3940 E. Miraloma Ave.
CONTRACTOR INFORMATION:
MESA ROOFING CORPORATION
2550 E MIRALOMA WAY
ANAHEIM, CA 928060000
BUSINESS PHONE: 949548-3012
JOB DESCRIPTION:Tear off existing and reroof 82 squares with BUR
VALUATION: 20,000.00
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Ucense Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, 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 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 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 License 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
did not build or improve for the purpose of sale).
D I, as the owner of the property, am exclusively contracting with licensed contractors to construct 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
p...qontractor(s) licensed pursuant to the Contractor's license law).
U I am exempt under Sec. , B & P.C. for this reason:
Date: Owner:
I WORKER'S 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 performance of the work for which
this permit is issued.
J<t>1 have and will maintain worker's compensation insurance, as required by Section 3700 of
't""'fie labor Code, for the performance of the work for which this permit is issued. Myworker's
Compensation insurance carrier and policy are:
Carrier: STATE Fl ND
BUILDING PERMIT NO_ BLD2005-03154
TYPE OF PERMIT CITY
Reroof
DATE: 9/30/2005
JOB ADDRESS: 3940 E MIRALOMA AVE
LEGAL DESCRIPTION: P BK224 PG 17 PAR 17
APPLICANT: DiRK CANNIZZARO
OWNER INFORMATION:
BENDER TIN
3940 E MIRALOMA AVE
ANAHEIM, CA 92806
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 154
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: JNJ
Policy Number. 639-0000102-03
This section need not be completed if the permit is for one hundred dollars ($100) or less.
o I certify that in the perfonnance 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 worker's compensation laws
of California, and agree that if I should becom subject to the worker's compensation
provisions of section 3700 of the Labor d, I shall forthwit comply with those provisions.
Date: 9/30/2005 Applican
WARNING: FAILURE TO SECURE AGE IS
UNLAWFUL, AND SHALL SUBJEC AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDI"nON 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 t~a~_ there is a construction lending aQ~ncyfor the
performance of the work for which this permit is issued (Sec.3097 .Civ .C):
Lender's Information:
I certify that I have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to building construction, and
herebyauth rize representives of this city to enter upon the above mentioned property for
inspecti urposes.
Date: 9/30/2005
Signature of Appli nt or Agent
permit shall expire by Urn tion and become null and void If the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new Dermit is reauired to commence or continue work.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000 of vsion 3 of the Business and
Professions Cod /7
9/30/2005 {/-
Date:
NUMBE
564151
TYPE
TYPE
EXPI RATION DATE
413012007
Contractor
HiC
C39
Construcion Tvpes:
VN, ,
Fees paid for Permit:
Total:
569.89
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/uter
SetbacklFormslTrenches (Footings)
Do not install sublloor or pour 1I00r 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 ,
Roof (Sheathing/Diaphragm/Frame) 1", oJ I,) 01A^, le,
Masonry (Reinf./Bond Beam/Pre-Grout) ,
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. 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
Water 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 Lisl/Business License 765-5194
Zoning 765-5139
Building Final (Last Inspection - Only III, ',~ I- pt-u {}
After Above Complete)
PARTIAL INSPECTIONS
Buildina Insoections
Mechanical Inspections
Plumbina Inspections
Electricallnsoections
BUILDING PERMIT NO. BLD2005-03344
TYPE OF PERMIT CITY
Miscellaneous
DATE: 10/21/2005
JOB ADDRESS: 3940 E MIRALOMA AVE
LEGAL DESCRIPTION: P BK 224 PG 17 PAR 17
APPLICANT: SUSAN THOMSON
OWNER INFORMATION: CONTRACTOR INFORMATION:
BENDER TIN FACILITY BUILDERS & ERECTORS
3940 E MIRALOMA AVE 2903 S SATURN ST #C
ANAHEIM, CA 92806 BREA, CA 928210000
JOB DESCRIPTIONAdd entrance structure and stone veneer
VALUATION:
15,000.00
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 154
ARCHITECT/ENGINEER INFORMATION:
HOWARD PARSELL
4854 MAIN STREET
YORBA LINDA, CA 92886
PROCESSED BY: MJL
OWNER-BUILDER DECLARATION
here ya irm under pena yo perjury t at am exempt rom t e on tractor's cense w or t e allowing reason ee. 7031.5 BusIness and
Professions Code: any city or county which requires a permit to construct, 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 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 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 110t intended or offered for
sale (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 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
did not build or improve for the purpose of sale).
o I, as the owner of the property, am exclusively contracting with licensed contractors to construct 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
fl..!(ontractor(s) licensed pursuant to the Contractor's License Law).
