2920 E. Miraloma
TYPE OF PERMIT C ITV
Reroof
"
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
, CENSUS COD!:: 555
QUARTER SE:bTION: 131
2</
BUILDING PERMIT NO. BlD2005-01005
DATE: 4/12/2005
JOB ADDRESS: 2920 E MIRA,LOMAAVE
LEGAL DESCRIPTION: 'EUCAL YPTUS FOREST TR LOT 18 ALL -EX
APPLICANT: AL SOUZA
OWNER INFORMATION: CONTRACTOR INFORMATION:' ARCHITECT/ENGINEER INFO.RMATION:
Harry'Rieger CONEX ROOFING COMPANY
2920 E Miraloma Ave 2011 N BATAVIA ST
Anaheim, CA 92806 ORANGE, CA 928650000
, BUSINESS PHONE: 714520-5207
JOB DESCRIPTION:Tear off existing roof and replace with 34 squares of 30 yaElf composition shingles and 29 squares of built-up roof.
VALUATION: ' 13,000.00
I OWNER-BUILDER DECLARATIONI ,
I hereby affirm under penalty of perjury that I am .exempt from the Co~tractor's; Ucense Law for the following reason (Sec. 7031.5 BUSiness and ".
Pmfessions Code: any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issLiance, also
requires the applicant for such permit to file a signed statement that he is licen!:;ed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7QOO of Divi.sion 3 of the Businessand Professions Code) or that he is exempt therefrom 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 mo(e than five hundred dollars
($500). .
o -I, as owner of property, or my-emp"Joyees witli wages as their sole compe,hsation, will do the work, and the structure is not intended or offered for
sale {Sec. 7044 Business and Professions Code: The Contra9tor's Ucense La'w does not apply to an' owner of property who builds or improves
thereon"and who does such work himself or: helSelf 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_
djd not build or improve for the purpose of sale). " "
D "I, as the owner of the property, am exclusively contrecting with licensed contractors to consfruct the project (Sec. 7044 Business and Professions.
Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts: for such projects with
,El..Qo.ntractor(s) licensed pursuant to the Contractor's Lioonse Law). '
U I am exempt under Sec. " , B & P.C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION i I
I hereby affirm under penalty of perjury one of the 'following declarations: . \. .
o 'I have and will'maintain acertificateofconsentto self-insurefOrWOrker'~lcompensation.,
as provided for by Section 3700 of the Labor, Code, far the performance 01 the/work for which
Ih. permit is issued. . i
I have and W, ill maintain worker's compe, nsation insurance, as required bY~,.S,ecuon 3700 of 4/12/2005
Labor Code.. for the performance of the work f~:>r which this permit is issue~'1. Myworker's Date:
,Compensation in,su~ance carrier and policy are: "' i '
Carrier: STATE COMPENSATION INSURANCE PoHcyNumber. 1799501-2004 '
This section need_not be cOmpleted if the pennit is for one hundred dollars {$100}:or less."
o I certify that lnthe performance_ of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the workers cm'npensation laws
of California, and agree that if I should become subject to the worker's compe,nsation
pro~isions of Section 3700 ~f,the Labor Code, I shjP fort ith comply with th1e provisions,
Date: 4/12/2005 Applicant: ~--1:- ,
WARNING: FAILURE TO SECURE ORKER'S COMPEN ATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJEC AN EMPLOYER TO CRIMINAL PENAL.:TIES AND CIVIL
FINES UP TO.ONE HUNDRED TH USAND DOLLARS ($100,000), IN ADDlmON TO THE
COST OF COMPENSATION. DAMAGES AS PROViDED FOR IN SECTION, $706 OF THE
. LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
'hereby affirm under penalty of,perjury that there is a construction. lending agency for the
performance of the work for which this permit isissu,ed (Sec.3097.Civ.C):,
-L-et"4e:'$~nfo~mation~ . . ----~----
PROCESSED BY: MSM
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
J icensed u nde provision!? of chapter 9 (commencin'g
with Section OO)ot Oivsion 3' 0 the Business and
Profession ode.
NUMBER
753053
TYPE
EXPIRATION DATE
8/31/2006
C39
Construcion Tvpes:
VN, ,
Fire Sprinklered?
NO
I certify that I have read this application and state that the above information is correct J
agr e to comply with all city ordinances and state laws relating to building construction, and
her y authorize representives of this city to enter upon the- above mentioned property for
i ion p rp?~s.
",4. Date: 4/12/2005
Signature of plicant or Agent
The permit shall expire bY limitation andbecome null and void if the building or
work has not passed fi naJ inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
Fees paid for Permit:
Total:
312.28
.'
. ~....
'INSPECTION RECORD
,INSPECTION . ' DATE INSPECTOR,
T.emporaryPower Pole ,',) . .
Plumbi ng (Drain/Waste Pipe) "
Elecirlcal Ground Electrode/OIer
SetbacklFormsfTrenches (Footings) .
Do not install sub floor .or pour floor sl"b until the
fOllowing applicable items have. been signed:
Plumbing (Water Pipe.Sprinkler Valv,!!s)
Mechanical (Groundwork) .
I:lectrlcal (Underground Conduit)
Pre-slab (Compactlon/Membrane.Rei nt.
Underpinning (Floor Joist/Girders)
Do not cover or concealthe work belOW unltl the
following applicable items have been signed:
1 st Floor Shear .
Firesprinkler (Rough)
2nd Floor Shear. (\ , /.
Roof (SheathiIl!llDiaphraQln/Frame) '1/IQ/o<1 c"'" 't,.vV ','
Ma$onry (ReinfJBondBeamlPre-Grout) c..._
Rough Plumbing (Top Out) .
Rough Mechanical .'
Rough Electrical ,1/
Rough Electrical .
Framing (Only after Plbg.. Elee.. M~Ch.. and Fire)
Insulation (SoUndlEnergy)
po, not tape or pla~ter un,til 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
j:xterior Plaster (Brown Coat)
T -Bar Electrical .
T.-BarMechanlcal .
T -Bar Structural
Sewer
Water Engineering Bacldlow
Water Service . ,
FINAL INSPECTIONS , . Dale Inspector
Electrical Final .
Plumbing Final' ,
Mechanical Final
Gas Test .
Engineering/Grading Final, 765-5126 ..
Fire Depl Final'765-4040 .
Water Engine&rlng '765-5268
'Sub ListlBuslness license 765-519
Zoning 765'5139' . J ,
Building Final ~ast Inspection, Only W""~r- I. .
. .' fter Above Complete),' '-.~/<...
PARTIAL INSPECTIONS
ections
Mechanica/lnsoections
Plumbinalnsoections
Electricallnsoections