229 Mall Pl.
BUILDING PI;RMIT NO. BLD2004-04107
TYPE OF PERMIT
Reroof
DATE: 11/10/2004
JOB ADDRESS: 229 SMALL PL
LEGAL DESCRIPTION: N TR 1940 LOT 84
BUILDING DIVISION'
200 S. ANAHEIM BLVD.
(714) 765- 5153
INSPECTioN REQUEST LINE:
(714) 765 - 4626.
CENSUS CODE: 555
QUARTm SECTION: 27
APPLICANT: KERRY CHAFEY
OWNE;R INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
Flo Y Tarlton CHAFEY ROOFING
229 S Mall PI . 11301 EUCLID ST #21
Anaheim. CA 92804 GARDEN GROVE. CA 928400000
I
, . . . BUSINESS PHONE: 7146';6-1747
JOB QESCRIPTION:Tear off existing roof and replace 24 squares of 20 year; bmposition shingles:.
VALUATION: 5,210.00 PROCESSED BY: MSM
I . OWNER-BUILDE~lbECLARATION .
I hereby affirm under penalty of perjury that I am exempt from-the Contractel's' License Law for the following reason (Sec. 7031.5 Business and'
Professions Code: any dty.or C9untywhich requires a permit to construct; ?Jter, im"prove, demolish or repair any structure, prior to its issuance, also
. requires the applicant for such permit to file a signed statement that he is Itdi-nsed pursuant to the provisions of the 'Contractor's License Law (Chapter
9)(commencingwith Section 7000 of Oivision3 of the Business and Profes_5:'ions Code) 'or thafhe is exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit su!)Jects the applicant to advil penalty of not more than five hundreddollars
($500). . " . ....
01;' as owner of property, .or my employees-with wages as their sole com~nsation, will do the work, and the structure .is not intended or offe'red tor
sale (Sec. 7044 Business and Professions Code: The Contractor's LicensEt}.aw does not apply to an owner of-property who builds or,im"proves
thereon, .and who does such work himSelf 'or herself or through his or her ()\o'~..}, employees, provided that suchimplOyements are not intt;l'nded or
offered for sale. If, how'ever, the building or improvement is sold ,with one y{~r of completion, the owner":builder will have the burden of proving that he
did not build or improve for the pUlpose of Sale). . . '/ _ '
D I, 'as the ow~er of the property, am exdusively contracting with Iicense::.t contractors 'to construct the project(Sec. 7044 Business ard Professions.
Code: The Contracto~'s License Law does not apply to an owner of property;who builds or improves thereon, and who con'tracts for such projects with
~ontract'or(s) licensed pursuant,to fhe Contr~ctor's L}cense Law). '.
U lam exempt-under Sec. " B & P.C.for this reason:
Date: Owner: .
I WORKER'S COMPENSATION DECLARATION
I he~eby affirm under penalty of pe~ury one of the following declarations:
.01 have and will ,maintain a certificate, of consent to self-insure for worke. is compencation,
as provided for by Sedion 3700 of the tabor Code, for the performancs' of the work. for whiCh
ihi 'permit is issued... . . .' j
, 'have and will mainta.in worker's .compensati'on insurance; as requi~a by se-:;t~n 3700 of 11/10/2004
Labor Code, for the performance of the work for which thiS permit is iss1;~d. Myworker's . Date:
Compensation insurance carrier and policy. are:
Carrier: STATE FU NO
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perj~ry that I am
licensed under provi.sions of ch;.pt'er 9 '(commencing
with Section 7QOO)_of Divsion 3 of the Business an
Profession de.
Policy Number.,. 000629~q000060-2003
NUMBER
679674
TYPE
. --.
This section need not be completed if the pennit is for one hundred dollars ($1G~)or less.
o ,I certify' that i~. the performance-ofthe work for which this permit is iS$i~.€:~, , sha" not
employ any person in any manner so as to become subject to the worker'f i:;ompensation laws
of CaLifomia, and, agree' that if I should become 'su bject to the worker's com~.Hhsaticn
provisions of Section 3700 of the labor Go e,1 shall forthwith comply ith Hi-:Jse provisions.
Construcion Types:
VN, ,
Fire Sprinklered?
Date: 11/10/2004 Applicant:
WARNING: FAILURE TO SECURE ORKER'S COM ENSATION V .AGE IS
1.!NLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN/,LTlES AND CIVIL
FINESUPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADr;WnON TO THE.
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION. S706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. '.
I CONSTRUCTION LENDING AGENCY
! herehy_affirm,under .penalty,of__veriury ~!r8tth~re.!<;. a'tf.\!"\stnJctiof'\ 1~f'<:Fn~'~~QC'Jf~r thA
performance of the work for which this permit-i's issued (Sec. 3097:C;v.C):.
Lender's Information:
I certify that I have read this application and state that the above informatior. is correct. I
agree to oomply with afl city ordinances and state laws relating to bu ilding construction, and
hereby authoriZe representives of this city: to-enter upon the above mentione=l property for
ins ection p rposes.
Dale: 11/10/2004
Sign re of Applicant At,. .
The permit shall expire by limitation and become null and void if too building or
work' has not passed final inspection 365 days from the date of pen"it issuance. A
new perrrJit is re:quired to commence or continue work.
EXPIRATION DATE
10/31/2005
C39
NO
Fees paid for Permit:
Tofal:
235.35
- INSPECTION RECORD
INSPECTION DATE INSP~CTOR
'. Temporary Power Pole
Plumbing (DralnlWaste Pipe) .
Electrical Ground Electrode/Ufer .
SetbacklFormsfTrenches. (Footings) . .
Do not install subflooror pour floor slab untiLlhe
following appiicable items have been signed: .
Plumbing (Water Pipe.Sprinkler Valves) .
Mechanical(GrOUndwork) . ' . .' .
Eledrlcal (Underground Conduit) .
Pre-slab(Compaction/Memb~ane.Rei nt.
Underpinning (Aoor Joist/Girders). I
Do not cover or conceal the work below untuthe
following applicable items have b~en signed: .
1 st Floor Shear . . .. .
Firesprinkler (Rough) ,.
2nd Floor Shear ,
Roof (Sheathing/Diaphragm/Frame) 1/ It,
Masonry (ReinfJBond BeamlPre-Grout)
Roligh Plumbing (Top Out)
Rough Mechanical . .
Rough E1ectrical(ury Wall)
Rough Electrical .
Framing "(Only after Plbg" Elec.. Mach., and Fire) . '.
Insulation (SOUndlEnergy) .
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 Piaster (Brown Coal) . . . .
T -Bar Electrical . .
T -Bar Mechanical
T-Bar .Structural
Sewer .
Water Engineering Backflow .
Water Service
FINAL INSPECTIONS Date.. Inspector'
Electrical Final
Plumbing Final. . .
Me.chanicat Final. .
. .
Gas Test . '.
Engineering/Grading Final 765-0126
Fire Dept, .Final 76.54040
Water Engineering 765.5268 .
Sub List/Business License 765-519 .
. .
Zoning 765-5139
Building Finat ~ast Inspection. Only . IIb~l II.. .V' -
fler Above Complete)
PARTIAL INSPECTIONS
Buildina Inspections
Mechanicallnsl)ections
Plumbina Inspections
Electrical Inspections