140 S. Pueblo Place
CONTRACTOR INFORMATION.
T & G ROOF REMOVAL
960 ENTERPRISE ST
ORANGE. CA 928670000
BUSINESS PHONE: 714637.1530
JOB DESCRIPTION:Tear off existing roOf and replace with 26 squares of eagle!i!etile ICBO# 4660.
VALUATION: 10AOO.00
I OWNER-BUILDER DECLARATION.
I hereby affirm" under penalty o.f perjury that I am eXE.lmpt from t~e Contrador'!~ License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any-city or county which requiresa permit to construct, alter, improve, demolish or repair any structure, prior-to its issuance, also
requires the applicant for such permit to file a signed statement that he is licerlsed pursua-nt to the provisions ofttie Contractor's License Law (Chapter
9)(commencing"with Section 7000 of Division 3 of the Business and Professi0ns Code) or that he is exempt therefrom" and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant-for a permit subf1Cts the applicant to a evil penalty of not more than five hundred dollars
($500). .. .. . ,. . .' .
o I, as owner.of pr9P~rty, or my employees with wages as their sole compJosation, will do the work, and the structure is not ili~ended or offered for
sale (Sec. 7044 Business and Professions Cod~:, The Contractor's'license L~w does not apply to an owner of property:who builds or improves
thereon, and who does sum wOrk himself or herself orthrough his or her owdemployees, prOVided that such implOvementsare not intended or
offered for sale. if, however, the building or improvement is sold with,one ye'i'r of oompletion, the owner-builder will have the burden of proving 'that he
did not build or improve for.the purpose of sale). . ~; , . ,,' .
D _I. as the owner of the property, am eXdusively cpntrading with Iicensed'?O:1tract.ors to construct the project (Sec. 7044_Business arid- Professions
Code: The Contractor's license l~w does not apply to an owner of property\vho builds or improves-1hereon, and who oontracts for sum prOjects with
~ontractor(s) licensed pursuant to the Contractor's license Law),
LJ I am exempt under Se'c. " 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- ma !ntain a ce'rtificate of oonsent to' se If-i nsure fo r worker''S' cc,mpensation,
~s rovided for by Section 3700 Of the LabOr Code, for the performanoe of th~w0l1<.for which
thi :permit is issu_ed. . .. .'. .', ,. .
j I. have and will maintain worker's com.pensation insurance, as required b.1 S~ction'3700 of
t ,LaborCqde, for the performance of the work for which this permit is issu~. Myworker's
C mpensation insurance carrier and. policY are: . ':
C rrier: STATE FUND Policy Number. 238-0001315
BUILDING PERMIT NO. BLD2005-00807
TYPE"OFPERMIT CITY
Reroof
DATE: 3/2512005
JOB ADDRESS:. 140 S PUEBLO PL
LEGAL DESCRIPTION: N TR 5778 LOT 8
. APPLICANT: TOM CARSTENSEN
OWNER INFORMATION:
.Warren A O'Avirro
140 S Pueblo PI
Anaheim. CA 92807 .
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REOUESTLlNE:
(714) 765.4626
CENSUS CODE: 555
QUARTER SECTION: 197
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: DUC
~
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury thaU am
licensed under provi~ions of chapter 9 (commen . 9
with 8ection7000) of DWs' 3 of the Busin
Profession de.
3/25/2005
Date:
This section. need not be completed if~e pe,nnit Is for one hundred dollars ($10CI_or less,
o I certify that in .the_ perfonnance of the work for which this permit is issued, .' shall not
employ any person in a'ny manner so as to become subject t9 the worker's c~lmpensation laws
. of Califomia, and agree that if I should beCome su to the work pensation
prOViSions of Section 3700 of the labor Code.. I 0 hwlth th thJ. ovisions.
NUMBER
657689
TypE
TYPE
C39
HIC
EXPIRATION DATE
10/31/2006
Construcion Types:
VN" .
Fire Sprinklered?
NO
Date: 3/25/2005 . Applicanl:
WARNING~ FAILURE TO SECUR 0
UNLAWFUL, AND SHALL SUBJECli AN. MPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED lHOUSAND DOLLARS ($100,OOO),I!'I ADDIT!ON TO THE
COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SI;CTION 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 construction lendjnga~encyforthe
performa'nceof the work for which -this permit is issued (Sec. 3097:Civ.C):
Lender's Inforr1)ation:'
.-e~________.,_;l.
Date: 3/25/2005
Signature of plicant or Agent
The mit shall expire by limitation a!1dbecome null and void if the building or
work has not passed final inspection 365 days from tlie date of permit issuance. A
new permit is required to commence or continue work.
Fees paid for Permit:.
Total:
235.87
INSPECTION RECORD
FINAL INSPECTIONS,
ectrical Final
umbing Final"
echanic'al Final
as Te,st
ngineeringlGrading Final 76505126
re Dep!. Final 765-4040
ater Engin....ring 765-5268
ub Li,st/Business License,765-519
oning 765-5139
uilding Final (Last Inspection- Only
, , After Above Complete
PARTIALI!'lSPECTIONS
uildina Inspections
Date
Inspector
INSPECTION DATE INSPECTOR EI
,
Temporary Power Pole PI
Plumbing (DrainIWaste Pipe) M
Electrical Ground Electrode/lifer', ' G
SetbacklFormsfTrenches (Footings)
Do not installsubfloor or pourtloor slab until the,' , E
following applica,ble items haye been signed:
Plumbing (Water Plpe.Sprinkler Valves) Fi
Mechanical (Grollndwork) W
Electrical (Underground Conduit) ,
Pre-slab,(CornpactlonlMembrane.Reinf. S
Ul)dilrpinning (ROOJ: Joist/Girders) Z
Do nolcover or conceal the worl< below, unlU the '" B
following applicable items have been signed: '
1st Floor Shear
Flresprinkler (Rough) ,
2nd Floor Shear, , .d B
~..b.k
Roof (Sheathing/Diaphragm/Frame) ;;.: , ' ",
Masonry (ReinfJBond BeamlPre-GlOllt) , , ,
Rough Plumbing (Top Out) "
Rough p,iJechanical
Rough ElectrICal all)
,Rough Electrical ,
Framing (Only after Pfbg.. Efec.: tAech.. and Fire} f ' ,
Insulation (SoundlEnergy) , M
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 , ' ,
Inie,rior Lath
Exterior Lath ' ' PI
GENERAL ITEMS ,
Exterior Plaster (Brown Coal)
T .Bar Electrical ,
T-Bar Mechanical . "
T -Bar Structural . , "
Sewer ' ,
Water Engineering Backflow EI
Water Service
,
~
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..-
eChanicallnspections
umbina Inspections
ectricallnspections