1102 W. Park Ln.
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: 61
BUILDING PERMIT NO. BLD2005-o1324
DATE: 5/9/2005
J08 ADDRESS: 1102 W PARK AVE
LEGAL DESCRIPTlON:N TR 3794 LOT 22
CONTRACTOR INFORMATION:
GREAT WESTERN ROOFING
2.05 S BERKELEY CIR
FULLERTON, CA 92831..0.000
. . BWSINESS PHONE: 714738-5848
JOB D~~CRIPTION: Tear off. existing and reroof 37 squares with compo~itjon shingle
VALUATION: 14,000.00
I. . OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Lawfor.the following reason (Sec. 7031-.5 Business and
Professions Code: any city or county which requires a permit to construct, alter, improve, demolish or repaifanystructure, prior to its' issuance; also
requires the applicant tor such permit to file a signed statement that he is licensed pursuant to the p-rovisions of the Contr",-ctor'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 violatian of Section 7031.5 by any applicant for a P!3rmit $ubjec!s the applicant to a civil penalty of not more than five hundred dollars
~~ .. .
D I, as owner of property, or my employ.ees with wages as their sole comperu:ation, will do the wQrk, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contnictor's License Law doe.$ not apply to. an owner of property who builds or ir:nproves
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 campletion, the oWner~builder will have the burden of proving that he'
did not build or improve for the purpose of sale). ". . . . . .
o .1, as the owner of the property, am exClusively contracting with licensed Contractors to construct the project (Sec. 7044 Business and Professions
Code:, Tile Contractor's License Law does not applY to an owner of. property wro builds or improves th~reon, and who contracts for such projects with
~ontracto((s) licensed pursuant to the Contrac~or'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:
o I have and will maintain a certificate of consent to self~insure for worker'scompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which ~
this permit is issued.
t;3-I have and wiU ~aintain 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 carner and policy are:
Carrier: INDEPENDENT STAFFING SOLUTIONS Policy Number. ISS100010301
APPLICANT: JAY MOREAU
OWNER INFORMATION:
Calvin J Queyrel
1102 W Park Ave
Anaheim, CA 92801
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: JNJ
LICENSED CONTRACTORS DECLARATION
1 hereby affirm under penally of perjury that I am
licensed under provisions of chapter ,9 (commencing
with Section 7000)" of Divsion 3 of the Business and
Professions Code. .
5/9/2005
Date:
This section need not be completed-if the pennit is for one hundred dollars {$1 00) 0\ less.
o I certify that in the performance o.f the work for w~lch this permit is iSSU69.l shall not
employ any person in any manner so as to become subject to the worker's cotnpensatlon laws
of Calitdmia, and agree that if I shoulp bec:ome subject to the o'rker's compehsation
provisions of Section 3700 of the Labor: Code, I .sh forthwit co ply with those provisions.
Date: 5/9/2005 Applicant~
WARNING: FAILURE TO SECURE WORKE OMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TOONE HUNDRED 11-iOUSAND DOLLARS ($100,000), IN ADDITI,ON 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 that there is a construction lending ag.cr.;:;y for the
performance of the work for which this permit is i.ssued (Sec. 3097 .Civ.C):
Lender's Information:
NUMBER
361389
TYPE
EXPIRATION DATE
8/31/2006
C39
Construcion Tvpes:
VN, ,
I certify that I have read this application ar:d state that the above information-is correct. I
agree to comply with all city ordinances and $l:atelaws rel.;:tting to building construction, and
here-by authorize representives of this city to enter on the above mentioned property for
inspection purR s..
Date: 5/9/2005
Fees paid for Permit:
Total:
310.95
Signature of Applicant or Agent
e 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 coril,!,ence or continue work.
INSPECTION RECORD
. INSPECTION DATE INSPECTOR
Temporary Power Pole ..
Plumbing (DrainlWaste Pipe) .
Electrical Ground Electrode/Ufer . ..
SetbacklFormslTrenches (FooiiilgS)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe.Sprinlder Valves)
Mecha.nical (Groundwork) . .
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane.Reinf. . .
Underpinning (AoorJoistlGirdet:s). . .
Do. not cover or conceal the work below until the
following applicable items have been signed: .
1 st Floor Shear ..
Firesprinklet: (Rough) .
2nd Floor Shear . . n
Roof (Sheathing/Diaphragnv'Frame) . I~g.(j( ~.
Masonry (ReinfJBond BeamlPre,Grout)
Rough Plumbing (Top Out) .
Rough Mechanical . . .
ROugh eectric:llll&JrY ..all) ..
Rough Electrical
.Framing (Only after Plbg., Etec., Mech.. and F.ire) .
Insulation (SoundlEnergy) .
po 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 Coal) . .
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 Flpal T65.5126 .
Fire Dept. Final 765-4040 .. . .
.
Water Engineering .765.5268
Sub List/Business license 765-519'
Zoning 765-5139 ..
Building Final \tasrlnspeetion. Only. .s-/o/em- ~-&.
.. . Iter AbOve Complete)
... PARTIAL INSPECTIONS
. Building Inspections.
Mechanical Inspections
Plumbing Inspections
Electricallnsoections