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115 N.Merrimac Dr. BUILDING PERMIT NO. BLD2005-02001 TYPE OF PERMIT CITY Reroof DATE: 6/29/2005 JOB ADDRESS: 115 N MERRIMAC DR LEGAL DESCRIPTION: TR 5063 LOT 3 ALL -EX NWL Y 55 FT- APPLICANT: OWEN CARSTENSEN OWNER INFORMATION: Bruce Switzky 5881 Camphor Ave Westminster, CA 92683 ElM BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 CENSUS CODE: 555 QUARTER SECTION: 156 CONTRACTOR INFORMATION: T & G ROOF REMOVAL 960 ENTERPRISE ST ORANGE, CA 928670000 BUSINESS PHONE: 714637-1530 JOB DESCRIPTION; Tear off existing and re-roof 44 squares of 30 year composition shingles for Units 1-4. VALUATION: 10,275.00 PROCESSED BY: SAM ARCHITECT/ENGINEER INFORMATION: OWNER-BUILDER DECLARATION 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 fire a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9)(commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation 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 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 provlng that 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 for 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 I hereby affirm under penalty of pe~ury one of the following declarations: o 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 ermit is issued. I have and will maintain worker's compensation insurance, as required by Section 3700 of or Code, for the performance of the work for which this permit is issued. Myworker's ompensation insurance carrier and policy are: arrier: STATE FUND Policy Number. 238-0001315 This section need not be completed if the pennit is for one hundred dollars ($1 00) or less. o I 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 worker's compensation laws of California, and agree that if I should beco e subject to the worker's compensation provisions of Section 3700 of the' Labor C , I shall fo hwi ply wi those provi..ons. Date: 6/29/2005 Ap lica . WARNING: FAILURE TO SECUREWO KER'S UNLAWFUL, AND SHALL SUBJECT AN EMPL R TO CRIMINAL PENALTIES AND CIVIL FINES UPTO ONE HUNDRED 1HOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVI DED 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 author! epresentives of this city to enter upon the above mentioned property for in ection p 0 s. Date: 6/29/2005 of Applicant or Agent The permit shall ex e by Iimttalion 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 oermit is reauired 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 Divsion 3 of the Business and profeSSion~c O/d -L2- 6/29/2005 'l ~ Date: Contractor NUMBER E IRATION DATE 657689 10/3112006 TYPE C39 TYPE HIC Construcion Tvpes: V N, , Fees paid for Permit: Total: 385.30 City of Anaheim Building Division INSPECTION RECORD INSPECTION DATE INSPECTOR Temporary Power Pole Plumbing (Drain/Waste Pipe) Electrical lOround Electrode/Ufer SetbacklFormslTrenches (Footings) DO,not install subfloor or pour floor slab until the following applicable items have been signed: Plumbing (Water Pipe/Sprinkler Valves) Mechanical IGroundwork) Electrical (Underground Conduitl 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 ISl)eathfnQ/Diaphrallm/Frame) .-(rrK' -AVI ~'WJ(f</ Masolry~Bond Beam/Pre-Grout) Rough Plumbing (Top Out) Rough Mechanical Rough Electrical (Dry Wall) Rough Electrical Framing (Only after Plbg., Efe., Mec. And Fire) Insulation (Sound/Energy) Do not tape or plaster until the following applicable items have been signed: Drywall Penetrations (Fire Rated) Electrical Penetratlons (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 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 Building Final (Last Inspection - Only After Above Complete) INSPECTOR PARTIAL INSPECTIONS Buildlna Insoections Mechanicallnsoections Plumbina Insoections Electricallnsoections