1021 N. Lomita Ave.
BUILDING DIVISION
200 S. ANAHEiM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714)765 - 4626
CENSUS CODE: 555 .
QUARTER SECTION: 52
BUilDING PERMIT NO. BLD2004-03700
TYPE OF PERMIT . CITY
Reroof
DATE: 10/4/2004
JOB ADDRESS: 1021 N lOMITA ST
lEGAL DESCRIPTION: N TR 2373 lOT 10
,.,
APPLICANT: FRED FARMER
OWNER INFORMATION:
Barry Bonin.
t021 N Lom/ta St
Anaheim, CA 92B01
ARCHITECT/ENGINEER INFORMATION:
CONTRACTOR INFORMATION:
CHRISTOPHER ROOFINI; CO,INC
1240 N ANAHEIM BLVD
ANAHEIM, CA 928010000
BUSINESS PHONE: 714897-4541
JOB DESCRIPTION: Tear off existing & reroof 18 s~ with 30 yr composition sh'ngles & 2 sq with BUR
VALUATION: 3,600.00 '. PROCESSED BY: MSM
L . OWNER-BUllDEROECLARA TION
I hereby affirm under pena-ltyof perjury that I am exemptfrom the Contractor's Ucense Law for the following reason {Sec, 7031.5 6Usjlie~s and
Professions Code: any.dty or county which requires a permit to construct. alter, improve, demolish or repair any structure, prior"to its issuance, "also
requ Ires the applicant for such permit to file a signed statement that he is licc-;lSed pursuant to the provisions'of the Contractor's license law {Chapter
9)(commencing with Section 7000 of Division 3 OJ the Business and Profec;si<:;f\s'-Code) or that he is exempt therefrom and the basis for the alleged '
ej(emption. Any violation of Section 7031.5 by any applicant for a peJ:mit ~fJ"iects tt:1e ,applicant to a dvil penalty of nqt more than flve hundred dollars
($500), '. . ! .' .
o I, as owner of property. or my employe-as with wages a:s.their sole comr:;....!sation. wili do the work. and the structure is not intended,or offered for
. sale (Sec. 7044 Business and Professions Code: The Contractor's license Lhwdces not apply to a'n owner of property who builds or improves .
thereon,onP who does such work himself or helSelf or t~rough his or her OWl employt-es. provided that such irrlprovem~:mts are not ,intended or
offered for ~le. If, however, the building-or improvement is sold with one ye:r of complefion, the owner-builder will have the burden-of proying thath~
did not build or improve for,thepulpa~e af sale). t "
[J I. as the owner dfthe property. am exclusivelyeontrading with Hcens.ed '!xin-tr~ctors to construct the prcject (Sec. 7044 B\Jsiness _~nd PrafesSian_s
Code:'The Contractor's License Law does not apply to an owner of-property "Nho-builds or improves thereon, and who rontracts fqr such projects wnh
fU(ontractor(s) licensed pursuant to th,e.Contr~ctor's ~icel1se Law). J .,'"...
.U tamexempt_lloderSe:c... . ,B&P.C. for this reason: _-..:.:.-..:~ . . .
Date: Owner: ;
I WORKER'S COMPENSATION DECLARATION -:'r--- ----1
, hereby affirm un~er penaltY of perjury one of. the following declarations: . .
o I have"and will maintain a certifICate of ronsent to self-insure for worke,'!. compenSatiQn,
as pro\t.ided for by Sect:ion3700 of the Labor Code, for the performance 0fth:: 'Nark for Which.
thi~~rmit is issued. " ' . .','
(g'l have and will maintain worker:s compensation insurance, asrequiled bS'; Section 3700 of,
the Labor Code', for the performance of the work for which this permit is iSSut:d. Myworker's
Compensation insurance earri,er and policy are:
Carrier; STATE FUND
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 afthe Business;and
Professior.s C~ ~
'1014/200i., V 4-?!A~'
Oate: Contractor. '
Policy Number. 2850000:30625
NUMBER
624118
TYPE
TYPE
EXPIRATION DATE'
8131/2005
This section need not' be completed it"the' pellllit is for one, hundred d6Uars ($1 00', of less.
