1735 Pheasant St.
CONTRACTOR INFOR~"ATION:
ROOFING STANDARDtic'.
301 N OBERLE PL
PLACENTIA, CA 92870 C')~O
. BUSINESS PHONE: 7~4 2-'i5~5497 .
JOB DESCRIPTION:Tear off~hake and install 27 squares of Eagle lite CO:>:WJilo Tiles 5.71bs ICBO # 5492
VALUATION: 9,000.00 PROCESSED BY: ODC .
.1 . OWNER-BUILD!:;, DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contraa$r'J License Law for the following reason. {Sec. 7031.5 Business and
ProfessionS Code: anydty or county which requires a permit to coristruct,~lt~t;. imprO\Je"demolish ,or repair any structure, prior to.lts issuance,' also
requires the applicant for such permit to file a signed statement that heis n~:eilsed pursuant to the provisions afthe.Contractor's License Law'CChapter
9)(commenclng with Section 7000 of Division 3 of the Business and Profes~:~ns Code} or that he is exempt therefrom and the basis forth"e alleged
exemption. Any violation of Section 7031.5- by any applicant for a perrr.jtsl,I'hJects the 'applicant to a,ovil penalty of not more tl1an five hundred do"ars
($500). .. ':, .. .
o I, as owner of property, or my employees with wages as their sole cOI"T;(')ensation. win dci the-wark, and the structure is not intended or offered far
sale (Sec. 7044 Business and Professions Code: The Contractor's Licerlsa L;;w does not apply to an owner of property who'buildsor improves
thereon, and who does such work himself or herself or through his or her o:;;;'!)cmployees, provided that such improvements are not intended or
offered for sale. If, however, the bUilding or improvement is sold with Oi'l~ :..~';;r of ccmpletion, the owner-builder will have the bLJ~~n of proving that he
did not build or improve for the purpose of sale). .'_
D I, as the owner of the propertY, am exClusively 'contrading with Iicen$03CI mntractors -to construct the project (Sec. 7044 Business and Professions
C~de: The Contractor's License Law does no~ apply .to an owner of proper..:.\who .buYds or improves'thereon, :mo who contracts for sum projeQts with
fi!J<o.ntractor(S),licensed,pursuant to the Contractor's, License L~w). ,,-j . - ,
U"I,9mexemptunderSec. _ . ,B&P.C.forthisreason: _i: . ' ,
Date: . 'awner: - ,
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarationc: ,
o I ,have '~nd will maintain a' cerli-ficate of oonsent to self-illSure for worker~ compensation,
as provided for by Section 3700 of the Labor Code, for the performanCe of ~L;..~ '/':011< for which
this permit is'issued.
o I have and will maintain worker's 'compensation insuranc~, as require!:: t /3ection 3700 of
the Labor Code, for the performance of 'the work for which this pe.rmit is:s::.l:~J. My wo"rker's
Compensation insurance carrier and policy are: '
Carrier: NO EMPLOYEES Policy Number. EXEMP'r
This sectio not be completed if the (iennit'is for one hundred dollars -i;1(i"~\ 2' less. .
. erlify that in the performance ,of the work for which this permit is'1~..:bc( I shall not
employ any person in any manner so as to become subject to the w6rk~~s't~:.mpensatjonlaws
of Califomia, and agree that, if., should become subject to the wor1<e!"'s ~qni~":;.ls3tion
provisions of Section 3700 of the Labor oz.e, I shall forthwith "'ri'PIYWit~fn.',"_$e provisions.
Date: 12/9/Z003 Applicant: . ,^^,"_Q. ~- L~ ~r- .
WARNING: FAILURE TO SECVREWORKER'S COMPENSATION COVE:!'{\GE IS '
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIM INAL f>:EIiI,*l TiES AM:> CIVIL
FINES UPTO ONE HUNDRED 11-I0USAND DOLLARS ($100,000),IN ,'\f,.t)i'i1~:JN TO THE
COST OF COMPENSATJON, DAMAGES AS PROVIDED FOR IN SECTi(Ji~! af06 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. .,.;
I . CONSTRUCTION LENDING AGENCY. ";':S:~,:
'I~er~~y :a.tfirm unde,~ ~na lty. of perjury. th~t ttlere. ~~_~~r~!fuctjo~,J~Jip:iPt~;lf~!.:;t~8~/fgrJh~, ,.