U 'am exempt under Sec. , B & P.C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certificate of consent to self-insure for worker's~ompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the'work for which
this permit is issued.
~ I have and will maintain worker's compensation insurance, as required by Section 3700 of
t Labor Code, for the pertormance of the work for which this permit is issued. Myworker's
C mpensation insurance carrier and policy are: I
C rrier: STATE FUND Policy Number. 1713742
This section need not be completed if the pennit is for one hundred dollars ($1 00) or less.
o I certify that in the 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 corppensation laws
of Califomia, and agree that if Is uld become subject to the worker's compensation
provisions of Section 3700 of e La Code, shall - rt w. h comply with those provisions.
Date: 10/21/2005 Appllcan
WARNING: FAILURE TO SECU ORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJ CT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED OUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, AMAGES AS PROVI DED FOR IN SECTION 3706 OF THE
. LABOR CODE, INTEREST I', D ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lendiny agency for the
performance of the work for which this permit is issued (Sec. 3097 .Civ.C)< ;
Lender's Information:
I certify that I have react this application and state that the above information IS correct. I
l'lgree t mply with :all city ordinanC13S and stRte raws relatil10 to building con$truction. and
hereb t orize representives of this city to enter upon the above mentioned property for
nsp' r . L-<1A"'~'
WlUVVI..Q Date: 10/21/2005
Signature of Applicant or Agent
mit shall expire by limitation and become null and void if the building or
work s not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
LICENSED CONTRACTORS DECLARATION
ere ya ITrn un er pena 0 perjury t at am
liCensed under provisions of chapter 9 (commencing
with Sec' 7000) of Divsion 3 of the Business and
Professio e.
Construcion Types:
VN, ,
Fire Sprinklered?
EXPIRATION DATE
4130/2007
B
YES
Fees paid for Permit:
Total:
387.16
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Uler
SetbacklFormsfTrenches (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 JoisVGirders)
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
Roof (Sheathing/Diaphragm/Frame)
Masonry (Reinf./Bond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. 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
Water 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 LisVBusiness License 765-5194
Zoning 765-5139
Building Final (Last Inspection - Only II , It [)1.4f1
After Above Complete)
PARTIAL INSPECTIONS
Building Inspections
Mechanicallnsoections
Plumbing Inspections
Electrical Inspections
TYPE OF PERMIT -'"
Tenant Improvement (Limited) C IT,Y,.
DATE: 7/25/2005
JOB ADDRESS: 3940 E MIRALOMA AVE
LEGAL DESCRIPTION: P BK 224 PG 17 PAR 17
ElM
BUILDING DIVISION
200 S, ANAHEIM BLVD,
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 437
QUARTER SECTION: 154
BUILDING PERMIT NO. BLD2005-01561
APPLICANT: SUSAN ANTHONY
OWNER INFORMATION: CONTRACTOR INFORMATION:
BENDER TIN FACILITY BUILDERS & E'RECTORS
3940 E MIRALOMA AVE 2903 S SATURN ST #C
ANAHEIM, CA 928060000 BREA, CA 928210000
JOB DESCRIPTION,enant improvement, 3,778 sf office
70,000,00
ARCHITECT/ENGINEER INFORMATION:
JOSEPH H VERTREES
532 LAMBERT RD
BREA, CA 00000 0000
PROCESSED BY: DEF
OWNER-BUILDER DECLARATION
I here ya Irm un er penalty 0 perjury t at am exempt rom the on tractors License w or the following reason ec.7031.5 usiness and
Professions Code: any city or county which requires a permit to construct, ali~r, 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 lice>lsed pursuant to the provisionsof the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professi~'lns Code) O( that he is exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subects the appJicant to a dvll penalty of not more than five hundred dollars
~~. .
D I, as owner of property, or my employees with wages as their sole comp!'ll1sation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License L.iW 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 owr employees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one yea of completion, the owner-builder will have the burden of proving that he
did not build or improve for the purpose of sale). !
o I, as the owner of the property, am exclusively contracting with licensed ~f}ntractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of property ,,,ho builds or improves thereon, and who contracts for such projects with
fUfontractor(s) licensed pursuant to the Contractor's License Law).
U I am exempt under Sec. , B & P.C. for this reason:
Date: Owner:
I
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following dectarations:
o 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 performance of the'Work for which
this permit is issued.
