124 W. Simmons Ave.
BUILDING PERMIT NO. BLD200S;01621
~~~O~?F PERMIT CITY
DATE: 513112005
JOB ADDRESS: 124 W SIMMONS AVE.
LEGAL DESCRIPTION: . N TR 6184 LOT 6
APPLICANT: ROB TAYLOR
OWNER INFORMATION:
Helen Rawhouser
'124 W Simmons Ave
Anaheim;. CA 92802
CONTRACTOR INFORMAtiON:
TA YLOR ROOFING
8602 LOW MEAD DR
HUNTI NGTON BEACH; CA 926460000
BUSINESS PHONE:. 714 964'8131 .
J<?S'DESCRIPTION:Tear off existing roof and replace with 16,squaresof 50 Y,ear composition shingles.
BUILDING DIVISION
200 S. ANAHEIM BLVD..
(714) 765.5153
INSPECTION REQUEST LINE:
(714) 76.5..4626
CENSUS CODE: 555.
QUARTER SECTION: 89
d-~
ARCHITECT/ENGINEER INFORMATION:
VALUATION:
6,400.00
PROCESSED BY: MSM
OWNER-BUILDER. DECLARATION
I ,here ya irm under penalty 0 perjury that I am exempt from the Contractor's.~cense,Law for the to Iqwing reason ( ee, 7031.5 BusJness .and
Professions Gode: a'ny city or county which require~a permit to construct, aner.~ improve, demolish or repair any structure, prior to its_ issuance, also
requires the applicant for such permit to file a signed statement thafhe is licerlsed pursuant to the provisions of the Contractor's License Law (Chapter
9)(cornmencing with Section 7000 of Division 3 of the Business and Professio6s Code) or that he is exempt thelefrom and the basis for the alleged.
exemption. . Any violation of Section 7031.5 by any applicant for a permit subj&:ts the applicant to a civil penalty of not more, than five hundred dollars
($500).
O' I, as owner of property', or my employees with wa'ges as'their sole compehsation, will do the wor'k, alld the structure is not ilitended or offered for
sale (Sec. 7044 Business and Professions Oode: The Contractor's license La~ does not apply to an owner or property who b.ui/ds or improves
thereon, 'and who does such work himself or h~rself 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 wifl hfwe .the burden of, proving that he
did not bLlild or improve for thepuiPOse of sale). ' ,: , '
o I, as the owner of the pr9P:erty, am exclusively contracting with Ilcensed cOntractors to construct the proJect (Sec. 7044 Business and~rofessions
COde: The Contractor's License Law does not apply to an owner.of property who builds or improves thereon, and who contracts for s,uch projects_with
a contractor(s) licensed pursuant tathe Contractor's,Ucense Law).
o 'am exempt under See, , B & P.C. for this reason:'
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm underpemaltY of perjury one of the following_ declarations-:
o I have and will 'maintain' a certiiicateof consent to setf":insure for worker'shompensati6n,
as provided for by -Section 3~OO of the Labor Code,' for the performance of the'\vork for which
~hi permit is issued. ,. ' . ::'. '.
f have and wil\maint~in work,er's comp'ensation insurance, as required by Section 3700 of 5/31/200
. Laqor Code,. for the performance of the. work for which this permit is issued: Myworker's Date:
\Compensation inSurance carrier and policy are: ' , }
Carrier: NO EMPLOYEES . Policy Number. EXEMPT, ...
I
LICENSED CONTRACTORS DECI..AFlATION
I hereby affirm under penalty of perjury that I am
licensed. under provisions o/lchapter 9 (commenc,ing
with Sect~n 7000) of i fcln '3 of th~ne and
Professions ode, <f' .
. .
. .
~I section need nolbe completed if the pennit is for one .hundred dollars ($1 00) Or less.
