443 S. Paseo Serena
BUILDING PERMIT NO. BLD2005~00150
TYP&OF PE:l<MIT
Reroof
DATE: 1/19/2005
JOB ADD~ESS: 443 S PASEO REAL
LEGAL DESCRIPTION: N TR 8220 LOT 56
APPLlCANT:DANIELBURNS '
'OWNER INFORMATION:' CONTRACTOR INFORMATiON:
Gregory R Erikson BURN S DANIEL ' .
443 S Paseo Real 9892 COLONY GROVE
Anaheim, CA 92807 VILLA PARK, CA 9266700)0
JOB DESCRIPTION: Tear off existin9 and install 38 squares of B.U.R.
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 198
ARCHITECT/ENGINEER INFORMATION:
VALUATiON: ' 8,500.00, ,'I. PROCESSED BY: ErvfA
I: , ' . OWNER-BUILDERtoECl.ARATION ' ,,'. ,
I hereby affiqn under penalty of perjury that J am exempt from the Contrago{'s Lic~l1se~~)~w' for the following reason (Sec. 7031.5 Business and
Professions Code: any otyer countywhich requiresa permit ~o construct a1?er,!rr:prove, demolish or repair any structure. pri<,)r to its issuance, also .
requires the applicant for such permit to. file a signed statement that he iglic~\;l~d pur~'uarit to the provisiQns of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Profess-rSns Code) orthat he is exempt therefrom and the basis for the alleged .
exemption. .Anyviolation of Seetio,n 7031.5 by any applicant for a: permitsutletts the applicant to a'dv~ penalty of not more than five hundred dollars
($500). ",.
o -I, as owner of properi'/; or my,,~inployees with wages as their sole com~ns2t:on" will do the work, and the structure is not intended or offered for
sale-(Sec. 7044 Business and Professlons Cede: The Contractor:s license lbw'does not apply to an owner of pr.oIJl'":rty who builds or improves
thereon, and who does such work himself or herself or through his or her owh cmpio}'ees,provided that suCh improvements are not intended or
offerea for sale. If, however, .the buitd'tng or improvement is sold with one yt-"'~' of wmpletio!'\_the ^ovmer-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 exdusively contr"c1ctingwith Iicensed';c::mtractorsj9;construet the proj~ct (Sec. 7044 Bll"siness and,Professions
Code: The Contractor's License Lawdoes not apply to an o\'vner of property1who bui":ds"br Improves thereon, and who oontracts for such projects with
a -contractbr(s) lic'ensed pursuant to the Contractor's license L'aw). .
o ! am exempt undei Sec. __ ,-8 & P.C. forth is reason:
Date: Owner:' i
I WORKER'S COMPENSATION DECLARATION -' ,~
I hereby. affirm under penalty of perjury one of the fOllo\ying declarations:
o ,I have and will maintain a certificate of consent to self-insure for worker';'; compensatio~,
as provid r by Section 3700 of the labor Code, for the performance of (h~'.....ork for whidl
this it is issued. '
have and will maintain worker's compensation insurance, as required c;,; Section 37QOof
the. Labor Gode, for the performance of the work for which this permit.is iSSU~'d" i\:iywvrker's
Comp~nsation insurance carrier and policy.are: . f
Carrier: STATE FUND Policy Number. 1627556'
This section need not be completed if the pennit is for one hundred dollars ($10~ or lass.
o I certify that in the performance of ork for which this permit is issued, I ~hall net
.employ 'any person in any manner s as to b come . e to he worKers cOmpensation laws
of ,Califomia, and agree that if I sh uld beeo sub' to h orker's't;:ompensation
provisions of Section 3.700, ofth e l or Code, I ~] rt comply With th~se provisions.
Date: 1/19/2005 Applicant: '
WARt~ING: FAILURE TO SEClJEWORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES. AND CIVIL
FINES UPTO.ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDiTION TO THE. .
COST OF COMPENSATION, DAMAGES'AS PROVIDED FOR IN SECTION ~3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I . CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a con-struction lendil19 ag~'ncY;for the
performance of the work for which jhis permit is issued (Sec. 3097 .Cw.C):' -
Lender's Information: ' ,
1
LICENSED
I here affirm u
iicensed nder provisi
with SeC\ion 7000) of
Professioh(.: .
1/19/2005
Date:
NUMBER
462067
TYPE
TYPE
CTORS DECLARAT!ON
er penalty 0 perjury that I am
ns of (commencing
ivsio u'sinessand
,
Conti8ctor
EXPIRATION DATE
8/31/2006
L1C
HIC
ConstruCion Types:
VN, ,
Date: 1/19/2005 '
267.70
Signatu e 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.C9mmence or c~ntinue work.
Fees paid for Permit:
Total:
INSPECTION RECORD
. INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe) .
Electrical Ground ElectrodelUfer . .
SelbacklForltl!\lTrenches (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.
Underpinnlnll (Floor Joist/Girders) .
Do not cover .or concealthe work below unlil the
following applicable items have been signed:
1 sl. Floor Shear. . .
Firespriilkler (Rough) .
2nd Floor Shear ,
Roof (Sheathing/Diaohragm/Frame) "?h-bc -;/
Masonry (ReinfJBond BeamlPre-GlOlltl ..
Rough Plumbing (Top Out)
Rough Mechanical .. . -:-
.Rough E1ectr nail) .
Rough Electrical
Framing (Only after Plbg..-Elec.. r>~eCh.. and Fire)
Insulation (SoundlEnergy)
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 Sen/ice . . ..
FINAL INSPECTIONS Date Inspector ..
Electrical Final . . .c....-., :.'. .
Plumbing Final .
Mechanical Final .
Gas Test. .
Engineering/Grading Final 765'5126 ..
.
Fire Dept. Final 765-<1040 .
Water Engineerin.g 765-5268 .
Sub.List/Business License 765-519 . .
. .
Zoning 765-5139 .. . .
Building Final ~ast Inspection- Only }/t{Pi A-:;,o[.
fter Above Complete}
PARTIAL INSPECTIONS ',{ I .1
JfI"J~v
Buildina Inspections.
Mechanical Inspections.
Plumbina Inspections
Electrical Inspections
-.