556 Silverado Way
TYPE OF PERMIT
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 180
BUILDING PERMIT NO. BLD2005-02614
DATE: 8/22/2005
JOB ADDRESS: 556 S SILVERADO WAY
LEGAL DESCRIPTION: N TR 7567 LOT 4
APPLICANT: SCOTT JOHNSON
OWNER INFORMATION:
PAUL MAJOS
5241 E SANTA ANA CANYON RD
ANAHEIM, CA 92807
CONTRACTOR INFORMATION:
WESTERN ROOFING SYSTEMS
2031 E CERRITOS AVE #7E
ANAHEIM, CA 92806-0000
BUSINESS PHONE: 7141778.6294
JOB DESCRIPTION:Tear off existing roof and replace with 20 squares of metro metal shingles ICBO# 5626.
VALUATION: 4,000.00 PROCESSED BY: MSM
ARCHITECT/ENGINEER INFORMATION:
OWNER-BUILDER DECLARATION
I hereby affirm under penalty 0 perjury that I am exempt from the Contractor's License Law for the allowing 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 fire a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 01 Division 3 of the Business and Professio~s 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 penaftyof 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 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 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).
o 'am exempt under Sec. , B & 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,
~s rovided for by Section 3700 of the Labor Code, for the pertormance of the work for which
th permit is issued.
I have and will maintain worker's compensation insurance, as required by Section 37000f
e Labor Code, for the performance of the work for which this permit is issued. Myworker's
ompensation insurance carrier and policy are:
Carrier: STATE FUND Policy Number. 1579948-2003
This section need not be completed if the pennit is for one hundred dollars ($100) or 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 compensation laws
of California, and agree that if I should becom s ~ect to the worker's compensation
provisions of section 3700 of the Labo Cod sh 0 hwith comply with those provisions.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provision of chapter 9 (commencing
with Section 7000) of io 3 of he Business and
Professions e.
8122/2009
Date:
Contractor
NUMBER
675902
TYPE
EXPIRATION DATE
8/31/2005
C39
Dale: 8122/2005 Applicant:
WARNiNG: FAILURE TO SECUR ORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJE AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED CUSANO DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, MAGES 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 agency for the
performance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
Construcion Tvpes:
VN, ,
Fire Sprinklered?
NO
,
, .' _. .' .i~-_.. __,>""::-_-'___2.';"'''--''''''
I certifythall have reaJ this: appiication and state that the above information rscorrects~:--- ,-
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.
- .:'.<<'"
$"}-"
Date: 8/22/2005
Fees paid for Permit:
Total:
170.20
Signatu of Applicant or Agent
The mit shall expire by limitation and become null and void if the building or
work has not passed Ii nal inspection 365 days Irom the date 01 permit issuMCe. A
new Dermit is reQuired to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
Setback/Forms/Trenches (Footings)
Do not install sUl!floor 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
fC1110wing applicable items have been signed:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear Ii
Roof (Sheathing/Diaphragm/Frame) I fJlds:5 J .....lJOwSk.1
Masonry (Reinf./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)
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
I"~
FINAL INSPECTIONS DATE
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 (Lastlnspectlcn. Only
After Above Complete
INSPECTOR
Building Inspections
Mechanical Inspections
Plumbing Inspections
Electrical Inspections