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1221 N. Walden Ln. TYPE OF PERMIT Residential Remodel CITY DATE: 6/2/2005 JOB ADDRESS: 1221 N WALDEN LN LEGAL DESCRIPTION: N TR 7666 LOT 44 ElM BUILDING DIVISION 200 S. ANAHEIM BLVD. . (714) 765 - 51'53 . INSPECTION REOUESTLINE: (714) 785: 4626 CENSUS CODE: 437 QUARTER SECTION: 195 BUILDING PERMIT NO. BLD2005'll1652 . CONTRACTOR INFORMATION: SKYLIGHTS PLUS 5732 ALFRED AVE WESTMINSTER, CA 926830000 BUSINESS PHONE: 714381-5055 JOB DESCR1PTIOW Install (2) 2'x4' skylights, no rafler cuts VALUATION: 1,700.00 APPLICANT: JEFFERY CYRIL OWNER INFORMATION: Wing K Tse 1221 N Walden Ln Anaheim, CA 92807 ARCHITECT/ENGINEER INFORMATION: PROCESSED BY: ENO OWNER'BUILDER DECLARATION I hereby affirm under penalty of perjury hat I am exempt from the Contractor's icense Law for the followIng reason (Sec. 7031.5 Business~and Profe$siOns Code: any city or countywhich-requirBs a permit to. construct, arb:.)r, improve, demolish or repair any structure,pdor to its issuance, also requires the applican't for such .permitto: file a signed statement that he is licensed pursuant to the'provi~ions of the Contractor's License Law (Chapter 9)(commencing With Section 7000 of pi vision 30t the Business and Professions Code) 9r that he!s 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 ~~ . -' o I,.as owner of-property, army employees with wages as.t~eir sole compensation, will do the worK and the structure is not intended.or offered for sale (Sec. 7044 Bus'jness and Professions Code: The Contractor's Ucense Law does not apply to an ownet of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are.not jntended or offered for sale. If, however, the building or improvement is sold with one year of completion, the owner-builder will have the burdenof.proying that he' did not build or improve for the pU\pose of sale). . . ' o I, as the owne( of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Su'siness and Professions Code: The Contractor's License Law does not apply to an owner of property who buil.ds or improves thereon, and who contracts for suCh projects with fJJ(on.tractor(s) licensed pursuant to the Contractor's Ucense Law). U I am exempt under Sec'. ; B & P .C. for this reason: Date: OWner: I WORKER'S COMPENSATION DECLARATION I !"tereby affirm under penalty of perjury one of the following'decla'rations: o I have and will maintain a certificate of consent to self-insure for worker's.compeTisation, as provided for by'Section 3700 of the Labor Code. for the performance of th.ework for which this permit_ is issued. ~ve and will maint?in worker's compensation insurance, as required by Section 3700 qf the-Labor Code, for the performance of the work for which-"this permit is issued. Myworker's Compensation insurance carrier and policy are: Carrier: STATE FUND LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9 (c mencing with Section 7000) of \-sio 3 f t B sl ess and . Professions Code. 6/212005 Date: Policy Number. 1715105 NUMBER 740408 TYPE TYPE EXPIRATION DATE 113112007 Th~s section need not be compJete~ if the pennit is for one hundred dollars ($100) or _less. ' o I certify that in the pertonTI_anee of the work for which this permit .isissued, I shall not employ.any person in any manner so as to become subject to the orker's compensation laws of Califomia. and agree that if I should become sub'eet to the WQ r's compensation provisions of Section 3700 of th.e Labor ~ode sh I f hwi e ly with those provisions. Date: 6/212005 ' Applicant: c:--- WARNING: FAILURE TO SECURE WORKER EN' TION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPl 0 C IMINAL PENALTIES AND CIVIL FINES UPTO ONE HUNDRED THOUSAND DOLLARS.