910 N. Mohawk Ave.
A?PLlCANT: PAUL POWDERLY T
OWNER INFORMATION: CONTRACTOR INFORMj.ti"ioN:
Wendell L Williams' ROYAL ROOFING COMf,'lINY
1142W Norlh Sl 81111 COMMONWEALTHA'VE
Anaheim, CA 92801 BUENA PARK, OA 90621 ',"00
, , BUSINESS PHONE: 714' 5.iI-0100
JOB DESCRIPTION Replace existing shake with 30 year comp shingle. 22 s<ll'"es, ,
VALUATION: 5,900.00 , I
I OWNER-BUILDErtoECLARATION
I hereby affirm-under penalty of perjury that I am exempt from the CqntractQf~'.~ Ucense Lawf,or the following reason (Sec. 7031.5 Business and .
Profession~ COOd:, any city or county'which requiresa.permit to c'onstruct,'~':,!er, improve. demolish or repa ir ariy,strtlcture...priorto itS issuance, arso'"
requires the applicarltfor such permit to file a signed statement that he is I.ic"Jn::~d .pursuant to the provisions of the COl'llract,cr's License Law (Chapter
9)(commencing with Section 7000 of Division.3 of the Business and Profes~;&~s--Code) or trot ti~ is exempt therefrom arid tht:i-basis for. the alleged
exemption. Any'violation of Section 7031.5 by any applicant for a permit Si.:~j.:;:cts the'applicant to a dvil penalty'of not mOre then five himdroo dollars
($500)., . i ' , '
o I, as owner of property, Qr my employees with wages as th~ir sole ccmr.~nsatiol1,'Will.j9 the work, ar:d the structure is !1ot intended oroffered.for
sale (Sec. 7044 BusinesG and Professions Code: 'The Contractor's Licens;::: J.awdoes not apply to an owner of property who bllildsor improves
thereon, and who does such' work himself orherself or thro.ugh his 'or her ow;., employees, proviJed that such ilTiprover:.n~nts <;I're not intended or
offered for sale. If, howe_ver, the buildi.1g or improvement is sold with one Y~~jr of completion, the owner-builder will have the burden of proving that he
did not build or imptove for the purpose Qf sale).. . '. 1: "" " , '. .,
o 1-, as theowiler of the property, am exdu3~verycontractiflg with I icelisc,{contracl:ors to construCt the project (S?c: 7044 Business and Professions
Cod_e: The ,Contractor's License; Law does not 'apply to an owner pf proper.~t:.;\'il'a builds or rmoroves thereon; anj,~ha.~ntracts for such projects witli
~cntractor(s)licensed pursuanttatheContractor'slicense Law)"., /.; . . . , . ",,' ' .
),am exempt under Sec. ' ,B& P.C, for this reason:' '~..__" , ' "
Date: Owner: . ":' 1 .
I WORKER~S COMPENSATION DECLARATIOIl _~l.
I hereby ffjrm unde! penalty .of pe~ury one of the fc.Howing dec!n,ations: i
Dave and wi:! mainfain a certificate of consent to self.insure for wcr~'e(':; CCfn~ens3tion,
a rovided 'for by Section 3700 of the Labor Code, for the performal1ce 'Orti1,!;l \-,ork tor whic.i1
lis permit is. issued. . . . ,;, .
have and will maintain worker's compensation insurance, as required t',I,Section 3700 of
th abor Code, far thE! performance of the work for which this perr:nlt !s if.~~i:d, ~yworker's
ompensation Insurance carrier and policy are:
Carrier: NATIONAL UNION FIRE
BUILDING PERMIT NO. BlD2004-00070
I
'-'i~
. TYPE OF PERMIT CITY
Reroof '
DATE: 1/12/2004
JOB ADDRESS: 910 NMOHAWKAVE
LEGAL DESCRIPTION: ' N TR 2396 LOT 19
'r;
v
BUILDING DIVISION
200 S. ANAHEIM <lLVD.
. (!14) 765, 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: ' 434
QUARTER SECTION: 45
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: CAL,
Policy Number.' 9101121'
Canstrucioli TYPias:
VN; "
Date: 1/12/2004 Applica " . .
WARNING: FAILURE TO SECU ORKER'S C SATION COVr:~"\yE S,
UNLAWFUL, Arlm SHALL SUB CT AN-EMPLOYER T RIMINAL PE~JAc'f.lcS AND CIV)!: .
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,OOQ),IN ALlt..iJoNT9THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR iN SECTlq:37Q6 6FTHE'
LABORCODE,INTERE,ST AND ATTORNEY'S FEES. '.
'I CONSTRUCTION LENDING AGENCYj .
I hereby affirm IJnd_et_pen,altyof p~rj~ry that there is a co'nstructiqnJJ>-:~:i!l-'L~,l~.zrl~V i0r.the~__-.:.__'__~~",_,,~_-,-__
perrormance ofthe work 'for which this permitis iSS!Jed(Sec.~:l97 .Civ.C): ' " .
Lender's Information: .
state that the above information is correct. I
state laws relating to bu Uding cOllStruction, and'
o enter upon the' ve mentioned property for
EXPIRATION DATE
1/31/2005
C39
HIC
te:_1/12/2004
153.10
Signature of nt or Agent
, The permit shall expire by limitation and bec<ll1l9 null andvoid if the building or
w()fk has ncrt passed final inspection 365 days frCllll the date Of pern.t issuance. A
new permit is required to COmme!ICe or continue work.
Fees paid for Permit:
Total:
INSPECTION RECORD
. INSPECTION . .. DATE INSPECTOR
o.
Templ)rary POVier Pole . , .
Plumbing (DrainlWaste Pipe) , . .
Electrlcal.Ground Electrode/Ufer . . .
SetbacklFormsrrrenches (Footings) .
Do not install subfloor or pourfloor slab .unti I the
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (GroundwOrk) . .
Electrical (Vnderground Conduit).
Pre,slab (Compaction/Membrane.Reinf.
Underpinning (Floor Joist/Girders)
Do. not <:over or conceallhe work below until the .. .
following.applicable items have been signed:
1 st Floor Shear . .
Firesprinkler (Rough) . ..
2nd Floor Shear 0 .
Roof (Sheathing/Diaphragm/Frame) i '/410;' '/ =
Masonry (ReinfJBond EieamlPre-Grout) . .
Rough Plumbing (Top Out) .. ..
Rough Mechanical
Rough Electrical (Dry Wall) . . .
.Rough Electrical .. . .
Framing (Only after Plbg" Elec.. t..-lech.. and Fire)
Insulation (SoundlEnergy) .0 .
po no\, tape or plaster until the following applicable
It~ms .~ve_been signed: . , -
Drywall .
Penetrations (Fire Rated) ElectriCal . : .
Penetrations (Fire Rated) Me.chanical
Penetrations (Fire Rated) Plumbing :
Interior Lath . : . . .
Exterior Lath
. . GENERAL ITEMS
Exterior Plaster (Brown Coal)
T -Bar Electriear . .. . . .
T -Bar Mechanical .
T -Bar. Structural
Sewer . . . .
Water Engineering Backflow . . .
Water Service. .
FINAL INSPECTIONS.
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final. 765-6126
Fire Dept. Final 7654040
Water Engineering 765-5268
Sub List/Bus.iness License 765-519
Zoning 765-5139
Building Final (Last Inspection. Only / > .~^ ,A
After Above Complete) ,- ou v
PARTIAL INSPECTIONS
Buildina Inspections
Date
Inspector
Mechanicallnsoections
Plumbinalnsoections
Electricallnsoections