513 E. Simmons
TYPEOFPERIVIIT CITY
Reroof.
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 99
BUILDING PERMIT NO. Bi.D2005-03092
DATE: 912712005
JOB ADDRESS: 513 E SIMMONS AVE
LEGAL DESCRIPTION: N TR 3945 LOT 6
CONTRACTOR INFORMATION:
WESTMINSTI:R ROOFING CO INC
9612 SUTHERLAND WY
GARDEN GROVE, CA 928440000
BUSINESS PHONE: 714541-5351
JOB DESCRIPTION:Tear off existing materiai, install 27 squares of claymax tile 10 house and atlched garage. ICBO #3523 5.8Ibs. per tile.
VALUATION: 10,200.00 PROCESSED BY: ENO
I OWNER-BUILDER O'ECLARATION
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 tor such permit to file a signed statement that he is Iicen~;ed 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 therefrom and the basis for the alleged
exemption. Any 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 Ucense Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own E1rnployees, 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-builder will 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 ccntractors 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 I am exempt under Sec. , 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 maintain a certificate of consentto self~insure for worker'sc-ompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
1'J-1 have and will maintain worker's compensation insurance, as required by Section 3700 of
~bor Code, for the performance of the work for which this permit is issued Myworker's
Compensation insurance carrier and polley are:
Carrier: STATE RJND Policy Number. 285000001374
APPLICANT: ROBERT LE
OWNER INFORMATION:
THANH HOANG
513 E SiMMONS AVE
ANAHEIM, CA 92802
ARCHITECTIENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty a. perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 the Business and
Profession C .
9/27/2005
Date:
EXPIRATION DATE
8/31/2007
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
'[1.A'certify that in the performance of the work for which this permit is issued, I shall not
~y any person in any manner so as to become subject to the worker's compensation laws
of Califomia, and agree that jf I should become subject to he worker's compensation
provisions of Section 3700 of the Labor Code, I sh9'~fort ith comply with those provisions.
Date: 9/27/2005 Applicant:
WARNING: FAILURE TO SECURE 'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJEC AN EMPLOYER TO CRiMiNAL PENALTIES AND CIVIL
FiNESUPTO ONE HUNDRED TH SAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DA AGES AS PROVIDED FOR iN SECTION 3706 OF THE
LABOR CODE, iNTEREST AND "'HORNEY'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:
NUMBER
694940
TYPE
C39
Construcion Tvpes:
VN, ,
Fire $orinklered?
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 bulldingconstruction, and
hereby authorize represen . es of this city to enter upon the above mentioned property for
insp~ion pu .0OOS.
Date: 9/2712005
Fees paid for Permit:
Total:
245,39
ignature of Applicant or Agent
The p mit shall expire by limitation and become null and void if the building or
work. as not passed final inspection 365 days from the date of permit issualCe. A
new permit is required to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Uter
SetbacklFormsfTrenches (Footings)
Do not install sublloor or pour 1I00r slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Rein!.)
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 Flo9J'-Sl:1ear (
Roof tSheath~iaphragm/Frame) ~L ;.:r
Masonr)'-tKemf.lBond Beam/Pre-Grout) V
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mee. And Fire)
Insulation (Sound/Energy)
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
Interior Lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat)
T.Bar Electrical
T-Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Back1low
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 765.5194 ,
Zoning 765-5139 I ,
Building Final (Last Inspection. Only (tis
Altar Above Complete) Jt\/vcw<i, lC. (
,
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbing Inspections
Electrical Inspections