223 Sagamore
TYPE OF PERMIT CITY
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BlVD.
(714) 765 - 5153
INSPECTION REQuEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 162
BUILDING PERMIT NO. BLD2005-03288
DATE: 10/11/2005
JOB ADDRESS: 223 N SAGAMORE ST
LEGAL DESCRIPTION: N TR 4476 LOT 20
CONTRACTOR INFORMATION:
DALE'S ROOFING, INC
13781 NEWHOPE STE
GARDEN GROVE, CA 9284,30000
BUSINESS PHONE: 714534 6398
JOB DESCRIPTION:Tear off existing material, install 24 squares of 30 year GAF shingles to house and attached garage.
APPLICANT: DALE MILLER
OWNER INFORMATION:
REALTY C I NGE
12461 HARBOR BLVD
GARDEN GROVE, CA 92840
ARCHITECT/ENGINEER INFORMATION:
VALUATION: 4,800.00
I OWNER-BUILDER DECLARATION
I hereby affIrm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a 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 licensed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt thefBfrom and the basis for the alleged
exemption. MY violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).
o I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's license Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or hemelf or through his or her own employees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one year of completion, the owner~bujlder wlll 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 exclusively contracting with licensed contractors to construct the project {Sec. 7044 Business and Professions
Code; The Contractor's License law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with
~ontractor(s} licensed pursuant to the Contractor's License Law).
U 1 am exempt under Sec. ,B & P,C. for this reason:
Date: Owner:
I
PROCESSED BY: END
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certificate of consent to self-insure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
G I have and will maintain worker's compensation insurance, as required by Section 3700 of
~Labor Code, for the performance of the work for which this permit is issued. Myworker's
Compensation insurance carrier and policy are:
Carrier: STATE FU ND
Policy Number. 285-01 UNIT 0001446
LICENSED CONTRACTORS DECLARATION
I here y affirm under penally of perjury that I am
licensed under provisions of chapter 9 (commencin
with Section 7000) of Di 30t e au 'ness
Professi Code
~:r'hiS section need not be completed if the pennit is for one hundred dollars ($100) or less.
certify that in the perfonnance of the work for which this permit is issued, I shall not
m loy any person in any manner so as to become subject to the worker's compensation laws
of Califomia, and agree that if I should become subject to the orker's comp ation
provisions of Section 3700 of the Lab Code, I r fo w' co with e provisions.
NUMBER
503508
TYPE
TYPE
EXPIRATION DATE
12/31/2006
HIC
C39
Date: 10/11/2005 Applicant:
WARNING: FAILURE TO SECURE RK COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJE AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED OUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION AMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST ND ATTORNEY'S FEES.
/ CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the
pertormance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information;
Construcion Types:
V N, ,
Fire Sprinklered?
NO
I certify that I have read this application and state that the above information is correct I
agree to comply with all city ordinances and state laws relating to building construction, and
hereby authorize. re nti s of this city nter upon the above mentioned property for
insp ion p 0 s.
Date: 10/11/2005
Fees paid for Permit:
Total:
244,87
ignature 01 Applicant 0 Agent
it shall expire by limitation and become null and void if the building or
work s not passed final inspection 365 days from the date of permit issuance. A
new permit is reauired to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
SetbacklForms/Trenches (Footings)
Do not install sublloor or pour 1I00r slab until the
following applicable items have been signed:
Plumbing (Water PipelSprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Condull)
Pre-slab (CompactlonlMembrane Reinf.)
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable Items have been signed:
1st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (SheathinglDiaphragm/Frame) ib, U/I \' JAA>"wY.;v- {
Masonry (RelnfJBond Beam/Pre-Grout) I I
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
Insulation (Sound/Energy)
Do not tape or piaster until the following applicable
items have been signed:
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Flre 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 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 L1st/Buslness License 765-5194
Zoning 765-5139
Building Final (Last Inspection - Only 1"{~~ -~(,6
After Above Complete)
PARTIAL INSPECTIONS
Building Inspections
MechanicallnsDections
Plumbing Inspections
Electrical Inspections