5221 E. Woodwind Ln.
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: 177
BUILDING PERMIT NO. BLD2005-03103
DATE: 9/28/2005
JOB ADDRESS: 5221 E WOODWIND LN
LEGAL DESCRIPTION: N TR 4181 LOT 5
APPLICANT: DIEGO LOPEZ
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
JO SE SERNA DIEGO A LOPEZ CONSTRUCTION
5221 E WOODWIND LN 4618 PENNY ROYAL
ANAHEIM. CA 92807 CORONA, CA 917200000
BUSINESS PHONE: 909734 2228
JOB DESCRIPTION:Tear off existing and reroof 24 squares with 3D-year composition shingles
V ALUA TION: 4,200.00
I OWNER-BUILDER IlECLARATION
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 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 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 sUbjflCts 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:lsation, 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 yeal' of completion, the owner-builder will have the burden of proving that he
did not build or improve for the pu rpose of sale).
o I, as the owner of the property, am exclusively contracting with licensed c)ntractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of property \o\'ho builds or improves thereon, and who contracts for such projects with
a contractor(s) licensed pursuant to the Contractor's License Law),
D I am exempt under Sec. , B & P .C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I 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 ~ompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
this permit is Issued.
~ I have and will maintain worker's compensation insurance, as required by Section 3700 of
the Labor Code, for the pertormance of the work tor which this permit is issuec. Myworker's
Compensation insurance carrier and policy are:
Carrier: STATE COMPENSATION
PROCESSED BY: JNJ
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Bu ss and
Profes .
9/28/2005
Date:
Policy Number. 0583714-00
NUMBER
502634
TYPE
TYPE
TYPE
EXPIRATION DATE
1213112006
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
o I 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' lpensation laws
of Califomia, and agree that if I should become subject to the worker' per-sation
provisions of Section 3700 of the Labor Code, I shaU forthwith co ith those provisions.
B
HIC
C39
Dale: 9/28/2005 Applicant:
WARNING: FAILURE TO SECURE WORKER'S OMPENSATION C ERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF CDMPENSATION, 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 age'lcyfor the
performance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
Construcion Tvpes:
V N, ,
I certify that I have read this application and e at the above information is correct. I
agree to comply with all city ordinances 51 laws relating to building construction, and
hereby authorize representives of thi Ity t nter upon the above mentioned property for
in e.o url20se
Dale: 9/28/2005
Fees paid for Permit:
Total:
244,87
gnature 0 Applicant or ge t
The permit sh I 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 iSSUlWlCe. A
new permit is required to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormslTrenches (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 (Compaction/Membrane 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) jl>I.LA, Jl;)}J. U
Masonry (ReinfJBond BeamlPre-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 unliJ 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
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 (La.tln.pectlon - Only
After Above Complete)
INSPECTOR
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbing Inspections
Electricallnsoections