1123 S. Lemon St.
BUILDING PERMIT NO. BLD2005~221
...r
ElM
BUILDING DIVI$ION .
200 S. ANAHEIM BLVD.
(714) 765 -5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 85 ;}-1-
TYPE OF PERMIT C I.TV
Reroof
DATE: 4/28/2005
JOB ADDRESS: 1123 S LEMON ST
LEGAL DESCRIPTION: N TR 1909 LOTS
APPLICANT: JAVIER BARRIOS
OWNER INFORMATION: CONTRACTOR INFORMATION:
Javier Barrios
1123 S Lemon St
Anaheim, CA 92805. ~ .
JOB DESCRIPTION: Tear off existing and reroof 19.5 squares with composition shingle
VALUATION: 3,500.00
ARCHITECT/ENGINEEH INFORMATION:
. PROCESSED BY: JNJ
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjulytl)at I am exempt rom the Con!ractor's Ucense Law for the following reason (Sec. 7031.5 Busine~s and
Professions COde: any city or countywhich requires a permit to construct, atler!:-improve, demolish" or repair any structure, prior to its issuance, 'also
requires the applicant fo"r such'permit-to file asigned statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter
9)(comm~ncing with Section 70.PO 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 nat more than five hundred dollars
($500).. . ..... .
er.:P. as owner of property, or my employees with wages as their. sole compensation, will do the work; arid the structure is not intendedor offered for
sale (Sec. 7044 Bus'loess and Professions Code: The Contractor's Ucense Law does not apply to an owner of property who builds or improves
_thereon, and who does such work himself orhelSelf or thrqugh his or Her ow.n 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 riotbuHd or improve forthe purpose of sale). " _ ' ",~
o I, as the owner of the property, am,exclusive'X..'contracting with licensed contractors to construct the proj,ect(Sec.7044 Business and Professions"
Code: The Contractor's License Law does not app~to an owner of property who builds or improves thereon, and who contracts for such projects with
p.J(ontracfor(s) Iicen~ed pursua~t to the Contractor's License Law):
U I ~m~xempt under Sec. ,B & P.q.,forthjs reason:
Date: ' wner:
WORK~ COMPENSATION OECLARATION
I hereby affirm under penaity of pe~ury one of the following declarations:
:E:ave and will maintain a certifi.cate of oonsentto self-i'nsure for worker's compensation,
a rovided for,by Section, 3700 of the.,Labor Code, for the performan.ce of the work for which
is perm'it is issued. ' . '
0' I hav'e and will maintain worker~s compensation'insurance, as required by -Section 3700 of 4/28/2005
the Labor Code, for the performance of the work for which this permit is issued. Myworker's Date:
Compensation insur~nce carrieranq policy are:
Carrier:' Policy Number.
~n need not be oomplete-d rf the pehTIit is for one hundred dollars ($1 00) or Jess.
~ertify that in _the ,performance of ~he work for which this"permit is issued, '- shall not '
employ any person in any manner so as to'ti:tecome subject to the worker's compensation laws
of Califomia, and agree that if.1 should become subject to the worker's compensation
'proVisio~s of ~lion 3700. Of. the Labor Code, 1- shal~" forthwith comp~ with th~eproVisions.
Date: 4128/2005 . APPlica~ '.
WARN ING: FAILURE TO SECOR E WORKER'S COM PEN SA TION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TOCRIMINAL PENALTIES AND CIVIL
FINES.UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE.
COST OF COMPENSATION, DAMAGES AS PROVIDED'FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'SFEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm underpenalty,of perjury that there is a construction lending agency for the
performance of the work for which.thispermit is issued (Sec.3097.Civ.C):~
Lender's" Information:
<;
LICENSED CONTRACTORS DECI.,ARATJON
- I hereby affirm under penalty of perjury that am
licensed under provisionsofohapter 9 (commencing
with Section 7000) of Divsion 3 of the. Business and
~rofessions Code. .
Contractor
NUMBER
EXPIRATION'DATE
TYPE
Construcion Tvpes:
V N, ,
I certify thatl have read this.application and state that the above informatiOn is correct. ,
agree to comply with all city ordinances. and- state.laws relating to building construction, and
hereby authorize representives of this city to'enter upon the above m"entioned property for
i spection pwposes.,'
9lX( c,- () . Date: 4/28/2005
Signature of Applicant or Agent
permit shall expire by limitation and become null and void if the building or
wor.k has riot passed final inspection 365 days from the date of perinit issuance. A
new permitisrequired to commence or continue work.
Fees pai,d for Permit:
Total:
160.61
INSPECTION RECORD
, ,INSPECTION,' DATE INSPECTOR:
Temporary Power Pole r,
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/uter
SelbacklFormsfTrenches (Footings)
Do not install subfloor or pour floor slab unliUhe
followirig applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves) , ' ,
Mechlinical (GroUndWork) ','
Electrical (Underground Conduit)
I pre-slab (CornpactiorvMembrane.Reinf. ,
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below unt~lthe
following'applicable ilems have been signed: '"
1 st Floor Shear " ,
Firesprinkler (Rough), /I ,
2nd Floor Shear , n / ~ //tb<. '
Roofg'OlIIDiaphtagmlFrame) , , L f{.,JLt-
Maso' InfJBond BeamlPre-Grout) ,
Rough Plumbing (Top Out)
Rough Mechanical
Rough BectrlCaI (ory wall)
Rough Electrical
Framing (On~ after Plbg:', ~Iec.. Mech.. and Fire)
Insulation (SoundlE",rgy) , ,
00 not tape or plaster until the following applicable
items have been signed: '..
DrywalL ,
PfIfletrations (Fire Rated) Electrical ,
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing ,
Interior Lath ,
Exterior Lath ' ,
.. , GENERAL ITEMS
Exterior Plaster (Brown Coal)
T .Bar Electrical
T-Bar Mechanical
T -Bar Structur;II ,
Sewer
Water Engineering Backflow
Water Service " ,
FINAl,lNSPECTIONS . , Date ,Inspector,
Electrical Final' "
Plumbing Final ,
Mechanical Final ,
,
Gas Test , " '
EngineeringlGradingFinaI765~126 '
Fire Dep'!. Final 7654040 "
,
Water Engineering 765-5268
Sub Lis,t/Business License 765-519 ,
Zoning 765.5139
Building Final ~asllnspeclion. Only 5-l7cr;t; b. &<A~lJt
fter Above Complele) -
, PARTIAL INSPf:CTIONS
Buildinq InSDections
Mechanicallnsoections
,Plumbinq Insoections
Electricallnsoections