2020 S. Santa Cruz St.
OWNER-BUILDER DECLARATION
here ya Irm under penalty 0 perjury t at am exempt rom t e ontractors lCense aw or teal oWing reason ee.7031.5 usiness an
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)(commencing with Section 7000 of Division 3 of the 8usinessand Professions Code) or that he is exempt therefrom and the basis for the al/eged
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).
o I, as owner of property, or my employees with wages as their sole compe~ation, will do the work, and the structure is not intended or offered for
sale (Ssc. 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 Eimployees, 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 pUlpose 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....qontractor(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
r 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 wol1<. for which
this permit is issued.
e I have and will maintain worker's compensation insurance, as required by Section 3700 oi
the Labor Code, for the performance of the work for which this permit is issued, Myworker's
Compensation insurance carrier and poliW are:
Carrier: STATE FUND poncy Number. 285-2308-3
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
o I certify that in the perfonnance 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 Califomia, and agree that if I should become subject to the worner's compensation
provisions of Section 3700 of the Labor Code I shall forthwith com with those provisions.
BUILDING PERMIT NO. BL[{~5-02110
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TYPE OF PERMIT CITY
Reroof
DATE: 7/8/2005
JOB ADDRESS: 2020 S SANTA CRUZ ST
LEGAL DESCRIPTION: P BK 125 PG 32 PAR 16
APPLICANT: DICK DUFF
OWNER INFORMATION: CONTRACTOR INFORMATION:
GARY A POWERS SOUTH COAST ROOF INC
706 E 21 ST ST 1132 BARKLEY AVE
SANTA ANA, CA 92706 ORANGE, CA 928680000
JOB DESCRIPTION:Tear off existing and reroof 70 squares with BUR
VALUATION: 13,064.00
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 108
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: JNJ
Dale: 7/812005 Applicant:
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED 1HOUSAND DOLLARS ($100,000), IN ADDI110N 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 agency for the
performance 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 authorize representives of this city to enter upon the above mentioned property for
in~r~
- Date: 7/8/2005
,..- 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 issuance. A
new permit is reQUired to commence or continue work.
71812005
Date:
Contractor
NUMBER
STATE FUND
TYPE C55
TYPE C39
TYPE C43
EXPIRATION DATE
t 0/3112006
Construcion Tvpes:
V N, ,
Fees paid for Permit:
Total:
429.70
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
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 (Underground Conduit)
Pre-slab (CompactionlMembrane 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 <",' . /
Roof (Sheathing/Diaphragm/Frame) 'C_'/f).A<',A;,{';',I, .~
Masonry (Reinf./Bond Beam/Pre-Grout)
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
\
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 f1'/~ 01) fl.. f~d)
After Above Complete)
PARTIAL INSPECTIONS
Building Insoections
Mechanical Inspections
Plumbing Inspections
Electrical Inspections