820 S. Phlyllis Cir.
, ,
6tl1LOING pi':~rr NO,
aLD2004-03398
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CITY @~~~~Hr=IM
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BUILDING D!\; ISION
200 S. ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REQUEST LINE:'
(714) "/65 - 4626
TYPE OF PERMIT
Reroof
DATE; 9/7/2004
JOB ADDRESS: 820 S PHYLLIS CIR
CENSUS CODE: . 434
QUARTER SECTION; 124
LEGAL DESCRIPTION: N TR 7754 LOT 30
APPLICANT: JOHN SMITH
OWNER INFORMATION: CONTRACTOR INFORMATION; ARCHITECT/ENGINEER INFORMATION;
Roger Nelson JOHN SMITH ROOFING'
16285 Rocky Glen Rd 940 W. COLLINS
Perns, CA 92570 ORANGE, CA
BUSINESS PHONE; 714 2E~-GOOl
. JOB DESCRIPTIONfear off existing shake and iil.stal131 square of 30 year CC.TIPOf::Won 511ingle.
VALUATION; 6,500.00
I OWNER-BUiLDER DECLARATION
I hereby-affirm"under penalty.of perjury that I am exempt from the Gontracto::s License Law for the following reason (Sec. 7031.5 Business and
Professioni:: eod.e: any city or county which requires a permit to construct, o:ti~r. improve,' demolish or repair any stnJcture, prior to its issu3lice, also
requires the applicant for s_uch,-permit to file C:l signed statement that heis 1iei~Jsed pursuant to the provisions of the- Contractor'f; Lie-ense law (Chapter
. 9)(Commeneing with Seetio.n 7000 of Division 3 of the Business a:id Professte:ns Code) or that he is exempt therefrom and the basis for the alleged
exemptiml. AllY violaUon of Section 7031.5 by any applicant for a permit.subjects the applicant to a dvil penalty of not more' th~n five hundred doUa,s.
~~ ..
o I, as owner of property, or my employees w.ith wClges as their sole c<?mp~mation, will dc. the work. .and the structiJre is not intended or offered for
sale (Sec. 7044 Business and Professions Code;, The Contractor's License: t}l'..., does not apply to an owner of property who builds or improves
thereon,':::lnd whodoes sUch work himself or h~~elf or ttlrough hiS,or her uV{il employees, prcvidDd thCit slic.h imptovenle,...ts are no: intended or
offefed for sale. if, howev~..r, the uuilding orirnprovement is SO.ld W.ith Cll~ Yc:...'l~r":lf completion, the owner-builder 'l'ji~l heWS the burden of proving that he
did not buiJd or improve for the purpose of sale). -;, " ' "
o I. as the owner of the propert.,..;;::!r'!1 .exc:iu~lvely contract:ng '-"i.ith Iice.nse'.;!<:ontl"aclor~ to ccnstruct'the project (S~L:. 7044 Business Clnd Professions
Code: The Contractor's License Law does .not apply te. an own/?!r ef property';"ho b.uilds or improves thereon. and who contrar;ts' for suet. p,ojet:ts with
Momractor(s) li~ensed pursuant to.tt:e Contractor's Uce,n~ Law). . :\, '"
....-j ! 3m exempt under Sec. ___ ,B,& P.C..forthis rezson, ~--.J::, ~
.Date: Owner:
" WORKER'S COMPENSATION DECLARATION '.
I hereby affirinynder .penaity of perjury one of the fol;owing declaraH::ms,
D. I have and will .maintain a certificate of consen.t to self-insllrefor w('~rker:::~cOi'i1p~nsation,
as provided for by Sedion 3700 of the labor Code.. fer the. perforrn;:,nce Df i-~;~.'Nork for whic'1 I
Y1is;ermlt is issued. . ~ J,
'Kf'"1 have_and y..'ill main.tain worker's c~mpens3ticn insurance, a~'.eql.l;rec c_,,"Se:ction 3700 of'
the Labor Co~e, .for th.e performance of the work forwllich tl,is permit is issued. Myworker'S ,j
Compensation insurance carrier and polic.y are: -
Carrier: STATE FUND :>' . . Policy Number. 229-OOC(.;14607 I NUMBER EXPlRATION DATE
This.section-need !lot be completed if the'permit is for one hundred dollars ($10nj odess.. .. . ~J~~8 . C39 . 3/31/2005
o I certify that in the performance,of tt:e wq~k fpr Which this permit is .is..~ucJd, ~~$ha!! not, ~.
employ any person in any manner so as to become. subject t9 the vymke.r'~.~~).:Tip~n. sation taws . , -
of C~I~omia, and ~gree that if! should bee me sub.1 to ~~e ~r's C:;f!l~r:$~tion. . .
provlSlons of Section 3709 of the Labo; c. e, I .,1 fo w., .,.omply Wl~g:}h(:~~l?provlslons. I Construcion Tvpes:
". . / '.". '. VN
Date: -91712004. . Appii.cant: X , ~/ _ < ,- '.':-~' '.7:: Fj;e'S~rink!efed?
