2617 Paladin Ave.
TYPE OF PERMIT
Reroof
"
CITY
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714)765-4626.
CENSUS CODE: 434
QUARTER SECTION: 125
BUILDING PERMIT NO.
BLD2005-00697
i.
DATE: 3/14/2005
JOB ADDRESS: 2617 E PALADIN AVE
LEGAL DESCRIPTION: N TR 4030 LOT 61
CONTRACTOR INFORMATION:
BIENEK ROOFING CO
22622 LAMBERT ST #303 "
LAKE FOREST. CA 92630 0000
BUSINESS PHONE: 949 951'-3798
JOB DESCRIPTION:Tear off existing material, install 1/2" OS8, 151bs felt and~6 squares of 30 year composition shingles.
i.
VALUATION: 9,000.00 "
I OWNER-BUILDER'bECLARATION
I hereby affirm under pena~ of perjury t.hat I am exempt from the Contractoq.License Law tor the following reason (Sec. 7031.5 Business and
P-rofessionsCOde:. any dty or county which requires a permit to constr'uct, aMr, improve; demolish or repair any structur~f prior to its issuance, also
requires.the applicant for such permit to fife a signed statement that he is lic'e'b,sed pursuant -to the provisions of the Contractor's '-icense Law (Chapter
9)(commer:'cing with Section 7000 of Division 3 'of the. Business and Profess~s Code) o'r that he is exempt therefrom and the basis for the alleged
exemption. ,Any violation of Section 7031.5 by any applicant for a permit subj,hct3 the a pplicant to a dvU penalty of not more than five hundred dollars
($500): . ,. . . . ), .
o (-as owner of property, or my employees with wages as their sole compJnsati-':lI""!, will do the work, and the structure is not intended or offered-for.
sale (Sec. 7944 Business and Professions Code: The Contractor's License L~w does not apply to an owner of property who builds or improves
thereon, and who does such' work himself or herself or through his cr her oWIJ'empicyces,-provided that such impiOvements are 119t intended or .
offered for sale. If, however, -the building or improvement is sold with one ye"fr of completion, the ow'ner-builder wi,ll have the burden of proving that he
did not build or improve for the pu !pose of sale). _;t / _ '
D I, as the owner of the property, am exdusively contra.ding with ficensed _f:ntractors to construct the project (See. 7044 Business and Professions
Code: The Contractor's License Law does not apply to-an OiNner of pr9pertyyho build3 or improves thereon" and who contraCts for such proje~ts with
~ontractor(sJ licensed pursuant to the Contractor's license Law). '3, . .
. U I am exempt under' Sec.. . ,6 & P.C. for this reason:' .
Date: Owner: 'I.
e WORKER'S COMPENSATION DECLARATION -~L_=--.l
I hereby affirm under penalty of perjury one of the following declarations: !
o I have and will maintain a certificate of oonsent to self-insure for worksr's,compensation,
as provided for by Section 3700 of the Labor Code, for the performance of th~,vvork fer which
his ermit is issued. ~
~ I have,and will maintain worker's compensation insurance, as required bJ{-Sec~!on 3700 of
teL: bar Code, forthe performance of the work for which this permit is issu{~jJ... My worker's
Compensation insurance carrier and policy are: ,~
Carrier: STATE FUND Policy Number. 169162FgCC3
. - - - I
~iS section need not be completed if the pennit is for one hundred dollars ($100}:Qr :ess.
I c~rtify that in' the, performance of the work for Which this pe'rmit is issueS;; I shall not
, mp y any person in any manner so as to become subject to the worker's cc:r;1pensation laws
of California, and agree that if'l s ould become subject.to the worker's comM~sation
provisions of Sec~ion 3700 of the bar C e, I~sha" forthwith comply with tr!~<~e provisions.
APPLICANT: BRIAN OHALLORAN
.OWNER INFORMATION:
Nasim T Nesheiwa.t
2617 E Paladin Ave
Anaheim; CA 92806
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: ENO
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
license nder provisibns of chapter 9 (commencing
with Secr 7000) of Oi 'on 3 of the Business and
Professions ad .
EXPiRATION DATE
. 7/31/2006
C39
Date: 3/14/2005 Applicant: _ '<-
WARNING: FAILURE TO SECUR KER'S COMP ... .~:" I
UNLAWFUL, AND SHALL SUBJE TAN E OYER TO CRIMINAL PENAL.tIES AND CIVIL
FINES UPTO ONE HUNDRED OUSAND DOLLARS ($100;000), IN ADDJtlO~! TO THE
COST OF COMPENSATION, ;/IMAGES AS PROVIDED FOR IN SECTION}705 OF THE
'LABOR CODE. INTEREST D ATTORNEY'S FEES. .
ONSTRUCTION LENDING AGENCY . ,
~~reb'lLaff.jrm_und_eL.peo:'a lty__oLp_er.lu-ryJb:?lj~ there.Js...a_constructioo.lendin~:L~.:...0_I1C:Y for.the
performance' of the work for which this permit is issued (Sec.3097 .Civ.C):
Lender's Information:
Construcion Types:
VN, ,
Fi~e ~prinklered?
NO
. ate: 311412005
Fees paid for Permit:
Total:
310.45
Signa u Applicanlor Agent
permi s all expire by limitation and become null and void if the building or
w k-has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or contin~e work.
INSPECTION RECORD
. INSPECTION . . DATE. INSPECTOR
Temporary .Power Pole .
Plumbing (OrainM'aste f>ipe) .. .
Electrical.Ground Electrode/uter .
SetbacklFormslTrenches (Footings). . .
Do not install sUbflqor or pour floor slab until the
following applicable items have b.een signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit) . . . .
Pre-sl"b (Compaction/Membrane.Reinf. .
Underpinning (Floor Joist/Girders) . .
Do not cover or conceal the work below until the . .
following applit"ble items have been signed: ..
1.sfFloor Shear .
FireSprinkler. (Rough) .
2nd Floor Shear ,. . .
Roof (Sheathing/Diaphragm/Frame) . . 3/M()~
Masonry (ReinfJBOnd B!>amlPre-Gl"O\It) , .. ..
Rough Plumbing (Top Out). :
Rough Mechlll)ical
. 1 ROugh ElectrICal (ury Wall) .
Rough Elecirlcal .
Framing' . (Only afterPlbg.. Elec.. Mech and Fire) .
Insulation (SoundlEnergy)
Do not tape Or plaster until the following applicable
ite~s have been signed:, '.
Drywall . .
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical .
Penetrations (Fire Rated) f>lilmbing , .
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 L.istIBusiness License 765-519,
,
, ,
Zoning 765-5139
Bu. i1di'ng Final (Last Inspection- Only ,1_, I k::1l\, 1/:.,
)\fter Above Complete) r-:l/zv~ [OJ UI 0
, PARTIAL INSPECTIONS ,.. JI/
Buildinalnspectioris
Mechanical Inspections
,Plumbina Inspections
Electrical Inspections