120 W. Simmons Ave.
BUILDING PERMIT ~\
i '
.
TYPE OF PERMit
Reroof
~
BLD20C5:-a0612
,
CITY
, DATE: 31912005
JOB ADDRESS: 120 W SIMMONS AVE
LEGAL DESCRIPTION: N TR 6184 LOT 5
APPLICANT: GLEN BRINAGH
OWNER INFORMATION:
Rufino P Lasala
'120 W Simmons Ave
, Anaheim, CA 92802
BUILDING DIVISION
200 S, ANAHEIM BLVD,
(714) 765" 51,53
'INSPECTION REOUESTLlNE:
(714) 765 - 4626 '
CENSUS CODE: 434'
QUARTER SECTION: 89
ARCHITECTIENGINEER INFORMATION:
CONTRACTOR. INFORMATION:
,ADAMS ROOFING ~D CONTRACTING
1572 MARSHALL LN
CORONA" CA 917190000 ;
BUSINESSPHONE: 909279-':>472 , '
JOB DESCRIPTION:Tear off wood shake, Install7l16~ OSB, 30 Ibs felt, and1esquares of 30 year composition shingles,
VALUATION: 6,200,00 PROCESSED BY: ENO
I OWNER.BUILDER DECLARATION
I hereby ~ffirm under pena.1ty of perjury that J am exempt from the Contractor';> License Law for the following reason (Sec. 7031.5.ausiness and
Professions Code: any city or county-which requires-a permit to construct, c:s.~~r; improve, demolish or repair any structure, prior to its'iss!-,ance,.alSo
requires the applicant for such permit to file a sig:ned statement that he is liCe1sed pu.rsuant-to the previsions ot-the Contractor's license, Law (Chapter
9).(t;Ommencing with Section 7000 of Division 3 of the Business.and Professk'ns Code) or that ,he is exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for if permt subjects the applicant to a civil Penalty of nut more than 'five t1undred dOllars
($500), , '; " ,
.0 I, as owner of pro~rty, or my employees. with wages as their sole compi;.nsatiory, will do the work, and the ~tructure 'is not intendecfor offeredfo~
sale (Sec. 7044 Business and Professions Code:' The Contractor's License li3.w does not apply to an owner of property who builds or improves
ther~on, and who does such work himself or h.erself qr ~hrQUgh hi~ .or her owrl' employees, provided that such improvements are not intended. or
offered for sale. If, hOwever, the building or improvement is sold with one yei,r of completion, the own.er';'buDder wPl have the burden of proving that he
. did not build or Improve for th~ purpose of sale). . !
O. I, as the owner oithe property, am exdusively contracting with licensed"!;ontractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License lawdoes not applY, to an owner of property'fiho builds or improves thereon. and who contracts for such projects with
~ontractor{s) licensed pursuant to the Contractor's' License' law). i .
U, I am exempt under Sec" , - ,B.& P.C. for this reason: I
Date: Owner: !
I WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penalty of perjury .one .of the following declaration.s: ,\ '
o I have and will maintain a certificate of o::msent to self~jnsure forworker'd'colnpensation, .
as, provided for by Se~ion 3700 of the.Labar.Code, for th.e performance ofth~wcrk for which
,this permlt is is'sued, .. ;'j
(i' 'I have, and will maintain worker's compensation insurance, as requiled b,~ Sectio,' n 3,700 of 3/9/2005
(thi:J.,LaborCode, for the performance of the work for Which this permit is issu~ij. .My worker's Date:
Compensation insurance carrier and policy are: . .1 .
Carrier: STATE COMP INS, CO, Policy Number.- 285-02 tJl~ iT 0002071 '
I
, ,
.. . ,
. This section need not be completed if ~e pennit is for one hundred dollars ($1 Oof~riess.
~ certify that in the perfonnance of the work for'which this permit is i.$Sue(I~:rshall not :
employ any person in'any manner so as. to becrim s bject to the worker's coHrpensationJaws
ot Cal ifo mia, and agree that jf I should be e 50 to the worker's compehsation
provisions of Section 3700 .of.the L or ode, I s I rthwithco Iy with th.~~e provisions.
Dale: 3/912005 Applicant:, ,
WARNING: FAILURE TO SECU WORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJ CT'AN EMPLOYER TO CRIMINAL PENALTIES ANDCiVIL
FINES UP TO ONE HUNDRE 6USAND DOULARS ($100,OOO), IN ADDITION TO THE
COST OF COMPENSATION AMAGES AS PROVIDED FOR iN SECTION 3706 OF THE
LABOR CODE, INTEREST D ATTORNEY'S FEES,
CONSTRUCTION LENDING AGENCY
NUMBER
652470
TYPE
TYPE
TYPE
EXPIRATION DATE
8131/2006
B
HIC
C39
Construcion Types:
VN, ,
Fir~ Sprinklered?
~ H-,ereby.affirin l!rde,!: _!kilty cf.pe!'"jury t~t there is a CO!"l..bir'..!.Ct!on _Iendir"!{:! a2~nc'Y fo!' the
performance ofthe'work forwhidl this permit is issue'd (Sec.3097 .etv.C):
lender's Information: '
Date: 3/912005
7 Signa ure of Appllcan or gent
ermit shall expire by limitation and become null and void if the building or
wor has not passed finalll1SPection 365 clays from the date of permit issuance, A
new permit is required to commence or continue work. '
NO
Fees paid for Permit: .
Total:
160.73
INSPECTION RECORD
INSPECTION
Temporary Power Pole
Plumbing (DllIiniWaste Pipe)
eieclrical Ground Electrode/uter
SetbacklFormslTrenches (Footings)
Do not instal! sub loor or poudloor slab until the
following appliGable itel)ls have been signed:
Plumbing (Water Plpe.Sprinkler Valves)
Mech3nical (Groundwork)
Iectri!:a1 (Underground Conduit). .
re-s ab{Compac:tionlMembrane.Rei
. Undllrpinning (Roar JoistlGirders)
Do not rover or oonceal the work elow un!. the
following applicable itel)ls have been signed:
1st Floor. Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof Sheathi Di hili m1Frame A
Masonry.(ReinfJBond 8eamlPrQ-Grout)
Rough Plumbing (Top Out)
Rough Me!:hanicai
Rough ectrical al
Rouh Electrical
Framing -{Only after Plbg., .EJec,. r,,1ech., and Fire}
InsulatiQrl (SoundlEnergy)
Do not tape or plaster until the following applicable
items have been signed: '
Drywall.
Penetrations (Fife Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations {Fire Rated) Plumbing .
Interior Lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Browh Coat)
T -Bar Electrical
T-Bar Mechanical
T -Bar Structural
Sewer
Water Engineering Backflow
W er Service .
DATE
INSPECTOR
FINAL INSPECTIONS -, ,
Electrical Final
PlUmbing Final
Me!:hani!:al 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 ./Last InspeCtion- Only. d. Mo ""..
Alter AbOve Complete) :;ny-..
PARTIAt.INSPECTIONS.
BuildinQ Ins~ctions.
p-~'il. Inspector
MechanicallnSDections
Plumbina InSDections
ElectricallnsDections