532 S. Westgate Dr.
TYPE OF PERMIT CITY
Reroof
. BUILDING DIVISION
.200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434.
QUARTER SECTION: 134.
BUILDING ?ERMIT NO, BLD2004-01778
DATE: 5/1 7/2004
JOB ADDRESS: 532 S WESTGATEDR
LEGAL DESCRIPTION: N TR 4182 LOT 11
CONTRACTOR INFORMI'TION:
AMERICAN ROOFING COMPANY
1234 E LINCOLN AVE
ANAHEIM, CA 92805-0000
BUSINESS PHONE: 714 530-4311
JOB DE.SCRIPTIONJear off and re.rool 5sq flar rool (base ply plus cap) Gara;].. (HIH)
VALUATION: 750.00 . ....
I . OWNER-BUILDER)JECLARATION
I, hereby affirm under penalty of perjury that-I am exempt from-the Contractors l;.icense.-Law for the following reason {Sec. 7031.5 Business and
Profession's Code: any city,6': cauptywhich requires a permit to construct, alter,'"improve, demolish or repair any structure; prior to itsissuance,._also
requires the applicant for such permit to file. a signed statement that he is licE,lsed pursuant to the provisions of the Contractor's, License Law (Chapter
9)(c;:ommencing.witl:l Section 7000-of Division '3 of the Business and Professi~n's,Code) or that he is exempUherefrom and the basis, for,the alleged
exemption. Any violatioD of Sec;tlon 7031.5 by any applicant for a permit subi~cts the applicant 'to a dv~ penalty of hot more tha n five hundred dollars
($500). ....... .. .... ........ . .
D- I, as owne,r of property, or my employe,es with wages, ,as their sole comE;:cnsation, will do the yvork,and the, ~tructure ',is not interided or. offered for
. sale (Sec~ 7044 Bus.iness_and Profess-ions-Code: The Gontractor's-Ucense L:~w does not apply to an oWDerof property who,buildsor improves
there_on, and who does: such work himself or herself or through hi$ or her own employt;!es, provided that such imprOvements are not intended or '
offered for_ S?le. If, however, the building or imp~ovement is sold with'one-yezr of Completion"the owner-builder .will haVe the burden of proving that h,e
did not build or improve for the purpose of sale). . ' , .
o 1. as the owner of the property, am exdusively Coritr?ctjng with,licensed:oontractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law dOe$ not apply ~o an ~wner of propertywho.-builds'orimproves th~reon, and who contracts for such projects with
. ~o,ntracfo~(s) licensed pursuantto the. Contractor's 'License Law).
,U I alT! exempt under. Sec.' , , B & P.C. for this reason:
Date:' Owner: .
I WORKER'S COMPENSATlONDECLARAT'ON
I hereby affirm under penalty of p,erjury one of the-falloWing,decla~ations: .
o I have and will ma intain. a certificate . of. consent to' self~insure for worker'~,: compensation,
as provided for by Section 3700 of th~ Labor Code, for the Periormance ofthaworl< for whim'
this permit.ls issued. '
. U5a f have and will m'aintainworker's compensation insurance, as,requiredbrS'ection3700 of
The't.abor Code, 'for the performance of the work for which this permit isi$Su(:~d. Myworker's
Compensatio(l insurance ,canter and policy are:
Carrier: , .. poncy Number: EXEMPT
T~is ~eeti9n 'rreed not be cOmpleted if the pennit is '~or one hundred ~oUars ($100; m- I~s.
0', certify that in the'perfonnan~eofthe work forw'hich this permit is isSuej" I ~an not
employ any person in any man.ner so as to become subj~ct to the worker's c(':rnpensation laws
afCalifomia, and ?gree that if I should become $Ubjed to the workei-'s compensatron
proviSions of Section 3700 oftl1~ Lab Code; I shall.forth comply with tt..<)s'~ provisions.
Date: 5;17/2004. Applicant: ~,r"-<---..........
WARNIN~: FAILURE TO SECURE ER'S C MP-ENSATION COVER-\GE is
UNLAWFUL, AND SHALL SUBJECT AN PLOYER TOCRIMiNALPENA!.TIES AND t::IVIL
FINES UPTOONE HUNDRED THOUSAND DOLLARS.($100,000), IN ADD'T10N. TO THE
COST OF COMPENSATION, DAMAGES'AS PROVIDED FOR IN SECTION 3706 Of THE
LABOR CODE, INTEREST ANO ATTORNEY'S FEES. .
