134 Land Ln.
TYF'EOF PERMIT
Reroof
ElM
BUILDING DIVISION
200 s, ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REOUESTLlNE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 33
t\
BUILDING PERMIT NO: BLD2005-01571
DATE: 5/25/2005
JOB ADDRESS: 134 S LAND LN
LEGAL DESCRIPTION: N TR 2001 LOT 31
APPLICANT: MARIO PINEDA
OWNER INFORMATION: CONTRACTOR INFORMAT:"I.oN:
Mario'WPineda. .
134S Land Ln
Anaheim, CA. 92804
JOB DESCRIPTION: Tear off existing and re-root 30 squares of composition shingles..
VALUATION: 9,000.00
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY' SAM
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the ontractor's License w or the following reason ( ec. 7031.5 Bus[ne$s and
Prof~ssions Code: any city.or county which require~a'perl'flit to construct, atter, improve, demolish or repair' any structure,prior to its.issu?-nce, also
requires the applicant for such permit to file a signed statement that he is licensed"pursuant to the provisions oftha Contractor's License Law (Chapter
9J(commenCing with Section 7000. of Division 3 of- the Business.and Professions Code) or 'that he i~ exempt therefrom and the basis for the allegeq
exemption. Any violation of Section 7031.5 by any applicant for a permit SUbjects the- applicant to a civil penatty of n.ot more than five hundred doll,ars
~ . . .
.1,85 owner of property, or my employees with wages as their'sole compensation, will do the work, 'and' the structure is not intended or offere-d for
( c. 7044 Business and Professions Coqe: The Contractor's License Law does not apply to an oWner of property '"Yho builds or, improves '
ereon, 8I1d who does such work himself or herself or-through his or her own employees, provided that such improl{S'mentsare not intended or,
offered for sale. .If, howev~r, the, building or improvement is.soh:twith one year of completion, the owner-builder will havel!1e burden of proving that he
igid not build or improve-for the purpose Qf sale).
o I, _as the owner. of the. property, am exclusivelY contracting with licensed contractors to construct the project (Sec. 7044 Business and ProfesSions
Code: The Contractor's License Law does- not apply to an owner'of property who builds or improves thereon, and who contracts for such projects with
Montractor(s} lic~ed pursuant to the Contractor:s Licen~ ~w). . ;
U. I am exempt under Sec.. '. ,B& _ for thi$ reason:
Date: . Owner:
WORKER'S S ON 0 CLAR ION
I hereby affirm under pe alty of JUry one,of the following declarations:
o I "have and will mai n. a certificate of consent to setf~insure for worke'r's compensation,
as prov}ded for by Section 3700 of the labor Code, for the performance Of the ~/ork for which
this permit is issued.. . . '...
o I have andwill-maintain.worker's comp~nsation insurance, as re qui re<:i by Section, 3700 of
the Labor Code, for the p~rformanceof the work forwhich this permit is issu~d., My worker's
Compensation insurance carrier and policy are:
Carrier: ,Policy Number.
This ectiOn need nOt be completed If lhe pennlt is tOr one hundred doll.rs ($1 00) or less.
, I rtify that in ,the- performance'of the' work for whichlhis_ permit-is issu'edi i shall not
10 any person in any manner so as to become subject to the. worker's compensation laws
of ornia, and agree that if I should become subject to the worker" mpensation
provisions of ?ectjon 3700 o~ the Labor, Cod shall forth~ith comp ith those provisions.
LICENSED CONTRACTORS DECLARATION
I. hereby a irm under penalty of perjury that I am.
licensed under proVisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
Professions .Gode; , .
5/26/2005
Date:.
Contractor
NUMBER
EXPIRATION DATE
TYPE
Date: 5/2612005 Applicant:
WARNING: FAILURE TOSECUREW ER'SC PENSATI COVERAGE
UNLAWFUL, AND SHALLSUBJEC N EMPLOYER TO CRI~INAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED OUSAND DOLLARS ($100,Ooo):IN ADDITION TO 1HE
COST OF'COMpENSATlON, DAMAGES AS PROViDED FOR IN SECTION 3706 OF THE,
LABOR CODE, INTEREST AND ATTORNEY'S FEES. . .
CONSTRUCTION LENDING AGENCY 'I;
I hereby affirm under penalty.of perjury that there is-a constructiOR lending agency for the.
performance of the yjork for which this permit is issued (Sec.3097.Gi\(.C): '11-
Lender's Information: --
Construcion Tvpes:
VN" .
~..i&.'
I cert(fy that 1_ have read this application. and state that the above information is correct.' I
agree to COI1'1pl with all city ordif,Jances and state laws relating to building construction, and
hereby author> _ representives of th.is c' t enter upon the above mentioned property for
insp . purp,o $:'
= ~ Date: 5/26/2005
Signatur of Applica or Agent
permit shall expire limitation and become null and void if the building or
work has not pasl;edfinal i ~ection 365 days from the date of permit issuance. A
new permit is required to commence. or continue work.'
Fees paid for Permit:
Total:
271.49
INSPECTION RECORD
. INSPECTION DATE INSPECTOR
Temporary Power Pole . .
Plumbing (DrainIWaste Pipe) . .
Electrical Ground Electrode/uter . .
Seiback/FormslTrenohes.(Footings) .
Do not install subfloor orpourfloor sial until the .
following applicable items haye been signed:
Plumbing (Water Pipe,Sprinkler Valves) ,
Mechanical (Groundwork) .
Electrical (UndellP'ound Conduit) . . .
.Pre,slab (Compaction/MeI11brane.Reinr. . .
Underpinning (l'Ioor Joist/Girders)
Do not cover or conceal the wo", below until the
following applicable items have been signed: . .
1st Fleior Shear . .. . .
Firesprinkler (Rough) . .
2nd ~or She~ ... .. II. /.1. !l,l '.
Ro~ .aphla!lmlFrame) "(t(ff)
Masonry (RelnfJBondBeamlPre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical ..
i KOugn t:Iectricallury wall) . . . .
Rough ElectrIcal. . .
Framing (Only aher.Plbg.. Elec.. Mech...and Fire)
Insulation (SoundlEnergy)
po f10r rape or pla~ler until the following applicable .
,temshave been signed:. . .. .. .
Drywall. . . . .
PenetratlQllS (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetralions(Fire Rated) Plumbing .
Interior lath .. .
. exteriOr lath .
GENERAL ITEMS .,
exterior Plaster (Blwm Coal) . . .
T -Bar Electrical . .
T-Bar Mechanical
T -Bar. Structural . .,
Sewer
Water Engineering Backflow . . . ..
Water Service . . .
..
FINAL INSPECTIONS . Date .Inspector .
Electrical Final. .. . . ..
Plumbing Finai ... '.
Mechanical Final
Gas Test .. . .
.
Engineering/GradIng Final 765-5126
Fire Dept. Final 765-4040 . .. . .
Water EngIneering 765-5268 . .
Sub List/Business LIcense 765.519 .. ..
Zoning 765-5139 . .
.
Building Fin.al !kasllnspection- Only l:.l$f:m L -'"
fler Above Complele) . -".
. PARTIAL INSPECTIONS
Buildina Inspections
.G,.~~
. .'~"""""11"1
Mechanical Inspections
Plumbina Inspections.
Electrical Inspections .