4637 Meadowglen Dr.
TYPE OF PERMIT CITY
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 165
BUILDING PERMIT NO. BLD2005-03213
DATE: 10/5/2005
JOB ADDRESS: 4637 E MEADOW GLEN DR
LEGAL DESCRIPTION: N TR 5988 LOT 51
CONTRACTOR INFORMATION:
ORANGE COUNTY ROOF MART INC
171 GEMINI AVE
BREA, CA 92621 0000
BUSINESS PHONE: 714879-1588
JOB DESCRIPTIONReplace existing roof with 25 squares of 30 year composition shingles and 4 squares of BUR
APPLICANT: KARYNA CRUZ
OWNER INFORMATION:
JOHN A LOUWSMA
4637 E MEADOW GLEN DR
ANAHEIM, CA 928070000
ARCHITECT/ENGINEER INFORMATION:
VALUATION: 10,586.00
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law 10r the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, atter, 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 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 bu ild or improve for the pu rpose 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
a contractor{s) licensed pursuant to the Contractor's License Law).
D .1 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:
o I 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 permit is issued.
;:;P: I 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 FUND Policy Number. 1770283-2004
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 Divsi 3 of the Business and
Professions Code.
11/7/2005
Date:
Contractor
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
D I certify that in the pertonnance 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 become subje to the worker's compensation
provisions of Section 3700 of the Labor Code, I rt with comply with th e provisions.
Date: 11/7/2005 Applicant. ~
WARNING: FAILURE TO SEC~ WORKER'S COMP NSATION COVERA E IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED 1HOUSAND DOLLARS ($100,000), IN ADDITlON 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:
NUMBER
818684
TYPE
EXPIRATION DATE
4/30/2007
C39
Construcion Types:
VN, ,
Fire Sprinklered?
NO
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
~ne;:i~~t~OItrize repre~sentlves of this city to eJnter upon the above mentioned property for
-?" . _.'" ^ _ _.I Date: 11/7/2005
r-- at of ~aT1M( 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 issuMCe. A
new oermit is reauired to commence or continue work.
Fees paid for Permit:
Total:
245.43
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbina (Drain/Waste 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 Valvesl
Mechanical (Groundworkl
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 II
Roof (Sheathing/Diaphragm/Frame) It!, /0 r 1.4J.l A ",'''/&'
Masonry (Reinf./Bond Beam/Pre-Groutl n
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 Coatl
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
Cross Connection Control (114)765-4280
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 11/11/0/
After Above Complete) ..\ Al\\ IlIJ15v:J
,
PARTIAL INSPECTIONS
BuildinQ Inspections
Mechanical Inspections
PlumbinQ Inspections
Electrical Inspections