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1263 E. Willow St. TYPE OF PERMIT CITY Reroof ElM BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 CENSUS CODE: 555 QUARTER SECTION: 93 BUILDING PERMIT NO. filLD2005-02579 . DATE: 8/17/2005 JOB ADDRESS: 1263 E WILLOW ST LEGAL DESCRIPTION: N TR 1770 LOT 117 APPLICANT: JUAN MORALES OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION: JUAN MORALES 1263 E WILLOW ST ANAHEIM, CA 92805 JOB DESCAIPTION:Tear off existing and reroof 24 squares with 30 year composition shingles VALUATION: 3,500.00 I OWNER.BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Sec. 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)(commenclng 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 !iOO). I, as owner of property, or my employees with wages as their sole compe~1Sation, will do the work, and the structure is not intended or offered for ale (Sec. 7044.Business and Professions Code: The Contractor's Ucense Law does not apply to an owner 01 property who builds or improves thereon, and who does such work himself or herself or through his or her ownempfoyees, 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 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 tothe Contractor's License Law). U I am exempt under Sec. B & P.C. for thi reason; Date: -0 Owner: <2- WORKER'S C M NSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: S- 1 have and will maintain a certificate of consent to self-insure for worker's compensation, as provided 10r by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. o I 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. My worker's Compensation insurance carrier and policy are: Carrier: PROCESSED BY: JNJ LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9 (commencing with Section 7000) of Oivsion 3 of the Business and Professions Code. 8/17/2005 Date: Contractor Policy Number. NUMBER EXPIRATION DATE This section need not be completed if the pennit is for one hundred dollars ($1 00) or less. R I certify that in the performance of the work for which this permit is issued,l shall not employ any person in any manner so as to become subject to the workers compensation laws 'Of California, and agree that jf 1 should become subject to the worker's compensation provisions of Section 3700 of the Labor Code, I shall10rthwith comply with those provisions. Date: 8117/2005 Applicant'1<=> a. I WARNING: FAILURE TO SECURE W RKER'S COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINESUPTO 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 I hereby affirm unde r penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (See.3097 .Civ .(:): Lender's Information: TYPE Construcion Types: VN, , I certify that I have read this application and state that the above information is correct. , 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 inspection purposes. 7-:tJ;Al/\ M" V tJ. / es;< Date: 8/1712005 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 issuMCe. A new Dermit is reauired to commence or continue work. Fees paid for Permit: Total: 244.87 City of Anaheim Building Division INSPECTION RECORD INSPECTION DATE INSPECTOR Temporary Power Pole Plumbing (DrainlWaste Pipe) Electrical Ground Electrode/Ufer SetbacklForms/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 (Compaction/Membrane 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) 2nd Floor Shear I I Roof (Sheathing/Diaphragm/Frame) PI.,,/. ~ .~'."';'J/vl Masonry (ReinfJBond Beam/Pre-Grout) II f 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 ... . . c FINAL INSPECTIONS Electrical Final Plumbing Final Mechanical Final Gas Test Engineering/Grading Final 765-5126 Fire Dept. Final 765-4040 Water Engineering 765-5266 Sub List/Business License 765.5194 Zoning 765-5139 Building Final (Last Inspection - Only 6 l- Atter Above Complete) INSPECTOR DATE PARTIAL INSPECTIONS Buildin9 InSDections Mechanical Inspections Plumbing Inspections ElectricallnSDections