5889-5891 Mountain Loop Trail
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:
BUILDING PERMIT NO. BLD2005-03725
DATE: 11/23/2005
JOB ADDRESS: 5889 E MOUNTAIN LOOP TRL 4
LEGAL DESCRIPTION:
CONTRACTOR INFORMATION:
BIENEK ROOFING CO
22622 LAMBERT ST #303
LAKE FOREST. CA 92630 0000
BUSINESS PHONE: 949951-3798
JOB DESCRIPTION:Tear oft existing. replace 112" OSB as needed. and reroof 28 squares with Ealgelile liie ICBO 4660 @ 5.8; Includes Ihe address range
VALUATION: of 58~;6881>bMounlain Loop Traii PROCESSED BY: JNJ
I OWNER-BUILDER DE,CLARATION
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 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 ProfessionsCode) 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, wlll 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).
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
a contractor(s) licensed pursuant to the Contractor's License Law).
D 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
~rmit is issued.
g-rnave 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: STATE FU ND
APPLICANT: PAUL GREG ROW
OWNER INFORMATION:
PAUL N CHMIEL
5889 E MOUNTAIN LOOP TRL
ANAHEIM, CA 92807
ARCHITECT/ENGINEER INFORMATION:
Policy Number. 1691621-2003
NUMBER
651509
TYPE
7
ThiS section need not be completed if the pennit is for one hundred dollars ($100) or less.
o f 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 compensation laws
of California, and agree that i I should become su tt 0 the wo r's co ion
provisions of Section 3 0 f the 0, aU hwith c Iy Jth those provr' s.
C39
Dale: 11/2312005 A
WARNING: FAiLURE TO SEC RKER'S CO
UNLAWFUL. AND SHALL SUBJECT AN EMPLOYE
FINES UP TO ONE HUNDRED THOUSAND DOLL
COST OF COMPENSATION. DAMAGES AS PROVi ED FOR I SECTION 3706 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 agency for the
performance of the work for which this permit is issued (Sec. 3097 .Civ.C):
Lender's Information:
Construcion Types:
VN. ,
Date: 11123/2005
Fees paid for Permit:
Total:
244.93
plicant 0 Agen
mitatio nd become null and void if the building or
spectio 365 days from the date of permit issuance. A
mmence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
'SetbacklForms/Trenches (Footings)
Do not install subfloor or pour floor slab untilthe
I following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
IMechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
Underpinning (Floor Joist/Girders)
I Do not cover or conceal the work below until the
following applicable items have been signed:
,1st Floor Shear
'Firesprinkler (Rough)
,2nd Floor Shear
IRoof (Sheathing/Diaphragm/Frame) 1\\1JllO(" '1" . Ac.KooV-
Masonry (Reinf./Bond Beam/Pre-Grout)
IRough Plumbing (Top Out)
Rough Mechanical
IRough Electrical (Dry Wall)
Rough Electrical
IFraming(onlY after Plbg., Ele., Mec. And Fire)
'Insulation (SoundlEnergy)
I Do not tape or plaster until the following applicable
items have been signed:
,Drywall
Ipenetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
I Penetrations (Fire Rated) Plumbing
Interior Lath
I Exterior Lath
GENERAL ITEMS
I 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
Cross Connection Control (714)7654280
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 ~1 ~t I@V~
After Above Complete) c..
PARTIAL INSPECTIONS
Buildin!llnsoections
Mechanicallnsoections
Plumbina Insoections
Electricallnsoections