I.. .. ..' .. · .CONSTiWCTIONLENDINGAGENCY .',_:~ . ..
~ !-.<:::r.;.b)' coft;:-l_"(....i,der p~rli::l;:tj -')f pe;~juryi.~~~lti-,~f~~ C:i Cui1StrliCI.ICOli lend llig ~~:;,3neY:Ttr the
performance of the work for which- this permit is'issued (Sec. 3097 Civ .C):
Lender's Inforl')1ation:
APPLICANT: LARRY BLEDSOE
OWNER INFORMATION:
Blanca. Bobadilla
532 S Westgate Dr
Anaheim, CA g2806
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: HRO.
I
I
LICENSEP CONTRACTORS DECLARATION
I hereby affirm under penalty of perJury that I am
licensed urider provisions. of chapter 9 (commencing
,witb Section.7000) of Divsion 3 of the Business and
:/7;hs.;~~nR.b;~. .",,~~ ;:.,.
Date: . '. ~_;;ctor
. .
NUMBER EXPI.RATION DATE
279101 513112004 .
TYPE C39
TYPE HIC
Construcion Types:
VN, ,
Fire Sprinklered? ,
NO
""..~
I certify that I have read th,is application and state that the above information!'3 correct. I
agree to comply with all city ordinances and state laws relating to.building construction, and
hereby authorize representives of this city to enter upon. the above mentioned property for
inspect' ur
,
Fees paid for Pennit:
Total:
0.50
te: 5/17/2004
i9nature of Applicant or Agent
The permit all expire by limitation and bllCome null and void if the building or
work has not passed flni!lil)Spection 365 days from the date of permit issuance. A
new permit is required to commence or.continue work. . .
INSPECTION RECORD'
Inspector'
, , INSPECTlQN,'
Temporary, Power Pole , ' , '
Plumbing (Di'ainlWaste Pipe)
, ElectrIcal Ground Electrode/lifer
SetbacklFlirms/Trenche$ (Footings)
" Do not install subfloor or pour floor slab unti I the
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler yalves)
MllChanicas (Groundwork) " , ,', ,
Electrical (Underground Conduit)
Pre...lab (Compaction/Membrane.Reinf. "
Underpinning (Floor JoisllGirclers) , '
Do not ,cOver or conceal the work below until the
following applicable.items have been signed:
1st Floor Shear ' ' ,'. , '
Firesprinkler (Rough),' ,
2nd Floor Shear ' " ' If
Roof (SheathinalDiaphragrrilFrame)t::'.". :lX-ve, U I D,
Masonry (ReinfJBond l3eamJl>re-Gro(it) ,
Rough Plumbing (Top Out) " '
Rough Mechanical . '
Rougn l:IectricallDry wall). "
RQugh Electrical '
Framing {Only afrerPIbg~.Elec..- f.'1ecl)..and.Fire;'
Insul"lon (SoundlJ;nergy) , '
Do ,not tape 'or plaster until the following applicable
items h",ve been signed: . " ,,' ,
. Drywall' " ',.:",
P4lIIetratiorls (Fire Rated) Electrical
P4lIIetrations (Fire Rated) Mechanical
P4lIIetratlonS (Fire Rated) Plumbing
Interior Lath , ' ,
EltterlorLath
: , GENERAL ITEMS'
Elcterllir Plaster (Brown Coat)" ' , ,
T .Bar Electrical'
T .Bar Mechanical', " ': "
T.Bar Structufll', "
Sewer "
Water EngineilrlngBackflow ,
Water Service,
DATE
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, INSPECTOR
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"Date
FINAL INSPECTIONS
Electrical F,il)al,
Plumbing Fi,nal '
.
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fi,re Dept. Final 765-4040
yYate,r Engineering 755-.5268
Sub List/Business License 765-519
, Zoning 765-5139 ,
Building Final'lLast Inspecti6n::Only
, ' ' ,After Above Complete) :- ~
'" , ' PARTIAL INSPECTIONS
BuildinQ Inspections
,
,
Mechanical Inspections
,
'Plumbina Inspections
Electrical.lnsDecti.ons '