292 N. Wilshire Ave.
BUILDING PERMIT NO. BLD2005-03\41
TYPE OF PERMIT CITY
Reroof
DATE: 9/30/2005
JOB ADDRESS: 292 N WILSHIRE AVE
LEGAL DESCRIPTION: SEC 9 T 4 R 10 POR SE1/4 SW1/4
APPLICANT: GEORGE PRINCE
OWNER INFORMATION:
ROBERT 0 SCHAFER
1450 W BEVERLY DR
ANAHEIM, CA 92801
CONTRACTOR INFORMATION:
SERVICE ROOFING COMPANY
440 E WALNUT AVE
FULLERTON, CA 926320000
BUSINESS PHONE: 714525.4232
JOB DESCRIPTION:Tear off exisitin9 and reroof 63 squares with BUR
VALUATION: 14,000.00
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 53
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: JNJ
OWNER-BUILDER DECLARATION_
I hereby affirm under penalty of perjury that I am exempt from the on tractor's License Law for the following reason ( ec. 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 Profession$ 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 subjeds the applicant to a civil penalty of not more than five hundred dO,lIars
($500).
o \, 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 6'mployees, 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 build or improve for the purpose of sale).
o 1, 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 herebyaffinn 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 c.ompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
[j-=1 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: ACORD Policy Numbe, 046000819005
This section need not be completed if the permit is for one hundred dollars ($100) or less.
o r 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 Califomia, and agree that if I should become subject to the worke' compensation
provisions of Section 3700 of the Labor Code, I shall forthwith c with those provisions.
Date: 9/30/2005 Applicai'it:""""
WARNING: FAILURE TO SECUREWO K COMPENSATION COVERAGi=Ts-
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND 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
'hereby affirm under penalty of perjury that there is a construction lending ?2e,,~yfor the
performance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
I certify that \ 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 authorize representives of this city to enter upon the above mentioned property for
in~ection purposes.
7 Date: 9/3012005
;;0< 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.
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 sness and
Professions Code.
.~
NUMBER
131545
TYPE
TYPE
EXPIRATION DATE
1/31/2006
C39
C2
Construcion Types:
VN, ,
Fees paid for Permit:
Total:
455.49
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
Setback/Forms/Trenches (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 (CompactionlMembrane 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) A
2nd Floor Shear , ;j Wi.
Roof (Sheathing/Diaphragm/Frame) C"': "U,.
Masonry (Reinf./Bond 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 List/Business License 765-5194
Zoning 765-5139
Building Final (Lastlnspectlo" - Only /Z!€J/c [r ~-pI}J.
After Above Complete)
PARTIAL INSPECTIONS
Building Inspections
Mechanical InsDections
Plumbing Inspections
Electrical Inspections