- ~;fOirf;a(lva~c;l"U'l~-lrivj;rfot'rlhiclnn;~'pei'rtiiilf"is~eti{Z;';;;c;'::-.;,){;i73.:',v.Cj:" ,1' -~. -'--- ,
Lender's Information: .'
~,.-
BUILDING PERMIT NO. BLD2003-04715
..-- ',~
,.
TYPE OF PERMIT CITY
Reroof
DATE: 12/9/2003
JOB ADDRESS: 1735 N PHEASANT ST
LEGAL DESCRIPTION: N TR 9149 LOT 64
APPLICANT: MIKE LEE
OWNER INFORMATION:
Herbert Reiner
1735 N Pheasant St
Anaheim, CA 92806
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765- 5153.
IN$P:=CTI6i~ REQUEST LINE:
(714) 765: 4626
CENSUS CODE: 434
. QUARTER SECTION: 130
. ARCHITECT/ENGINEER INFORMATION:
J
LICENSED CONTRACTORS DECLARATION---.l
I hereby affirm"under penalty.of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section'7000) of Divsion 3 of the Busin~!; an<;l.
Professions C~ _' n',' ," ~
12/9/2003 l..~ _ ~.
Dare: C~ntracror
NUMBER
741302
TYPE
TYPE.
~XPIRATlON DATE
10i31/2005
C39
HIC
Construcion Types:
VN" .
Fire Sprinklered?
l certify that I have rea' this <i!pplication ~nd state that the above information i, correct. I
_ agree to cqmpl . -all city ordinances and state laWs relating to building cl)r.struction, and
heJ'eb a lZe representives of this city-to e'nter upon the above mentioned property-for
insp IOn purposes. . Q ~
. .;" ^:... 9...., ~ .. ,------. . Date: 12/9/2003
. Signatur~ of Applicant or Agent
. The permit shall expire by limitation ami become null and void iUhe building or
work has n()tpassed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work. .
NO
'.,-,
Fees paid for Pennit:
Total:
195.65
INSPECTION RECORD,
INSPECTION . , ' , DAtE INSPECTOR
TemporarY Power Pole . '
Plumbing (DtainlWastePipe) ','
Electrical Ground Electrode/uter
SetbacklFornisfTrenches (Footings)
Do not install subfloor or pour.floor slab until the .
, fbllowingapplicable items have been signed:
Plumbing (Water Pipe.Sprlnkler Valves)
Mechanical (Grouridwork) .
Electrical (Underground Conduit)
PI'l!-slab(CompactionlMembrane:Rei nt.
Underpinning (Floor Joist/Gill:lers) , ,
Do not.cover or conceal the work belOW until the
following applicable items have been signed: .
1st Floor Shear , .' ,
Firesprinld.,. (Rough)
2nd Floor Shear
Roof (Slteathlng/DiaphragrWFralTll!)
Masonry (ReinfJBond BealTliPre-GrOut) , .. . ,
Rough Plumbing (Top Out) . "
Rough Mechanical .' .
Rough t:IectrlCaI (Dry wall) ,
Rough Electrical ,
, Framing (Only after Plbg, Elec. Mech. and Fire) ,
Insulation (SoundlE~rgy)
po'not tape or plaster until the.following applicable , ,
.tems 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 [}3te , Inspector '.
Electrical Final .. . ". ' ,
Plumbing Final , .,' .
'.
Mechanical Final " ,
Gas Test , .'
Engineering/Grading Final 765.0126 . .
.
Fire Dept. Final 765.4040 , "
,
Wat~r Engineering 765-526.8 . ,
Sub List/Business' License 765-519
Zoning 765-5139
Building Final~ilst Inspection. Only',
. , . fter Aba,ve Complete)" .
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections
Plumbina Inspections
Electrical Inspections
PER'M\1 EXP\REO .'
\NSPEC1\ON ..',
N01 'COMPLETED
. If .\ ~
o t>:f E ~..LfJ 1> ,.0 ,',', -'