~ 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 issuer. Myworker's
Compensation insurance carrier and policy are:
Carrier: STATE FUND Policy Number. 1713742
LICENSED CONTRACTORS DECLARATION
ere ya Ifm un er pena yo perjUry t at am
licensed der provisions of chapter 9 (commencing
with S io 00) of DiVSiO~h~ B:siness and
Professio 'C d . \., VltlLCY(
Contractor
This section need not be completed if the pennit is for one hundred dollars ($100) (II' less.
D I certify that in the 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 worker's cOIT'pensation laws
of California, and agree that if I shaul become subject to the worker's compemation
provisions of Section 3700 of the La or ode, I shall forth 'th co ply with those provisions.
Dale: 7/25/2005 Applicant(::::.
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALT,ES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3,'06 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES,
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agercyfor the
performance of the work for which this permit is issued (Sec.3097.Civ.C): L
I_p."'!dcr'~ !n~0rmGtivil:
NUMBER
610072
TYPE
EXPIRATION DATE
4/30/2007
B
Construcion Types:
"N, ,
ccupancy Groups:
B, , , ,
Fire Sprinklered?
T.I.Area:
YES
3,778
I certify that I have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to building construction, and
hereby orize representives of this city to enter upon the above mentioned property for
insp Ion rpose.
Date: 7/25/2005
Fees paid for Permit:
Total:
4.716.52
y
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 issuance. A
new permit is required to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION
DATE
INSPECTOR
Temporary Power Pole , 1
Plumbing (DrainiWaste Pipe) . N{Z/~J Dtv...J{v
Electrical Ground Electrode/Ufer I I /
SetbacklFormslTrenches (Footings) Yhl/.;r jJ ZU ?e
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
Roof (Sheathing/Diaphragm/Frame)
Masonry (ReinfJBond Beam/Pre-Grout)
Rough Plumbing (Top Out) Z'llhi pm JG
Rough Mechanical IU!'" // 7UW
Rough Electrical (Dry Wall) &') . '/. 1J_ Le-
Rough Electrical ,.
Framing (Only .ft~e" Mec. And Fire) l/zt/oi I)r Ji. ~'J,
Insulation (Sound/Energy) Pitt/a. Pi/It 0.'7
Do not tape or plaster until the following applicable
items have been sign'ld: f
q/{/ /0'\ JJ7A- (f
./ I
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 . \ h
T-Bar Mechanical I" L , ~ '
T-Bar Structural I'
Sewer
Water Engineering Backflow
Water Service
lv, Ir
11 / fV(; Vt/
FINAL INSPECTIONS
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 Inspactlon - Only rrf f j
After Above Complete) I (
IJ~U
PARTIAL INSPECTIONS
Buildino Insoections
8h~~ O:~~~}b~~!k1/
~/r)j"r (/;7;;.( I" '>,Jdo'>', {]>7fivC~.$
Mechanicallnsoections
Plumbing Insoections
Electrical Inspections
w
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PUBLIC WORKS DEPARTMENT FEES
-~ TRAFFIC ENGINEERlNGFEES--
:~~~~~:~C>~~~t~=M-~'~.~Y ~ .
SIZE: ~ I ~) S p- /Nl::; '", Oe- ~ I c:.-..
TRAFFIC SIGNAL FEES: '3 2. -r...7 - c:,.) - f
279-412-F724-3017 0'"
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~ TRANSPORTATIO~IMPACT AND IMPROVEMENT FEES:
278-412-F724-1818 "I. t: f - . yO) 2.' I L..( , , .
ot>
-
73:;
~
o TRAFFIC SANTA ANA CANYON FEE:
278-412-F724-2001
o EASTERN TRANSPORT A TION CORRIDOR FEE:
101-412-F724-6704
COMMENT: ~ S '<l z:r-, 1:::..l
REVIEWED BY: ALFRED YALDA (714) 765-5183 A '\
--DEVELOPMENT SERVICES FEES--
b~ tr I\~ (dS-
DATE: 1 ,
RlGHTOFWAY REVIEWED BY DATE:
o OLD ZONING CODE (i.e. in plan check or entitlement prior to July 8, 2004)
o NEW ZONING CODE
DEDICATION
CREDIT
STREET IMPROVEMENTIREP AIR
SEWER CONNECTION FEE
ACCT #
CITY SEWER ASSESSMENT
ACCT #
DRAINAGE ASSESSMENT FEE
ACCT #
GRADING:
WATER QUALITY MANAGEMENT PLAN (WQMP)
LAND SUBDIVISION:
REVIEWED BY: