874 S. Anaheim Blvd
TYPE OF PERMIT CITY
Reroof
DATE: 11/16/2005
JOB ADDRESS: 874 S ANAHEIM BLVD
LEGAL DESCRIPTION: N TR 230 LOT 2
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BUILDING DIVISION
200 S, ANAHEIM BLVD,
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 85
BUILDING PERMJ! NQ. . BLD2005-03645
APPLICANT: HERMINIA DOMINGUEZ
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
ANASTACIO VALLADARES
874 S ANAHEIM BLVD
ANAHEIM, CA 928050000
JOB DESCRIPTION:Tear off existing roof, resheath as necessary and replace with 26 squares of 30 year composition shingles; includes detached garage
VALUATION:
4,000,00
PROCESSED BY: JNJ
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5 Business 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 Business and 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),
~ I, as owner of property, or my employees with wages as thelr 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).
D 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
F!J(ontractor(s) licensed pursuant to the Contractor's License Law).
U I am exe t under Sec. ,8& P,C~or this re n:
Date': 2- 19 G Owne[,-= tA-f I '
WORKER'S COMPENSATION DECLARATION
~erebY affirm under penalty of pe~ury one of the following declarations:
[ have and will maintain a certificate 01 consent to selHnsure for worker's compensation,
s provided for by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
o I 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. Myworker's
Compensation insurance carrier and policy are:
Carrier: Policy Number.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty 0 perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Dlvslon 3 of the Business and
Professions Code.
12/6/2005
Date:
Contractor
NUMBER
EXPiRATiON DATE
This section need not be completed if U1e pennit is for one hundred dollars ($1 00) or less.
!A'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 worker's compensation
provisions of Section 3700 of the Labor Code, I sh!lU forthwith comply with those provisions.
"'<
Date: 12/6/2005 APpllcantA ' L ""'-
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVE E is
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTiES AND CiVIL
FINES UP TO ONE HUNDRED THOUSAND 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 penatty 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:
TYPE
Construcion Types:
V N, ,
Fire Sprinklered? NO
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 representlves 01 this city to enter upon the above mentioned property for
inspect'on purpo~s, ill
, t d..-V ~ #t;' Date: 12/6/2005
Signature of Applicant or t
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.
Fees paid for Permit:
Total: 244,87
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
'Temporary Power Pole
Plumbing (DrainlWaste 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 Pipe/Sprinkler Valves)
IMechanical (Groundwork)
;Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
IUnderpinning (Floor Joist/Girders)
I Do not cover or conceal the work below unlilthe
I fOllowing applicable items have been signed:
'1st Floor Shear
Firesprinkler (Rough)
2nd Floor S~
Roof l:Sfieathinpphragm/Frame) W""'''5 ". JAtJ.~i
Masonry (Reinf./Bond Beam/Pre-Grout)
Rough Plumbing (Top Out)
IRough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
,Framing (Only after Plbg., Ele., Mec. And Fire)
'Insulation (Sound/Energy)
Do not tape or plaster unlilthe following applicable
items have been signed:
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
,Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
I GENERAL ITEMS
'Exterior Plaster (Brown Coat)
IT -Bar Electrical
IT -Bar Mechanical
'T-Bar Structural
I Sewer
,Water Engineering Backflow
'Water Service
, .
FINAL INSPECTIONS DATE INSPECTOR
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Cross Connection Control (7f4J 785-428D
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 /2-.7.oS r:: LA <;/) '1#
After Above Complete)
PARTIAL INSPECTIONS
BuildinQ Inspections
Mechanical Inspections
PJumbinQ Inspections
Electrical Inspections