572 S. Paseo Carmel
TYPE OF PERMIT
Reroof
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CITY ;;ti' "iN_HElM
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BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 186
3J-
BUILDING PERMIT NO. BLD2004-04171
DATE: 11/16/2004
JOB ADDRESS: 572 S PASEO CARMEL
LEGAL DESCRIPTION: N TR 8533 LOT 42
APPLICANT: ARSENIO AGUSTIN
OWNER INFORMATioN:
ARSENIO AGUSTIN
572 S Paseo' Carmel
Anaheim, GA 92807
JOB DESCR1PTION:Tearoff existing roof and replCiCG with 25 squares of e3g(.~lite tile :CBO# 460.
VALUATION: 15,000.00);
I OWNER-BUILDER'OECLARA TION
I h~re_by affirm under penalty of perjury that I am exempt from the 'C9ntrac~oi~s.'l,.icens13 Law for the fol_lowing reason (Sec. 7031.5 Business and ..
Professions CCxle: any, dty or ~oun.tywhich requires a pGrmit to construct, aii$:", :ri1prove, demolish or relJair any structur~, prior to itsissu:.mce, also
r~qu, ires the ~pplic:.ant for ~uch per~it ~I ~l: a Sign~state.m,.'er.t that ':e is n~?~n~ed p~r$uant t~ the'pro\'i5i~n~ ~fthe C,~ntractGr's Li~e~~~.~~w,{Chapter
. 9,(commenclng With SectIon 7000 of DIVIsion 3 of tne Bus!ness and Profess~l)i1$ Cooe) or that he IS exemrt therefrom and the baSIS lor the'alleged
exemptio~\ Any violation of Sectior~ 7~3".5by any appli~a~t !or a permit su'qleds the appHcant tc'a dv:~ penalty of not more than five hundred dollars
~, ($':..?).~~',m.vner of property, or my employees with woge, s as th~ir sole cor"~(","otio,n. will oothe work, and ti,e'strudure isnot intendedo;, otiered fo,
E" (Sec.. 7044 Bus,iness and Profess:ons Code: The Contractor's,Ucei1se I]2:w does not apply to an owner of prOpGltY who bUil9,S or impro'Jes
ereon,.and who does such work hilT15etf or hemelf or th;ough his or her.o~'lit.empivvees, l..irovided that,sLicrllf""m:rovemonil:> a(e not int&nded'ol
offe~ed for sa'le. If. however, the b'J!lding. or improv'3ment i$soJd with ?fl(? ~"~!H' ':)f corrjlk;tioli, the owner-buildN Viill hay~) the !:mde,; of pro'".jng thet he
did"riot t;>Ulld or iniprove for the pwpose ofsare). " J . . ,.'
o "",,: as t OVi r 0fthe property, am exdu i contmding :with Hcens :\-0otracttori3 to construct t:,e pro;ect (Sec: ,(jl~, ~usiness ar.d Prcf,,!;sioi l!i
COdE::" T ~.C9ntra r's\.LicenSt3. La '{J e.<:.! t2ppiy 0 an own€.[ ofF:' 'erty,w bl!i!ds crj..llproves th~recn, and '^'h,o contract~ for t,I.ldl,proJeds,'wio:h
~ontr ttor(s) Jicen~.:. ant.t th C ,tractor!,; . ense La )" . .",' .
LJ I e ptu derSec. _~B&P.c.forfl-'1 ~o.. __________.__.____.
Dat... Owner:
L RKER'S C MPENSATION DECLA;;'IJQ.tL-=j:-==-~! r LICE~,~Sf:D.'t..:~)NTR.~GT;R~ l)ECi..AR.~~Oi~-i'
i hereby ".ffirm und,er' penaJty of'pedu.'Y one of the following decl<'\ratiol:.s:. CTT1~re:::):-.~ftTiin t,;nd(~tpenojiy of perjuri !h~'"
o ., have and.V{ilI mairitain-a'ce~i~catecf conssnt to $aif.jn$~Jrl:;.to~ wprkt..,(~j ,;o,r'p&l1c;ation, I licensed u.nCler prb.".i::;~')n<; cf c:-;apter 9 (commencJng
as provided for by Sectioh 3700 dthe Labot" Code, for the perfonnarn':e <::ft!i.J ;Ncrk forwhir-h I with Section 7000) ::::; D;'lSion ~ cf the Busine3s Cind
!his.permit isissued. , ' . :';'. ,I Profe$s[olls C0r.!e. '.
