721 La Reina
TYPE OF PERMIT CITY
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REOUESTLlNE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 18
BUILDING PERMIT NO. BLD2005-01776
DATE: 6/10/2005
JOB ADDRESS: 721 N LA REINA ST
LEGAL DESCRIPTION: N TR 2332 LOT 147
CONTRACTOR INFORMATION:
o C E IINC
10615 LAWSON RIVER AVE
FOUNTAIN VALLEY, CA 927080000
BUSINESS PHONE: 714962-9nO
JOB DESCRIPTION:Tear off existing, resheat as needed, and reroof 22 squares with 5O-year composition shingle
APPLICANT: TOM KORSVALL
OWNER INFORMATION:
James P Thompson
721 N La Reina St
Anaheim, CA 92801
ARCHITECT/ENGINEER INFORMATION:
VALUATION: 5,000.00
I 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 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 oi Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged
exemption. Any violation oi Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred donars
($500).
o 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 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 th~t he
did not build or improve for 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 ior such projects with
~ontractor(s) licensed pursuant to the Contractor's License Law).
U I am exempt under Sec. , B & P .C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
, hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certificate of consent to setf~insure ior worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
~is permit is issued.
~ 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: STATE COMPENSATION INS FUND
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 Di' of the Bus' as and
Professions e.
6/10/2005
Date:
Policy Nu mber. 229-01 UN IT 0014911
NUMBER
431058
TYPE
TYPE
EXPIRATION DATE
5/3112006
This section need not be completed if the pennit is for one hundred dollars ($1 00) or less.
o r 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 workers compensation laws
of Califomia, and agree that if I should become subja 0 the work's compensation
provisions of section 3700 of the Labor Code, I s ith 'th Iy with those provisions.
8
Hie
Date: 6/10/2005 Applicant.
WARNING: FAILURE TO SEC RE WO ER'S COMP SA TION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER 0 CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLL S ($100,000), IN ADDITION 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 penalty of perjury that there is a construction lending agency for the
performance of the work fot which this permit is issued (See.80S7 .Civ .C):
Lender's Information:
Construcion Tvpes:
VN, ,
I certify that I have read this application and state that the above information is correct. I
agree to comply with II city ordinances and state laws relating to building construction, and
herebyauthoriz p sentives of's to enter upon the above mentioned property for
inspectio p
Dale: 6/1 0/2005
Fees paid for Permit:
Total:
235.33
Applicant or Agent
e permit shall expire y 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 Dermit is reauired to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
I INSPECTION DATE INSPECTOR
iTemporary Power Pole
:Plumbing /DrainlWaste Pipe)
Iflectrical Ground Electrode/Ufer
'setbacklForms/Trenches (Footings)
I Do not install subfloor or pour floor slab until the
I following applicable items have been signed:
IPlumbing /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 ~ I
Roof (Sheathing/Diaphraam/Frame) &-13 -&J
Masonry (Reinf J80nd 8eam/Pre-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 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
Engineering/Grading Final 765-5126
Fire Dep!. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765.5194
Zoning 765-5139
Building Final (Last Inspection. Only '-'154 S~
Alter Above Complete)
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections
Plumbina Inspections
Electrical Inspections