6930 Michigan Circle
BUILDING PERMIT Nd~ BLD2004-04295
TYPE OF PE!'MIT .C ITY
Rero<Jf
ElM
BUILDING DIVIS10N'~>;o 'f:':j~;~';...
200 S.ANAHEIM BLVD"
(714)765-5153 ....
INSPECTION REQUEST L11'JE: ~"
(714) 765- 4626
CENSUS CODE: 555
.QUARTER SECTION: 211
DATE: 11/29/2004
JOB ADDRESS: .6930 E MICHIGAN CIR .
LEGAL DESCRIPTION: N TR 8377 LOT 26
./.
APPLICANT: JOH N SKIRZVNSKI . i
OWNER INFORMATION: CONTRACTOR INFORMA1rION:
Roger J Schaefer SHARP ROOFING . I
6930 E Michigan Cir 10782 S MEADS AVE U.
Anaheim Hiils,CA 92807 ORANGE, CA. 92869 01}~0" .
, BUSINESS PHONE: 714 77't0118
JOB DESCRIPTION: Tear off existing and reroof 19 squares with 50-composij~~h'sl1ingtes
VALUATION: 6;500.00 J " PROCESSED BY: SAM
L OWNER-BUIL~5tc:LARATION J
'hereby affirm under penalty of-perjury that I am exempffrom the ContractorI-iLice:ls6 taw for the folloWing re<1son (Ss9' ~'031.5 Business and ,_'
Rrofessions Code: any city or county which requires a permitto construct, aIt1t,r,:Cfrnptove, demOHsh.or repair any structiJie, 'prior tu its iSsuan~e, also
requires the applicant for such permit to file a sign~ -statement that he is licet.l-se~ pursuant to the,provisions of the Contractor's-License'Law(Ch;aptei- .
9)(commencing_withSe~tion, 7000 of Div!sion 3 of the Busin':'lss and _Professicf,S Code) o/that he is exempt th'3refrom and the basisforJ~e al-!eged-"
exemption. Any.violation of Section 7031.5 by any applicant for ~ perrn:f subjn?ts the applicant to a civil penalty, of not more than five'hundred d;~l!a,rs
~?)~S owner. of p~aperty,'or my em~oye~s with wages ps their. sole co",J...~I.\.~3tiO. n', will df) the. work,' and,th.8. slr~ct"re l< n~1 intend6d~'~ff.cr;~...;;..I.?.r
sale (Sec. 7044 BUSiness and Profess,lOns Code: The Contractor's LIcense l~iN does not appiy.to,an owner ot.property Wno' ,i,)U!lds or-Improves:;';~,_\:,
thereon, ,and who does such workhimsetf or herself or through his or her o:~.':r:~>rnploye<:>s, pro~lded that such Improvements'arc not i!1tended or:,>~>< .
o~ere~ fo~ sale:lf~ however, the.building or improvement is sold, with one V61f l)f complBtion. th~ owner-builderwil! ha~ the ~u~de~I.~t~~ov~~g't~~!,~?
o n~!:~~~~~~~~~~;~~.:~r J~o~~~~ ~:_::i~ely contracting with !iCensed:ttn'tracLors to constr~ct the ~rc~ect (Sec. 7044 '~USjn'~~~:'-~~~'~.:~f~ii~t~;
Code_: ,The.Contractor's, License Law does not apply to an owner of property'~b6 buUds or improves th\::lreot'l, and wh('l coni:ractsfcrsuch 'proje~t~:;~!th '
~ontr.actor{SJ lic.ensed pursu_ant to the Contractor's, li~!1se LaW)., '..' 'L' .. . -":,::,:,'f;~:?>"\'
)-.J 1~r'!le~emptunderSec., '_ ,B&P.C.forthisreason: _.-:.:, ___ .....
~,'.. . . WOR~;;'~ COMPENSATION DECLARATIONt~_ T L.!:ICENSEDCONn:U\CTO~ECLARATION
l.here~y affirm under penalty of-perju~ one of the following ~ecI2rations: .._ ','~: ,I. hereby 8fflrm L,;nder penaltf of, p rjur hatlam
o I have qnd will maintain a certificate of consent to self-insure for WOrker\1-.~;om'p(,nsation. licensed l,lnderprovi~jons or rhapt",(co t lericil1G' -'
ad. b S 3 L ad I Ih..t f A, ' . f wj~h SecUo!') ?{'OQ} of Divs. '3:of' s ' nd
, a~ proYid. . f?r y. ection. 700 of the aborC e, or epeilormanre,o, thriV..-OrK .orwh!ch I
thiS permIt IS ISSUed. . ii', Professions. Code.
