List/Business License 765.5194 Zoning 765-5139 Building Final (Last Inspection. Only '-'154 S~ Alter Above Complete) PARTIAL INSPECTIONS Buildina Inspections Mechanical Inspections Plumbina Inspections Electrical Inspections