2413 W. Marian Ave.
TYPE OF PERMIT CITY
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 27
BUILDING PERMIT NO. BLD2005-01989
DATE: 6/28/2005
JOB ADDRESS: 2413 W MARIAN AVE
LEGAL DESCRIPTION: N TR 2393 LOT 28
APPLICANT: JOSE GOMEZ
OWNER INFORMATION:
JOSE GOMEZ
2413 W MARIAN AVE
ANAHEIM, CA 92804-2265
JOB D!i'SCRIPTION: Tear off existing and re-roof 26 squares of 30 year composition shingles.
VALUATION: 6,500.00
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 cOl1struct, 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 of Division 3 of the Business and Professions Code) or that he is exempt the refrom 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 not more than five hundred dollars
($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 Ucense 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 that he
di t build or improve for the purpose of sale).
I; as the owner of the property, am exclusively contmcting with licensed contractors to construct the project (Sec. 7044 Business and Professions
od . The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects w~h
ontractor(s) licensed pursuant to the Contractor's License Law).
I am empt der Sec. C. f this re on:
Date: 6-<5 Ow
WORKER' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
D I have and will maintain a certificate of consent to self-insure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the pertormanoe of the worK tor which
this permit is issued.
o I 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:
CONTRACTOR INFORMATION:
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: SAM
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 of the Business and
Professions Code.
6[28/2005
Date:
Contractor
POlicy Number:
NUMBER
EXPIRATION DATE
TYPE
Date: 6128[2005 Applicant:
WARNING: FAILUR TO SE
UNLAWFUL, AND SHA BJECT MPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDIllON 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 the!'"e is a constructicillonding agenoyfor the
performance of the work for which this permit is issued (Sec. 3097.Civ.C):
Lender's Information:
laws relating to building construction, and
n t e a~ove mentioned property for
Date: 6[28[2005
Fees paid for Permit:
Total:
235.48
'-- 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 issuMce. A
new permit is reauired to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormS/Trenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing /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/Diaphragm/Frame) '"Ikloo; .\,l\IJavJ'5V- I
Masonry (ReinfJBond Beam/Pre-Grout) I (
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mt:c. 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
IWater Engineering Backflow
!Water Service
FINAL INSPECTIONS DATE INSPECTOR
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-5194
Zoning 765-5139 . .
Building Final (Last Inspection - Only 1fPPI 0)'.; '7"
After Above Complete)
PARTIAL INSPECTIONS
ections \\ ll. r
,:.,. \ ls \w" ~ e (.U<.l ~
Mechanical Inspections
PlumbinQ Inspections
Electrical Inspections