o ! have a nd will maintain worker's compensa:lor. insu:ance, a~ requiffjd bJ Sedion 37(IV of I 11/16/2004 _____.
the Labor.Code. for the performa:lce of the work fUl" ~hich this ~rmji b ;!"'5L':~tJ: :'V1Y'vVotKei'S i. Date'
CompensatiQn insurance carrier and policy are: .' I
Carrier:" Poli("j Number. NUl\,~8ER
,
CONTRACTOR INFORfvi(,TION:
I
\
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: MSM
Contractor
EXPIRATION DATE'
j;hi section need.not be completed !ftha permj~ i~-ror one hur;,jted dO"2~S ($il1P:;or ;es~.
, ,i certify that in tl:le perforTn.:lt'lce ofthe wCirKfcr which ttl~ i-lermiUs !ssu~93;'1 shaH'.pot
e, loy~ny person in:any manner' so a,s to becctne SUbJect to the wo "s ~{':';lpE:nSat ' !.' t~ws
of Califomia" and agree that if ! sh , . ecorne svbject to the DIke s com f~sativi( '<
provisions. of Sec!iOri 37~O oft~ ._abo!" de, J shail forth'" h 0 Jy withth. <>oruvi5ions:
Date: 11/16/2004 Appli nt: V , '
WARNING: FAILURE TO S CU~RKER't; COMPENSATION CO'JER..\G~ is
UNLAWFUL, AND SHALL S "CTAN f;MPLOYER TO CR:MINAl PEi'!A' m:s AND CIVIL
FINES URTO ONE HUNDRED'THOUSAND DOLLARS (~1GO,'\OO), IN ADC,:TlON TO THE
COST OF OOMPENSATION, DAMAGES AS PROViDED FOR iN S ECTI or.! 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
L CONSTRUCTION LENDING AGENC~
I hereby affirm under penatty of perjury that there is a consfrtJctior:!e;lr1i:1g a~.;e!lcy for the
performance of the'work for whiCh this permit!s issued (3ec.3097 .Civ.C): ,.
,G:;-,,~,j.er'sJ....j-c.':i:rr>~licn:,," "_'C-' __1-_
TYPE
~strucion Types:
$prinklered?
NO
I certify that I, have read this application and state that the above,information j~ correct. I
agree to oomply'with.atl city ordinances an state-laws relattng IO OOilding construction, and
. her ya o' e represent.ives of this ci t 'enter upon the above mentioned property for
i s,~cti npur s. .
Fees paid for Permit:
Total:
236.33
Date: 11/16/2004
Signature of Applicant or Agent
The ermitshall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of perlllit issuance. A
new permit is required to commence or continue Voiork.
INSPECTION RECORD
INSPECTION . DATE INSPECTOR
Temporary Power Pole .
. Plumbing-.(DrainlWaste Pipe) .
Electrical GroundElectrodelUfer
SetbacklFormsrrrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items. have been signed: .
Plumbing (Water Plpe.SprinklerValves)
Mechanical (Groundwork)
Electrical (Unde'llrouhdConduit)
Pre-slab (Compactlon/Membrane.Rei nt.1 .
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the.
follow;ng applicable items have been signed: .
1 st Floor .Shear . '. .
Firesprinklel' (Rough) . .
2nd Floor
. Roofi!Sheat!liAll1"DiaphragmlFrame) 111~ If
Masonry (ReinfJBond BeamlPre-Grout) . .
Rough .Plumbing . (Top Out)
Rough MechanIcal .
Rough ElectrICal (Dry Wall)
Rough Electrical
Framing (Only after pfbg.. Elec.. r...1ech.. and Fire)
. Insulation (SoundlEnergy)
pO not tape or plaster until the following applicable
Items-have been Signed: '., . .
Drywall . . ,
Penetrations (Fil'! 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/Gradin!! FinaI765.o12~ . .
Fi~e Dept. Final 765'4040
Water Engineering 765-5268
Sub List/Busi'ness License 765-519 .'
Zoning 765-5139 .
Building Final ~ast Inspection- Only if/gcC --rd..,. ,
fter Above Complete) .
PARTIAL INSPECTIONS Il/L ~
,. ....
Buildina Inspections
Mechanical Inspections
Plumbinq Inspections
Efectricallnspections