1250 Melanie Dr.
TYPE OF PERMIT CITY
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 206
BUILDING PERMIT NO. BLD2004-04230
DATE: 11/22/2004
JOB ADDRESS: 1250 N MELANIE DR
LEGAL DESCRIPTION: N TR 9170 LOT 13
CONTRACTOR INFORMATION:
SCOT'S ROOFING
1991 JUNIPERO #C
SIGNAL HILL, CA 907550000
BUSINESS PHONE: 562 986-'1661
JOB DESCRIPTION,ear off existing and install 24 squares of 7.2 lb. eagle lite tile, ICBO # ER2656.
VALUATION: 11,500.00
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 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).
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 License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or helSelf or through his or her own employees, provided that such improvements are not intended or
offered for sale. Jf, 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
APPLICANT: SCOT CHAMBERLAIN
OWNER INFORMATION:
TRUST BRIGGS
1250 N MELANIE DR
ANAHEIM, CA 928070000
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: MSM
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury 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
~ permit is issued.
~ t 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, My worker's
Compensation insurance carrier and policy are:
Carrier: STATE COMPENSATION FUND Policy Number. 229-0014157
This section need not be oompleted if the pennit is for one hundred dollars ($100) 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 bee bject to the worker's compensation
provisions of Section 3700 of the Lab C de, s I h comply with those provisions.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under pr .. ns of chapter 9 (commencing
with Section 0 ) of i siness and
Professi
8/2/2005
Date:
Contractor ".
NUMBER
708960
TYPE
EXPIRATION DATE
6/3012007
C39
Date: 8/2/2005 Applicant:
WARNING: FAILURE TO SECUR K 'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED ll-IOUSAND 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:
Construcion Types:
V N, ,
I certify that I have read this application and state that the above information is correct. I
agret:l to compi with all city ordinances and state laws relating to bUilding construction, and
hereby aut rize represenr f this city to enter upon the above mentioned property for
in )0 pur
Date: 8/2/2005
Fees paid for Permit:
Total:
482.59
Signature of Applicant or Agent
'The permit 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.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground 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 (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
Underpinning (Floor JoisVGirders)
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)
Masonry (Reinf.lBond 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 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 Dept. Final 765-4040
Water Engineering 765-5268
Sub LisVBusiness License 765-5194
Zoning 765-5139 n
Building Final (Lastlnspecllon - Only \\ ~t4ul _^ Xnft- -
After Above Complete) V. cr
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbing Inspections
Electricallnsoections