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1290 N. Willet Cir. BUILDING PERMIT NO. BLD2005-02155 TYPE OF PERMIT CITY Reroof DATE: 7/12/2005 JOB ADDRESS: 1290 N WILLET CIR LEGAL DESCRIPTION: N TR 7417 LOT 13 ElM BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 CENSUS CODE: 555 QUARTER SECTION: 200 APPLICANT: MI KE KLEI N OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION: THOMAS KDENNIS BILTWELL ROOF & MATERIAL CO 1290 N WILLET CIR 3310 VERDUGO RD ANAHEIM, CA 92807 LOS ANGELES, CA 900650)00 BUSINESS PHONE: 818986-4411 JOB DE,SCRIPTI9N:Tear off ~xisting and reroof 15 squares with 30-year composition shingles VALUATION: 5,100.00 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 cQuntywhich requires a permit to construct, altel~ improve, demolish or repair any structure, prior to its issuance, also requires the appUcant for such permit to file a signed statement that he is licenood pursuant to the provisions of the Contractor's license Law (Chapter 9)(commencing with Section 7000 of Division 3 of the Business and ProfessfonsCode) 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). D I, 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 Ucense La.N 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 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). D 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 a contractor(s) licensed pursuant to the Contractor's License Law). D I am exempt under Sec. , B & P.C. for this reason: Date: Owner: I PROCESSED BY: JNJ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: D I have and will maintain a certificate of consent to self~insure far warker'scampensatian, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ~ 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: STATE FUND. Policy Number: 46-11751-02 This section need not be completed if the pennlt is for one hundred dollars ($100) or less. D I 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 worke~s compensation laws of California, and agree that if I should b orne subject to the worker's compensation provisions of Section 3700 of lhe Labor e, I sh forthwit mply with those provisions. Dale: 7/12/2005 Applicant: WARNING: FAILURE TO SECURE WORKER'S COMPENSA TlON COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), 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 affirm under penalty of perjury that there is a construction lending agen-cyfor the performance of the work for whidl this permit is issued (Sec. 3097 .Civ .C): Lender's Information: I certify that I have react 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 a horize representives of this city to enter upon the above mentioned property for insp "purpo Date: 7/12/2005 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 permit is required to commence or continue work. LICENSED CONTRACTORS DECLARATION I hereby a irm under penalty of perjury that I am licensed under provisions of chapter 9 (commencing with Section 7000 of Divsion 3 of the Business and Professions Cod 7/12/2005 Date: NUMBER 458005 TYPE TYPE TYPE Contractor EXPIRATION DATE 6/30/2006 B C10 C20 HT AC Construcion Types: VN, , Fees paid for Permit: Total: 160.62 City of Anaheim Building Division INSPECTION RECORD INSPECTION DATE INSPECTOR Temporary Power Pole Plumbing (Drain/Waste 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 (SheathinglDiaphragm/Frame) I !>/!/d ,/\7 . If,,,. Masonry (ReinfJBond Beam/Pre-Grout) , . Rough Plumbing (Top Out) Rough Mechanical Rough Electrical (Dry Wall) Rough Electrical Framing (Only after Plbg., Ere., 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 (Last Inspection - Only 0-10-OS fM Jf...r:,r.j! After Above Complete) PARTIAL INSPECTIONS Buildina InSDections Mechanical Inspections Plumbing Inspections ElectricallnSDections