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200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax www.anaheim.net/building SEPT 2008 B717 CITY OF ANAHEIM PLANNING DEPARTMENT BUILDING DIVISION REROOF SELF-CERTIFICATION INSPECTION FORM This form is to be completed by the licensed roofing contractor participating in the City of Anaheim Reroof Self-Certification Program. Upon completion and inspection of all reroofing work and inspection by the roofing contractor, in order to final the permit, this completed and signed form must be faxed (714) 765-4607 or delivered to the City of Anaheim, Building Division, 200 S. Anaheim Blvd. #145, Anaheim, CA 92805. A rebate will be awarded within 10 working days upon permit final. Job Address Permit Number Owner name Contractor Name C-39 License No. Contractor Phone Initial the items below when each inspection is completed: Structural Support Inspection: I certify that the existing roof support structure where the reroofing occurred is substantially free of obvious sagging and deflection and that the roof sheathing or roof decking is, in my judgment, structurally sound. Roof Sheathing Nailing Inspection: I certify that roof sheathing was installed and fastened in accordance with the manufacturer’s installation instructions and with the requirements of the 2007 California Building Code, Sections 2308.10.8 (roof sheathing), and Table 2304.9.1 (sheathing nailing) as adopted in Title 15 of the Anaheim Municipal Code (AMC). In addition, minimum clearances to combustibles for all HVAC vent/chimneys have been verified and maintained as required by Title 15 of the Anaheim Municipal Code. Final Inspection: I certify that the roof and the roofing material covered under the above mentioned reroofing permit has been installed and fastened in accordance with the manufacturer’s installation instructions and the requirements of Chapter 15 of the 2007 California Building Code as adopted in Title 15 of the Anaheim Municipal Code. Contractor’s Signature Date Print Name ---PAGE BREAK--- 200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax www.anaheim.net/building PAGE 2 OF 2 CITY OF ANAHEIM PLANNING DEPARTMENT BUILDING DIVISION We would like to know about your experience with our Reroof Self-Certification Program. Please take a few minutes to give us your feedback below. 1. Was the reroof self-certification program/process easy to understand/follow? YES NO 2. If no; what was the most difficult aspect of the program/process? 3. Did we provide you with clear, accurate, and consistent information throughout the process? YES NO 4. What was the most positive or beneficial aspect of your participation in the reroof self certification program? 5. Overall, how would you rate your experience with the reroof self-certification program from 1 to 5? Displeased Very Pleased 1 2 3 4 5 6. Would you participate in this program again? YES NO 7. Please provide any additional comments or concerns you may have below. We appreciate your recommendations for how we can enhance your Building experience. Sincerely, Julie Seay, CBO Building Official