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323 S. Shields TYPE OF PERMIT CITY Reroof ElM BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 CENSUS CODE: 555 QUARTER SECTION: 20 BUILDING PERMIT NO. BLD2005-02997 DATE: 9/19/2005 JOB ADDRESS: 323 S SHIELDS DR LEGAL DESCRIPTION: N TR 2755 LOT 5 APPLICANT: DICK VAN HAMERSVELD OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION: JOHN W LOLKUS DICK VAN HAMERSVELD ROOFING CO 323 S SHIELDS DR 19712 MEADOWS CIR ANAHEIM, CA 92804 CERRITOS, CA 907030000 BUSINESS PHONE: 562924-5308 JOB DESCRIPTION:Tear off existing and reroof 26 squares with 50-year composition shingles VALUATION: 7,300.00 PROCESSED BY: JNJ OWNER-BUILDER DECLARATION I hereby a irm under penalty of perjury that I am exempt from the Contractor's Ucense Law for the fo! wing reason ( 00.7031.5 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 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 Businessand 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 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 License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or helSelf 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 bu~d or improve tor 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 I am exempt under Sec. , B & P.C. for this reason: Date: Owner: WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: o J have and will maintain a certificate of consentto self~insureforworker'scompensation, as provided for by Section 3700 of the Labor Code, for the performance of the Work for which this permit is issued. E>t-l 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. My worker's Compensation insurance carrier and policy are: Carrier: STATE FUND Policy Number. 285-0000731 This section need nol be completed if the pennit is lor one hundred dollars ($100) or less. o J 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 Califomia, and agree that if I should bee e bj cl: the worker's compensation provisions of Section 3700 of the Labor C ,sh with c m y with those provisions. Date: 9/19/2005 Appllcantr':::" 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 "!HOUSAND DOLLARS ($100,000), IN ADDI1l0N TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 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 agell(';yfor the per10rmance of the work for which this permit is issued (Sec. 3097.Civ.C): Lender's Information: 9/19/2005 Date: Contractor NUMBER 383051 TYPE C39 EXPIRATION DATE 1013112007 Construc;on Tvpes: VN, , read this application and state that the above in1ormation is correct I ith all ity ordi n es and state laws relating to building construction, and ntive of is city to enter upon the above mentioned property for Date: 9/19/2005 Fees paid for Permit: Total; 246.10 Ignature 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. City of Anaheim Building Division INSPECTION RECORD INSPECTION OATE INSPECTOR Temporary Power Pole Plumbing (DrainlWaste Pipe) Electrical Ground ElectrodefUfer SetbackfFormsfTrenches (Footings) Do not Install subfloor or pour floor slab until the following applicable items have been signed: Plumbing (Water PipefSprinkler Valves) Mechanical (Groundwork) Electrical (Underground Conduit) Pre-slab (CompactionfMembrane 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 (SheathingfDiaphragmfFrame) f'11~b Masonry (Reinf.fBond BeamfPre-Grout) Rough Plumbing (Top Out) Rough Mechanical Rough Electrical (Dry Wall) Rough Electrical Framing (Only after Plbg., E:le., 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 EngineeringfGrading Final 765-5126 Fire Dept. Final 765-4040 Water Engineering 765.5268 Sub List/Business License 765-5194 Zoning 765-5139 . BUilding Final (Lasllnspection - Only J .t \~ ./ After Above Complete) /~Jr ./7..,,;::> ~4 PLI PARTIAL INSPECTIONS Buildint;l Inspections Mechanical Inspections Plumbing Inspections Electrical Inspections