644 S. Webster Ave.
VALUATION: 16,000.00
I OWNER-BUILDER IlECLARATION
I hereby affirm under penalty of perjury that J am exempt from the Contractor's License Law for the allowing reason (Sec. 7031.5 Business an
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 appticant for such permit to me 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).
o I, as owner of property, or my employees with wages as their sole compe1lsation, 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 hel5elf 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 build or improve for the purpose of sale).
o I, as the owner of the property, am exclusively contracting with licensed Ctmtractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of property\o\'ho builds or improves thereon, and who contracts for such projects with
,a.Qontractor(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 hereby affirm under penalty of pe~ury one of the following declarations:
o I have and will maintain a certificate of consentto self-Insure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the pertormance of the work for which
this permit is. issued.
VII have and will maintain worker's compensation insurance. as required by Section 3700 of
'iFi'e Labor Code, for the performance of the work for which this permit is issueo. Myworker's
Compensation insurance carrier and policy are:
Carrier: MAINSTAY CAPTiVE COMPANY P cy Number MBS06010301
This section need not be completed if the pennit is for ne hundred dollars ($100) or less.
o I certify that In the perforrmince of the work fa hich this permit is issued, I shall not
employ any person in any manner so as to b. om ubject to the worker's compensation laws
of Califomia, and agree that if I should bee e j ct to the worker's compensation
provisions of Section 3700 of the Labor C e, I II forthwith comply with those provisions.
Date: 12/6/2005 Applicant: r
WARNING: FAILURE TO SECURE W R R'S COMPENSATION COVERAGE is
UNLAWFUL, AND SHALL SUBJECT N EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED 11-\0 SAND DOLLARS ($100,000), IN ADDIllON 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 perjy'ry 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 iniorrnati'on
. .
BUILDING PERMIT NO. ~BLD2005.03872
TYPE OF PERMIT CITY
Reroof
DATE: 12/612005
JOB ADDRESS: 644 S WEBSTER AVE
LEGAL DESCRIPTION: TR 796 LOT 17 ALL .EX W 30 FT.
APPLICANT: ROBI N LEWIS
OWNER INFORMATION:
TRUST HOSKINS
4402 BEULAH DR
LA CANADA, CA 91011
CONTRACTOR INFORMATION:
LEWIS & SONS CONSTRUCTiON iNC
310 S MAPLE ST #E
CORONA, CA 928820000
BUSINESS PHONE: 909273.0901
JOB DESCRIPTION:Tear off existing and reroof 60 squares with BUR
read this application and state that the above information is correct. I
lh an city ordinances and state laws relating to bu~ding construction, and
presentives of this city to enter upon the above mentioned property for
s.
Date: 121612005
Signature of Applicant or Agent
mil shall expire by limitation and become null and void'if the building or
wor has not passed final inspection 365 days from the date of permit issuance. A
new Dermit is reauired to commence or continue work.
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765 - 5153
INSPECTION REQUEST LINE:
(714) 765.4626
CENSUS CODE: 555
QUARTER SECTION: 28
ARCHITECTIENGINEER INFORMATION:
PROCESSED BY: JNJ
1216/2005
Date:
LICENSED CONTRAC
I hereby affirm under e
licensed under pro. n of
with Section 7000) 0"
Professions Cod
DECLARATION
Ity of perjury fhat I am
hapter 9 (commencing
of the Business and
NUMBER
416525
TYPE
TYPE
EXPIRATiON DATE
413012006
B
C39
Construcion Types:
VN, ,
----"*
Fees paid for Permit:
Total:
397.58
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipel
Electrical Ground Electrode/Ufer
SetbacklForrnslTrenches (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 (Compaction/Membrane Reinf.l
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
Roof (Sheathing/Diaphragm/Frame) -
1J /., /
Masonry (Relnf./Bond Beam/Pre-Grout) I
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
Insulation (Sound/Energy)
00 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
Cross Connection Control (714)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
Building Final (Last Inspection - Only I "1."-' (D~ -'9-~
After Above Complete)
PARTIAL INSPECTIONS
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Mechanical Inspections
Plumbina Inspections
Electrical Inspections