.blt:)-have'andwill maintain worker~s' cornpensation,tn~ur.ance, as requirea n~';"'e.::tion 3700 of! 11/'2!:v.2004 _'
~ l".abor'Code, fOJ.tt",e perfor~ance of the work for which this permit is iSSuer:. ':.I) Myworker's II Date: ' 7
Compensation Insurance carrier and polley are: , f'
~~~:~\i:::: :N~ completed if Ihepennil IS bPo:~~~n:~~e;~1:85-02 ~~;I::oml
o I certify~hatin the perforrnanceofAhe workforwhichthl~ I r t.Is'issl ,}'~) shail r.ot I
emploY,any person in any manner so as to become ubjec the ark I' "o;spensat;on ia\rvs
of Cal.ifon1ia, and agree thatif I should become su Ct to iv ;to: .h?8tion
provislonsof Section 3700 of the Labor Code. sh fort ,;C'~~ provislo'!1s.' Construcicn Tvpes:
. r~i'- V N, .
Date: .11/29/2004 Applicant: ..___
WARNING: FAILURE TO SECURE WORK 'S COMPENSATION COVERj,QE IS .
UNLAWFU.L, AN.'D. SH. ALLSUBJ. ECT AN EMPLOYER TO. CRIMINAL PENAt..t...r...!"..s ". ND..CiVILI . .
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), ::. P-DDrr,fpN TO THE.. .
COST.OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION '~-.i06 .or.THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. . Ii.;.' .
I . .. COI\!STRUCTIONLENDING AGENCY .it_--::>I . .. ..
!hen::!by,affirmunderpen(3:1ty of I?erjurj.thatthereis 3_--(;Gn'5truc!jOi!~!'=Fx:!;ng,c:?~$\i)Yf:::r;..th3-_ "',' _I"", _' -,--, , :' '. , /
.'~'perrormaP."..:..",=,"'c,ttilf:'V:!6rK~tcr~ntci:fthjs'veffl"'~~w::..;~t~\pGreb:'3--G5t;~I~;J3:~~'~""- ".,.- ,,' '.. '-",---'-"":':'~-;:<-':;'--~i"'--:;"""'~~~'''''':--''---'--o-:-'''-~.
Lender's Information:
ARCHITECT/ENGINEER INFORMATION:
NUMBER
57-1575
TYPE
TYPE
. E'XPIRATION PATE
5/30/2005
C.39
Hfe
....',
I certify that I have read this appli ation 'and state that the ab'ove informationis correct. .I
agree to 'oomply with all I n es and state laws relating to bUllding construction, and
hereby authorize repre tives thi~ city to enter upon the above mentioned property for
ins ectio p se
Fees paid for Permit:
Tolal:
160.76
Dale: 11/29/2004
Signature of Applicant or Agent. .
he permit shafJexpire by limitation and become null and void if the I)ullding 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.
INSPECTION RECORD
" INSPECTION " DATE INSPECTOR
"
Temporary Power Pole ,
Plumbing (Drain/Waste Pipe)
Electrical Ground Elec\rodelUfer
SelbacklFormsrrrenches' (Footings)
Do not install subfloor or pour floor slab until the ,
following applicable items have been signed: '
P/umbing.(Wliter Pipe.Sprinkler Valves)
, Mechanical (Groundwork)' , "
Electrical (Underground Conduit) ,
, Pre-slab (CompactionlMembrane.Reint.j
Underpinning (Floor Joist/Girders)
Do not 'cover or conceal the work below untU the
following applicable items have been signed:
1st Floor Shear " '
Fiiesprinkler (Rough) , ' "
:lnd, Floor Shear , ,
Roof (Sheathing/Diaphragm/Frame) l!. ' --/-t:A.L '~
Masonry (Reinf./Bond BeamlPre-GlOUt) ( r
Rough Pll!rribing .(Top Out) , '
Rough Mechanical ,
Rougn l:IectrlCllI (""y ....III ,
Rough Electrical
Framing (Only'after f>lbg.. Elec.. Mech.. and Fi~e)
Insulation (SoundlEnergy)
'Do not tape or plaster until the following applicable ,
items h~ve been signed: _. " . '..
Drywall ' ,
Penetrations (Fire, Rated) Electrical
Penelralions (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath , ,
, GENERAL ITEMS -
Exterior Plaster (Bra;vn Coat) ,
T -Bar Electrical' ' ,
T -Bar Mechan,ieal' , '
T -Bar Structural ,
Sewer , , ,
Water Engineering Backflow ,
Water Service ,
.
FINAL INSPECTIONS Date Inspector
Electrical Final " " ,
Plumbing Final , . -"-')
"
Mechanical Final "
Gas Test
Engineeringll;>rading Final 765-5126 , ,
Fire Dept. Final 765-4040 ,
\!Vater Engineering 765-5268, ,',
Sub List/Business License 765-519 , " '
Zoning 765-5139 I "
, ,
Building Final' ~ast Inspection. Only ~l4 d ~
, fter Above Complete) 1. '~VI
PARTIAL INSPECTIONS
, BuildinQ Inspections
./ '
"-'
",
Mechanical Inspections
PlumbinQ Inspections,
Electrical Inspections