2525 Maverick Ave.
'C'",-.
BUILDING PERMIT NO. BLD2004-04141
TYPEOFPERMll CITY
Reroof
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765- 4626
CENSUS CODE: .555
QUARTER SECTION: 125
DATE: 11/15/2004
JOB ADDRESS: 2525 E MAVERICK AVE
LEGAL DESCRIPTION: N TR 3706 LOT 20
APPLICANT: MARTIN TRUJILLO
OWNER INFORMATION: CONTRACTOR INFORMATION:
MARTIN TRUJILLOW
2525'E Maverick Ave
Anaheim, CA 928013
JOB DESCRIPTION: Tear off e,xistihg and re-roof 30 squares of45 ~ompositior, shingles.
VALUATION: 4,500.00
I OWNER-BUILDERpeCLARATION
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 coh'struct, ~J~-alr. imprcve, demolish or repa,ir-anystructure, prior to its issuance,also
requires the app.licant for such permit to file a signed statement that he'is 116~nSed pursuant to the provisions of the ,Contractor's License Law (Chapter:
9)(commencing with Section 7000 of Division 3 of the Business and Professic'i1s Code) or that he is exempt therefrom and the basi,S for. the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit su~jects the applicant to a civil penalty of not more than five hundred doll~rs
~$5}. .. , .. . ..
,,_as ow.ner.of property, or my employees witn wages.as their sole COin~,i1sation;, will do the work, and the structure is not intended or offered for
J See, 7,044 Business.and Professions Code: The Contractor's LicenseLlw doesnof apply to an owner of property who builds or improves
. ere6n, and who does'such work himself or herself or through his or her oW~l.iempldyees, prov.ided that such improvements are not intended or ,
offered for sale., If, however, the, building orimproveme':lt is sold with one y~rr.Of completion, the owner-builder wilL have the burdel'"! of proving,thet he
did not buildor improve for the purpose of sale).' , . " '
01, as the owner'ofthe property., am exdusively contracting with Ii ensed~ntractors to construct the project (See. 7044 Business arid ProfesSions'"
Code: The Contractor's License Law doe$ not apply to an owner of roperty 'fIiho bi..l!lds or improves' thereon, and who contracts for sUm projects with
~ontrador(s) lIcensed pursuant to the Contracto s cense aw)
LJ I 3m exempt under Sec. & . for ,<:'IS
Date: Owner' .
ARCHITECT/ENGINEER INFORMATION:
. PROCESSED BY: SAM
WORKER' ENSATION D C RATlot~
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 work~r'~'c.~mpensation.
as provided for by. Section 3700 of the Labor Code, for the performan~ rJfh,!~ Vi..ork fcrwhich
this permit is issued. .
o I have.and will maintain worker's compensation insurance, as required b~ Section 3700 of
the LaborCode,for the performanc.e of the work fOi which this permit is issue:d. My worker's
Compensation insurance carrier and pollcy are:
Carrier: ' Policy Number.
;- ",,, t
'This section need not be completed ifth.e-pennit is'for one hundred dollars ($100j:or:less. .
~"I certify that in the perforrnanceofthe work for which this permit is i55"" C,"j,shall not .
mPlo. Y any ~rson ,in a ny manner so as to b. ecome subject to the worke( cmnR.ensation laws
o alifomia, and agree that if I should bec me subj" rker's pel"lsation
pro,,-;isions of Section 3700 of the Labor C d sh fo . h 0~1y' lth th('.~e provisions. .
,'"
~
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury, that I am
licensed under provisions ofchapter9(commencing
. with Section 7000) of Divsion 3 of the Business and
Professions Code. "
11/15/2004
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Date: 11/15/2004 . Applicant:.
WARNING: FAILURE TO SECUR
UNLAWFUL, AND SHALL.SUBJE AN EMPLOYER TO CRIMINAL PENALflES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADOmON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR COD E, I NTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY _.
I hereby affirm under penalty of perjury that there is a construction lending a:;:;~:ndyfort~e
performance of the work for whidl this :)ermit is issued {Sec.-3097 .Civ .Cj:
Lenoer's Information: .
Construcion Types:
VN, ,
Fire Spri~klered?
NO
-.- -'-----.'--.--
te that the above information is correct. I
state' laws relating to building comtruction, and
to enter upon the above m-entioned property for
Fees paid for Permit:
Total:
235.33
Date: \1/15/2004
gnature of Applica or Agent .
The permitshaJl expire by Iimi1ation and become null.andvoid if the building or
work. has not p.assed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
,INSPECTION RECORD
I, ,
INSPECTION DATE INSPECTOR
T eniporary Power Pole,
Plumbing (DrainIWaste Pipe) , ,
E"ctrical Ground Electrode/uter ' ,
Setbacklf'ormstrrenches (Footings) , ,
09 nolinstall sU,bfloor,or pour floor slab unti I the
following applicable items have been signed:
Plumbing (Water Pipe;Sprinkler Valves) ,
Mechanical (Groundwork) " '
E"ctricaJ (Underground Conduit) ','
'Pre-slab (Compaction/Membrane.Rei nt.
Underpinning (Roor,Joist/Girders) "
Do not cover or,conce,al the work below untn the
following applicable items have been signed:
1sIFloor Shear ,
Firesprinkler (Rough) ,
2nd Floor Shear ,
Roof,(Sheathlng/DiaphragmlFrame) ".'~'1I /)(1 /A.
Masonry (ReinfJBond Beari1lPre-Grout) VI ,
Rough Plumbing (Top Out)
Rough, Mecbanical
Rough E1ectrlC,at (Dry Wall)
Rough Electrical -
Framing. (Only-after Plbg.. Elec.: Mech.. arid Fire)
Insulation (SoundlEnergy) " , ,
po nol tape or pla~ler until the following applicable
',tems have been SIgned: ' ,
Drywall , , ' , ' " ,
peneirations (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 Structural
Sewer
Water Engineering Backflow
Water Service ' ,
FINAL INSPECTIONS, . Date Inspector' .
Electrical Final . I , , ',' ,',
Plumbing Fi,nal ,
Mechanical Final
Gas Tes,t
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040 ,
Water Engineering 765:5268 , '" "
Sub List/Business Lice!,se 765-519' ,
Zoning 765-513~ -
Building Final ' ~ast Inspection- Only ,IN!$.()i/ n T fl
, , fler Above Complete)
U
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections '
Plumbina Inspections
Electrical Inspections