WARNING; FAILURE TO SECUREW KER'S COM ENSATlON COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT EMPLOYER TO CRIIv1.INAL PEN/l.LT'",S Ai'JD CIVIL
. FINES UP TO ONE H,UNDRED lHOU~AND DOLLARS ($100,000), 'iN ~,Eirrn6N, TO THE
COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTlQr-> 3706 OF THE
LABOR CODE, JNTEREST AND ATTORNEY'S FEES. . '" '.' 1:'\
i . .' CONSTRUC)'ION LENDING AGENCY' : ". 4
. I hereby affirm under penalty of perjury that there ;s. constrUGtlor11~nding,"gdnf-'Y 'or the ..
~~~?~~,a.n,;:::~ of_~~~ ~ork for which this pe~mjt;5 :ssue~ {Se~.:O~7 S~'::SL~(. f-:,'_, . '.
,-c",'"'--:("",lId_.r,-..1t"..n.;" . -
PROCESSED BY: EMA
t--~
-~._-,--
LICE..S~[) CONTRACTORS DECLARATION_J
I hereooyaffir'm under, penalty of perjury that I am
11~ens.edui1der:provisions of . apter 9 mmencing
wit~ Section 7000 0 DIVS' .... f th siness and
Proiessiors Code '
9/7/2004' )c .
Date~
Con tractor
NO
("'\.. Dat": 9/712004
ignature of Applicant or Agent
ermit shall expirll by limitation and become null and void if thE! building or .
war has not pasS<ld final inspection 365 days from thll datil of ""rmit issuancll. A
new p~mit is require~ to co~menc~ or.continue work..
F~es paid for. Permit:
; Total:
310.20
INSPECTION RECORD
.. INSPECTIO"l .. .
. .. DATE' INSPECTO~
Temporary Power Pol.e ...
Plumbing (DrainlWa~e .Pipe)
. Electrical Ground ElectrodelUfer , .. .
. SetbacklForrnsfTrenches .(Footings).
Do not install sUbfloor or pour floor slab until the
. following .applicable items have been signed: . .
Plumbing (Water Plpe.SprinklerValves)
Mechanical (Groundwork) . .
Electrical (UndergroundConcluit) . . . .... .
Pre-slab (Compaction/Membrane.Rei nf. .
Underpinning (Floor Joist/Giiders)
Do not cover or conceal the work below .untilthe
following apRlicable items have been signed:.. . .
1.st. Floor Shear.. ..
FireSprinkler (Rough) . ..
2nd Floor Shear ... . . . ",,4 /
Roof (SheathinalDiaphragrnlFrame) . fl"4-Pv ~//
Masonry (Re.in~JBoncl Beam/Pr...Gl'll\It) , . .
Rough Plumbing (Top Out) .
Rough Mechal)ical
Rough ElectriCal (Dry Wall)
Rough Elecirical
Framing {Only after Plbg,; Elec.. Mech, and Fire)
Insulation (SoundlEnergy)
Do nottape or plaster until the following applicable
items' have been signed:, . "
Drywall , .
.Penetrations (Fire Rated) ElectriCaL .
Penetralions(Fire Rated) Mechanical
Penetr.a1ions (Fire Rated) Plumbil'!!l .
Interior Lath . . .
Exterior Lath .
. GENERAL ITEMS .. .
Exterior Plaster (Brown Coat) .... .
T -Bar Electrical .
T -Bar Mechanical... " . ..
T -BarStructllral .. .
" Sewer
Water Engineering Backflow ""
Water Service " .. .
FINAL INSPECTIONS Date . Inspector
Electrical Fimil ". .
Plumbing Final .
Mechanical Final .
.
Gas Test .. ..
Engineering/Grading Final 765-5126 .
Fire .Dept. Final 765-4040
Water Engineering 765-5268 .
SubL.;st/Business License 795-519
Zoning 765-5139 I
Building Final Itast Inspection. Only . ~1~~ld( rr~.
Iter Above Complete)
PARTIAL INSPECTIONS
BUild:;JpeCtiOn~ .. _ JJ..;:. ... .. n_1! ~
C/4. ~~C#:r' . /-1).~~,g
Mechanical Inspections
Plumbina Inspections.
Electrical Inspections