,0 I certify thatin the perionnance of the work for which this permit is issue:j,t~!1?nnot
employ any person in any manner so as to become subject to the worker's c;.mp'~nsation laws
of_ California. anq agree ,that jf I should become subject to the wori<er's CCfTlPCr'ls~~ion
provisions of Section 3700 of the Labor Code, I all forthwi omply with thnse_provisions.
;(}
Date: 1014/2004 Appilcant: ,
WARNING: FAilURE TO SECUREWO ER'S COMPENSATIONCOVEFWS'EIS
UNLAWFUL, AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENAl'tlESAND CIVIL
FINES UP 10 ONE HUNDRED 1HOUSAND DOLLARS ($100,000), IN ADCmbN fd THE
COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 3ro6 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES:i
I. CONSTRUCTION lENDING AGENCY _ t . .
1 ~erebyaJfj~~.~~!lder penatty of perjury ttlat there is a pO!1stru.;tion l~:md:ng ,~U!jicy for the' .
performance of the work for which this permit js issued (See. :;1097 .CivX:): .' --:~- -".-
Lender's Information: .
C39
HIC
Construcion Types:
VN, ,
L____
t certify that I have react this applIcation and state that the above lnforma.tion, is correct. I
agree to comply withal! city ordinances and state laws relating to bunding construction. and
hereby authoriZe r:epresentives of this city to enter upon the above mentl'Jned property for
insr, ~~es... '~ -' Date: 10/4/2004
p-t' ~~..
Signature of Applicant or Agent'
The permit shall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
Fees paid f9r Permit:
Total:
160,61
INSPECTION RECORD
. INSPECTION . DATE' . INSPECTOR
Tem'poraryPower Pole'
Plumbing (DrainlWaste Pipe)
Electrical Ground.Electrode/lIfer
SetbacklForll'lSfTrencheS (Fqotings) '. .
Do not install sub{looror pour floor slab until the
following applicable iiems' have been signed:' .
Plumbing (Water Pipe.SprinklerValves) .
Mechanical (Grouncjwork)
Electrical.(Underground Conduit) .
Pre-slab (\;ompactionlMembrane .Rei m.J
Underpinning (Floor Joist/Girder$) .
Do not cover or conceal the w'ork below until the .
following appli.c"bie ilems have been signed: '. .' .
1st Floor Shear . . . . . .
FireSprinkler(Rough)
2nd Floor Shear . A.q!
Roof (Sheathing/Diaphragm/Frame) ~.,..r.oti .
Masonry (ReinfJaond BeamJPre.Grout) ...... . .
Rough Plumbing (Top Out) '.
Rough Mechanical .'
KOugh 8ectriCaI \ury Walll. .
Rough Electrical ,
Framing - (On/yafter PIOg.. Elec,':l..-leCh, and Fire)
Insulation (SoundlEnergy) . .
po not tape or pla.~tet until the following applicable
Items have been signed:: .'. .' .
DryWall .. '.
Penetralio!lS (Fire Rated) Electrical .
Penetrati.ons (Fire Rated) Mechanical . .
Penetrations (Fire Rated) Plumbing
Interior Lath . . . t.
Exterior Lath . .
. .' GENERAL ITEMS
Exterior Plaster (Bl'l7Nn Coat).
T -Bar Electri~al . . I
T -Bar Mechanical .'. : '.'
T -Bar Structural .
Sewer, '.' .
Water Engineering Backflow
Water Service . . . .
.
FINAL INSPECTIONS. . . .
Electrical F.inal. '. . . .
Plumbing Final .
Mllch"nical F.lnal .
Cas Test ....
Engineering/Grading FiriaI765~126
Fire .Dept. Final 7654040
Date
. .'
'. .
.
Inspector
.
. .
Waler Engineering 76S~S268
Sub List/Business License 765.519' ....
Zoning 765-5139 .
. -
.'
.
Bu. i1dingFin., al (Last Inspection. Only . "nL/.. -ri. -I'\..'~
. . lifter Above Completej r7J<i(/IJ'I- -...J lIW. .
PARTIAL,INSPECTION'S' . .
Buildinq Inspections
. .
Mechanical Inspections
.,Piumbinq Inspections
ElectricallnSDections