7141 Scenic Cir.
TvP/;'OF PERMIT
Reroof CITY
DA TE: 3/~/2005
JOB ADDRESS: 7141 E SCENIC CIR
LEGAL DESCRIPTION: N TR 8516 LOT 35
ElM
BUILDING DIVISION
200 S: ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
. QUARTER SECTION: 216
BUILDING PERMIT NO. BLD2005-00607
CONTRACTOR JNFORMATION;
CAL STATE ROOFING
1095 MAIN STREET
ORANGE, CA 927030000 !
. BUSINESS PHONE: 714813-7736
JOB DESCRIPTION: Tear off existing and reroof 19 squares with light weight tile @5.8Ib/sq leBO 2656
VALUATION: 6,500:00 PROCESSED BY: JNJ
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty 'Of perjury that I am exempt from the Contrac:tor'$ License Law for the following reason. (Sec. 7031.5 Business and
Professions Code: any dty, or county which req_uires.'a permit to construct, alt~r. improve, demolish or repair any structure, prior to its issuance, also
requires the applicant for sudl permit to file a signed statement that he is licer.!$eci pursuant to the plOvisions'ofthe Contrador's license law (Chapter
9)(commencing with Section 7000, 'Of DiVision 3 of the Business and Professions Code) or that he is -exempt therefrom and the basis for the atleged
exemption Any violation of SeCtion 703'1.5 by any appli'cant for a permit subnk.~ts the applicant to a dviJ pena~yof not more than five hundred dollars
($500). . . . . .....
o I, as owner of propertY, or my employ,ees with wages as their sole compe.nsation, will do the work, and the structure is not intended or offered for
saJe(Sec. 7044 Business and Professions Code: TI"!e Contractor's License L~w does not apply to an owner of property who bullds or improves . "
thereon, and who does suCh Work himself or herself or through his or her own}~mployees, provided that such improvements are not intended or
offered far sale. If,_ however, the building or improvement is sold with one yea; of completion, the owner-builder will have the burden of proving that he
did not bu ild or improve for the purpose of sale). ;, "
.0 I, as the oW':ler of the property, am exdusive/y contracting with licensed i~;)ntractCirs to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License ~wdoes not apply to an. owner of propertyvrho bu~(ds or improves thereon, and wro oontracts for sum projects with
~ontractor(s) licensed p~rsuant to the-Contractor's License Law). . i .
U I am exempt under Sec. . ,B'&P.C.forthisreason:
Date: Owner:
t WORKER'S COMPENSATION DECLARATION
(hereby affirm under penalty ot" pe~ury one o~ the following declarations:
o I have and will maintain a ~ertifrcate qf oonsent to'self-insure for worker's,:::ornpensation.
as provided for by Section 3700 of.the L?lb9r Code, for the performance ofthe.'/<Iork for which- .
this permit is issued, {
~. have and will maintain worker's compensation insurance, as required by~Section 3700 of
the Labor Code, for the performance of the work for which this permit is issued: My worker's
CompensatiolJ insurance carrier-and pOlicy are: . . . J~
Carrier: 16779166-03 Policy Number. STATE F :"D
This section need not be completed if the perm.\.;s for one hundred dollars ($10ij) ';,itess.
o I certify thatin the performance ofthe wo'r~ for which this permit is isSued~ l~hall not
emploY,any person in any manner so as to become subject to the wpr~er's coMpensation laws
of Califom.ia, and agree that if I should become subject totl:te weiker' "corOPensation .
provisions of Section 3700 ofth_e Labor Code, I shall. forthwith~P with t~~;.E~9-Vi~iOn$.
Date: 3/8/2005 Appli"" . .
WARNING: FAILURE TO S UREWORKER'S OMPENSATlON COVERAGE IS
UNLAWFUL, AND SHALL' BJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUND ED THOUSAND DOLLARS ($100,000), IN ADDP'ION TO TI:iE
COST OF COMPENSATION, DAMAGES'AS PROVIDED FOR IN SECTION ~706 OF THE.
LABOR CODE, INTEREST .AND ATTORNEY'S FEES.
.1 CONSTRUCTION LENDING AGENCY
I hereby.affirm IJndE'r ~~nalty of,pRrjUry fr..at there i<; a r.:onsTJ';tloo !p.~v.-.Q 3<;~Y :~! ~:~
perfor~nce of the work for whidl this permit is i.ssued (5e6:3097.Civ.C):
<lender>s Information:
APPLlCANT:.FRANCISCO LAGUNAS
OWNER INFORMATION:
M8sih Azizi
7141 E Scenic Cir
Anaheim,CA, 92807
ARCHITECT/ENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARATION
I nereby affirm under penalty of perjury that I am
licensed under provisions of chapte'r 9 (commencing
with Section 70 ) of Divsion 3 of the Business and
~::;;~ons e. 1- c~i~l
NU"MBER EXPIRATION DJc
801616 1113012005
TYPE . C39
TYPE HIC
Construcion Types:
VN, ,
, .
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 bu ijding construction, and
herebyauthorize're otiveS. of this ~.t:'?nter upo. n the above mentioned property for
insp dlen purposeS: '_ /
------ . .~. Date: 3/8/2005
Signat re of Applicant .or Agent
The mitshall expire by limitation and become null and void if the building or
IN k has not passed final inspection 365 days from the date of permit issuance. A
n w permit is required to commence or continue work.
Fees paid for Permit:
Total:
160.76
INSPECTION RECORD
. INSPECTION . . DATE .INSPECTOR
Temporary Power Pole'
Plumbi ng (DrainlWaste Pipe) .
Electrical Ground Electrode/Ufer .
SelbaekfFormslTrenChes (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler \'lI/ves) '.
MechariiCal (Groundwork)
Electrical (Underground Conduit) .
Pre-slab (Compaction/Membrane.Reinf.: '.
Underpinning (Floor Joist/Girders) .
Do not cover or conCeal the WOrk below untnthe
following applicable items have' been signed:
1 st Floor Shear
Firesprinkler (Rough) .
2nd Floor Shear 'J .
Roof (Sheathing/Diaphragm'Frame) . ''''W--tl~
Masonry (ReinfJBond BeamlPre-GlOUt)
Rough Plumbing (Top Out) r .' .
Rough Mechanical
Rough ElectrICal Jury nail) .
Rough Electrical
Framing (Only aher Plbg.. Elec.. Mech.. and Fire) .
Insulation (Sou ndlEnergy) . .
Do not tape or plaster unti.1 the following applicable
items have been signed: . .
Drywall .
PenetratlOll$ (Fill! Rated) Electrical
Penetrations (Fire Rated) MeChanical
PenetrationS (Fire Rated) Plumbing
Interior Lath . .
Exterl.or Lath . .
GENERAL ITEMS
Exterior Piaster (BlOWn 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/Grading Final 765-5126 .. .
Fire Dept. Final 765-4040 .. . .
Water Engineering 765-5268 '.
. .
Sub list/Business License 765-519 .
Zoning 765-5139 .
Building Final Itast Inspection. Only '-1508 j4 .
fter Aba... Complete)
PARTIAL.INSPECTIONS ..
.. Buildina Inspections
Mechanical Inspections
Plumbina Inspections
.. Electrical Inspections