I certify that in the penormance of the work for whlch this permit is issued; J 'shall not
mploy any person in any manner so as to become supject to the worker's co~pensation laws
fCalifomia, and agree that if I should, become ject tq-the work's compensation
prqviSions of ~tion 3700 of the Labor Co " ~lIfo~m Iv Wi~h those prov,isiOnS.
Date: 513112005. Applicant:
WARNING: FAILURE TO SECURE
UNLAWFUL, AND SHALL 8UBJE AN EMPLOYER TO CRI INAL PENALTIES AND ClVlL
FINES UPTOONE HUNDRED OUSAND DOLLARS ($100,000), IN AODITION TO THE
COST OF COMPENSATION,. DA .AGES 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 p'~mit ,is issued (Sec.309? .Civ.C): '
Lender's Information:
NUMBER,
784622
TYPE
TYPE
EXPIRATION OAT
9/30/2006
C39
Hie
ConstruCion Types:
VN"
Fire Sprinklered?
NO
I certify that I have read this application and state that the abOVe information is correct. I
agree to.comply with allcity ordinances and state laws relating to bu>>ding construction; and
~~reby ,alJthoriz.e rap 'ntive~ c' to enter 1.:ipon the above mentioned property for
I nsp Ion purpo C f _-.
Date: 5/31/2005
Signature of Applica or Age,nt
The permit shall el(pire bilimita on and become null andvoid if the building or
work has not passed final insp tion365 days from the date of permit issuMCe. A
new permins required to commence or continue work. .
Fees paid for Permit:
Total:
160.75
INSPECTION RECORD
.INSPECTION' ,
, DATE INSPECTOR
T,emporary Power Pole, ,
Plumbing (DrainIWaste pipe)
Electrical Ground Electrode/uter ,
SetbacklFormslTrenches (Footings)
Do not install subflOOr or pour floor slab until the
following applicable Items have been signed: '
Plumbing (Water Plpe.Sprinkler Valves) ,
Mechanical (Groundwork)
Electrical (Underground Conduit) , ,
Pre-slab (CompactionlMembrane.Reinf. ,
Underpinning (Floor Joist/Girders)
Do not cover or conceal,the wor:k be,low until the
fOllowing applicable items have been signed:
1st FloorShear ' " ,
Firesprinkler (Rough) " I
2nf~~ ", " , / I '/] / .# '"
Ro athl Diaphragm/Frane) '::iltljb ".
Mas JBond BeamlPre-Grout)
RoughPlumbing (Top Out)
ROUgh Mechanical ", ",
: KOugn l:IectrlCaJl&.lr"Y ......,
Rough Electrical, ' ,
, Framing (Only after Plbg.. Elec.. tJ,ech. and Fire)
Insulation (SoundlEnergy)
!>o not tape or pla~ter until ,the following applicable '
.tems have been SIgned:
Drywall ' " :
Penetrations (Fire Rated) Electrical ,
Penetrations (Fire Rated) Mechanical
Penetrations (File Rated) P1ultlbing , ,
Interior Lath ' , , " "
Exterior lath " ,
GENERAL ITEMS ,
Exterior Ptaster (Brown COli\l) , '
T.Bar Electrical " ,
T-Bar Mechanical , ,
T -Bar Structural
Sewer " , ,
Water Engineering Backtlow,
Water Service "
-,
FINAL INSPECTIONS Date ' Inspector
Electrical Final, , ' ,
Plumbing Final ,
, ,
Mechanical Final , "
Gas Test . ,
Engineering/Grading Final 765.s126 " : "
, ' ,
Fire Dept Fin,at 765-4040 . ' .
Wate, Engineering 765-5268 , " ,
,
Sub List/Business License 765-519 ,
Zoning 765-5139 ,
.
Building' Final Itasllnspection- Only' ~/b~ ./ " L ./),. -
, flet Above Complete) ,
T I -V -,-
PAR IAL INSPECT ONS
Buildina Insoections
Mechanical'lnsoections
, PlumbinQ Insoections
Electrical Inspections