221 N. Shakespeare
BUILDING PERMIT NO. BLD2005.03677
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CITY QF~J1:NAHEIM
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TYPE OF PERMIT
Reroof
DATE: 11/17/2005
JOB ADDRESS, 221 N SHAKESPEARE ST
LEGAL DESCRIPTION: N TR 2767 LOT 61
APPLICANT: DUKE HANSEN
OWNER INFORMATION:
ELIZABETH G REBICH
221 N SHAKESPEARE ST
ANAHEIM, CA 92806
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 122
ARCHITECT/ENGINEER INFORMATION:
CONTRACTOR INFORMATION:
ROSS & BARROWS INC
260 E ALTON ST
SANTA ANA, CA 927070001)
BUSINESS PHONE: 714 557 '7440
JOB DESCRIPTION:Tear off existing roof and replace with 30 squares of 50 year composition shingles ICBO# 5443.
VALUATION: 8,326.00 PROCESSED BY: MSM
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 permi!: to construct, alte"', 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)(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 fjve hundred donars
($500).
o l, as owner of property, or my employees with wages as their soJe compensation, 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 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).
o I, as the owner of the property, am exclusively contracting with licensed Clmtractors 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 to the Contractor's License Law).
U I am exempt under Sec. ,8 & P.C. for this reason: _
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certificate of consent to self~insure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
~th' permit is issued. '
I have and will maintain worker's compensation insurance, as required by Section 3700 of
he Labor Code, for the performance of the work for which this permit is issued,": Myworker's
ompensation insurance carrier and policy are: (
Carrier: STATE COMP Policy Number. 046-02 UNiT 0010815
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000 'ygion 3 of the Business and
Professions C e..
11/17/200.
Date:
This section need not be completed if the pennit is for one hundred dollars ($1 00) ~w less.
o 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 worker's cO'1lpensation laws
of Califomia, and agree that if I should becom subject to the worker's compel1sation
provisions of Section 3700 of the La e, I all forthwith mply with thov>e provisions.
NUMBER
327802
TYPE
Construcion Tvpes:
VN. ,
Fire Sprinklered?
Date: 11/17/2005 Applicant:
WARNING: FAILURE TO SECUR WORKER'S COM ENSATIO COVERAGE IS
UNLAWFUL, AND SHALL SUBJ. CT AN EMPLOYER TO CRIMINAL PENAL1IES AND CIVIL
FiNES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDll10N TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 4106 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 agency for the
perfor~ance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
I certify that I have read 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 tho' resentives of this city to enter upon the above mentioned property for
i eet' urposes.
Date: 11/17/2005
81 ature of Appliea 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 issuance. A
new Dermit is reauired to commence or continue work.
EXPIRATiON DATE
10/31/2006
C39
NO
Fees paid for Permit:
Total:
245.20
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormsrrrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valvesl
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:
1st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear /
Roof (Sheathing/Diaphragm/Frame) VII.lp.-& y~
Masonry (Reinf./Bond Beam/Pre-Grout) II
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele'l Mac. 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
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 11'tt ~I(J{ '-i\\. \ tilL
After Above Complete)
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections
Plumbina Inspections
Electrical Inspections