147 S. Magnolia Ave. A-T
BUILDING PERMIT NO. BLD2005-02785
TYPE OF PERMIT CITY
Reroof
DATE: 9/6/2005
JOB ADDRESS: 147 S MAGNOLIA AVE
LEGAL DESCRIPTION: SEC 13 T 4 R 11 E 448 FT N1/2 NE1/4
APPLICANT: SAM DAVIS
OWNER INFORMATION:
DONALD CHONG
20440 VIA HABANA
YORBA LINDA, CA 92887
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 20
CONTRACTOR INFORMATION:
DAVIS ROOFING INC
978 N ELM #B
ORANGE, CA 928670000
BUSINESS PHONE: 714628-9525
JOB DESCRIPTION:Tear off existing roof and replace with 24 squares of built-llp roof over part of the garage area.
ARCHITECT/ENGINEER INFORMATION:
VALUATION: 5,650.00
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor'!; License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, atte,r, 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 licellsed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 01 Division 3 of the Business and Professi01s Code) or that he is exempt there1rom and the basis 10r the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil pena~y of not more than five hundred dollars
($500).
D 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 Ucense 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 that he
did not build or improve for the purpose of sale).
D 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).
D I am exempt under Sec. , B & P.C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
D I have and will maintain a certificate of consent to self-insure for worker's compensation,
as provided for by Section 3700 of the labor Code, for the performance of the work for which
ihO permit is issued.
I have and will maintain worker's compensation insurance, as required bySection 3700 of
Labor Code, for the performance of the work for which this permit is issued. My worker's
ompensation insurance carlier and policy are:
Carrier: STATE COMPENSATION INS Policy Numbe< 285-0001224
This section need not be completed if the pennit is for one hundred dollars ($100) ')I' less.
o I certify that in the perfonnance of the work for which this permit is issue~, 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 subject to the worker's compensation
provisions of Section 3700 of the La r Code, I shall forthwith mpl with those provisions.
PROCESSED BY: MSM
Date: 9/6/2005 Applicant
WARNING: FAILURE TO SECU RKER'S COM ENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJ CT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED OUSAND DOLLARS ($100,000), IN ADDI1l0N 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 for which this permit is issued (Sec.3097.Civ.C):
lender's Information:
I certify that I have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to building construction, and
hereby uthorize representives of this city to enter upon the above mentioned property for
insp i n purpo
Date: 9/6/2005
SIgnature of Applicant or Agent
The Ilermit shall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
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 ion 3 of the Business and
Professio Co .
9/6/2005
Date:
NUMBER
509824
TYPE
TYPE
Contractor
EXPIRATION DATE
10/31/2005
C39
HIC
Construcion Tvpes:
V N, ,
Fire Sprinklered?
NO
Fees paid for Permit:
Total:
226.84
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormsfTrenches (Footings)
Do not install subfloor or pour floor slab unlilthe
following applicable items have been signed:
Plumbing (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
Roof (Sheathing/Diaphragm/Frame) fl-7 -OS- iI!, fl<Al'9>'i {;/
Masonry (Reinf./Bond Beam/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 unlilthe 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 Dept. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-5194
Zoning 765-5139 I
Building Final (Last Inspection - Only ~~:zl. F; f
'" b-
Atter Above Complete)
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbina Inspections
Electrical Inspections