($100,OOO), IN ADDITION 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 affirmundEH pen~lty of perjury that there is a construction lending age>ncyfor the performaniZe of the work for which this permit is issued (Sec. 3097.Civ;C): Lende~'s Information: B C27 Construe ion Types: VN, ,. I certify' that I have read this application and state that the above information isco'rrect. I agree to comply wit~ aU city 'ordinances and state laws relating ,to building construction, and herebyautho e r-ep tiv of' s city to enter upon the above mentioned projJerty for inspection pu s. Date: 6/2/2005 fees paid for Permit: Total: 160.71 Ii ant or Agent . e permit s e i by I itationand 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 r",quired to commence or continue work. INSPECTION RECORD INSPECTION DATE INSPECTOR , Temporary Power Pole Plumbing (DrainlWasle Pipe) , EJeciricaJ Ground Electrode/lifer , SetbacklFormsfTrenches (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 (Undergro\lnd Conduit) , Pre-slab (CompactionlMernbrane.Reinf.) Underpinning (R6or Joist/Girders) , ,fJ? not cover or conceal the wor!<: below until the I , following applicable items have been signed: 1 st Floor Shear' , Firesprinkler (Rough) 2nd Floor Sh\lar Roof (Sheathina/OiaphragmlFrane) Masonry (ReinfJBorid BeanlPre-Grout) RQughPlumbing (Top Out) : ' , , Rough Mechanical, ' , , Rougn6ecmCaI (ury Wall) , Rough Electrical" , Framing (Only after Plbg., Elec.. Me-en" and Fire) '.r~O~ '1. flt ~oM-, Insulation (SoulldlEnergy) , Do not tape or plaster until the following applicable 'items have been signed:' . . DrylYall Penetrations (Fire Rated) Electrical Penetrations (Fire Rated) Mechanical Penetrations (Rre 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 Servi"e FINAL INSPECTIONS Date , Inspector Electrical Final , , , Plumbing Final , Mechanical Final , Gas Test , Engineering/Grading Final 765-5126 Fire Dept. Rnal.765-4040 , Water Engineering765-5268 Sub List/Business License 765'519 , Zoning 765-5139 . ' , - Building Final ~ast Inspection- Only , ~\(oto( r:,/lI\~ fter Above Complete) , PARTIAL INSPECTIONS Buildina Inspections Mechanicallnsoections Plumbina Insoections , Electricallilsoections TYPE OF PERMIT CITY Retoof ElM BUILDING DIVISION . 200'S, ANAHEIM BL\iD, (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 CENSUS CODE:' 555 QUARTER SECTION: 195 BUILDING PERMIT NO. BLD2005-01348 'DATE: 5/10/2005 JOB ADDRESS: 1221 N WALDEN LN _ LEGAL DESCRIPTioN: N TR 7666 LOT 44 APPLICANT: YOlANDA HUAPAYA OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION: Wing K TSe MCCORMACK ROOFING CO 1221 N Walden Ln 4091 E LA PALMA AVE #T Anaheim, CA 92807 ANAHEiM, CA 928070000 BUSINESS PHONE: 714630-5543 JOB" DESCRIPTION: Tear off existing and reroof 20 squares with 3D-year composition shingle VALUATION: 4;900,00 PROCESSED BY: SAM OWNER.BUILDER DECLARATION I hereby affirm under penalty 0 perjury that I am exempt from the Contractor's License Law or the. allowing reason (Sec. 7031.5 usiness and .Prof~ssions'COde: any city or county which requires a permit to cOl')struct,.arter, 'improve, demolish or repair any structure, prior to ,its issuance, "also requires the-appli'cant fonsu6h permit to fite a signed statement that.he is licensed pursuant to the pro,Visionsof the ContraCtor's license law (Chapter 9)(commencing withSection-7000 of Division 3 of the Business 'and ProfessionSCode) or that he is ex~mpt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora-permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500), '. . . o I, as owner of property, or my employees wIth wages as their sole compensation, will do the work, and the-structure is not intenilE~d ~r offered for sale (Sec. 7044 Business and ~rofes$ions Code: The Confractor's License Law does r)ot apply tl? an owner 9f property who ~uilds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such ifTIProvements are not intended or offered for sale. If, however; me building or improvement is sold with one year of completion; the owner.builder will have the burden of proving that he did not buUd'or improve for the purpose of sale). , ' o I, 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 wh:> builds or improves thereon, and who contracts for such projects. with ~ontractor(s) licensed p~rsu~nt to the Co,:\fractor's license Law). . U I am exempt under See: ! B & P.C. for this reason: Date: Owner: I WORKER'S COMPENSATION DECLARATION I hereby" affirm under penalty of perjury one 01 the fo"o~ing declarations: . o 1 have and will maintain a certificate of consent to self-insure for work~r'scrimpensation,. as provided for by Section 3700 of the Labor Code, for the performance of the wol1< for which' this permit is issued. '. . '. . : . ~ve and will maintain worker'~ comp~nsation insurance, as required by Skction 3700 of the Labor Code, tar the performance of the. work for which this permit is issued; . My worker~s Compensation inslj'rance carrier and policy are: Carrier: AMERICAN INTERNATIONAL GflOUP Policy Number. WC0701040200001 This section need not be completed if the penn!! is for 0110 hundred dollars ($100) Or I.... o I certify-that in t~e performance o'f the 'work for which this permit is issued, ) shaU not employ any per'~on in any manner so as to become subject to the worker's compensation laws of Callfomia, and agree that if I should be e bjed toe worker's compensation provisions of S~tjon 3700 ~f. the Leibo , I II fa h itl1 comply with these provisions. LICENSED CONTRACTORS DECLARATION I hereby affirm u . er penalty of perjury at I am licensed under provisJ ns of chapter 9 (commencing with Section 7000) of b,sion of t e . siness and Professions C NUMBER 643700 TYPE EXPIRATION DATE 6130/2006 511012005 Date: Date: 5/1 012005 Applicant:. WARNING: FAILURE TO SECUR ' WO UNLAWFUL, AND SHALL SUBJEC . AN MPLOYER TO CRiM L P FINESUPTO ONE HUNDRED THO SA o DOLLAR8 ($100,000), IN COST OF COMPENSATION, DAMAG AS PROVIDED FOR IN 8 LABOR bODE, INTEREST AND ATTORNEY'S FEES, . CONSTRUCTION LENDING AGENCY . I hereby. affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (S-ec.3097 .Civ.C): Lender's Information: . Construcion Tvpes: VN, , ERAGE 18 ALTIES AND CIVIL DITlON TO THE ION 3706 OF THE I certify that I have'rea~ this application and state that the above information is correct. I agree to comply with all city ordinances and 'state laws relating to"buUding construction, and hereb au orize r prese ives of this' city to enter upon the above mentioned property for i. ion rpo Date: 5/10/2005 Fees paid for Permit: Total: 160.61 Signature of Ap ; n qr ent It shall expire by Iim r n a become null and void if the building or work s not passed final inspec on 5 days from the date of permit issuance. A riew permit is required to commenc or continue work. INSPECTION RECORD . INSPECTION .' . . . . DATE .' INSPECTOR Temporary Power Pole . . . !"lumbing (DrainIWaste Pipe) Electrical Ground Electrode/Uter . SetbacklFormslTrenches (Footings) '. 00 not install subfloor or pour .floor slab until the. following applicable items have been signed: Plumbing (Water Plpe.Spri"kler Valves) '. Mechanical (Groundwork) . . Eledrical.(Underground Conduit) . Pre-slab (compac~lonIMembrane"Reinf. . . . Underpinning (Floor Joist/Gilders) '. I Do not cover or conceal the work below. until the , following applicable items have been signed: 1st Floor Shear . . . . Firesprinkler (Rough) 2ndF . . Ro6f (She "aphragmfFramel (fl1l0( 1. ( Masonry (ReinfJBond BeamJPre-GlOlIt) . . '- Rough Plumbing (Top Out) . . . '. Rough Mechanical . . i KD\l!Jn t:IectrlCat ILJI'Y waul Rough Electrical .' . Framing IOn~ after Plbg..Elec.. Mech.. and Fire; .' . Insulation (SoundlEnergy) . po nottape or pla~ter until the follOWing applicable lterns: 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 Electrtcal T ~Bar .Mechan.ical . . . T -Bar Structural . Sewer Water Engineering Backflow . . Water Service '. . FINAL INSPECTIONS . Date . Inspector Electrical Final . . . . Plumbing Final . .. ; . '. Mechanical Final . . Gas Test . . ...... Engineerlng/Gradill9 Final 765-5126 Fire Dept. Final 76.5-4040 '. . Water Engineering 765.5268 . ' . Sub List/Busl"es" License 765.519 . . ; . Zoning 765.5139 . Building Final ~astlnspection' Only VJ!IO(O< -r~~f~ fter Above Completel PARTIAL INSPECTIONS. . Buildin~ Inspections Mechanicallnsoections . PlumbinQ Inspections Electrical Inspections "