1582 W. Sim Pl.
TYPE OF PERMIT CITY
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BlVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 59
BUILDING PERMIT NO. BLD2005-02179
DATE: 7/13/2005
JOB ADDRESS: 1582 W SIM PL
LEGAL DESCRIPTION: TR 4417 LOT 12 POR OF LOT
CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
DAN DAN PETERSON SONSHINE RAINBOW ROOFI
27 CANYON RIM
POMONA, CA 917660000
BUSINESS PHONE: 909445-5726
JOB DESCRIPTION: Tear off existing and re-roof 24 squares of 30 year composition shingles.
APPLICANT: DAN PETERSON
OWNER INFORMATION:
MARGARET HOFFMAN
1582 W SIM PL
ANAHEIM, CA 92602
VALUATION: 5,400.00
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's Ucense 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 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 License La..., 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 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-builder will have the burden of proving that he
did not bu lid or Improve for the pu rpose 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
a contractor(s) licensed pursuant to the Contractor's License Law).
o 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 consent to selHnsure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
~'s permit is issued.
ave and will maintain worker's compensation insurance, as required by Section 3700 of
he or Code, for the performance of the work for which this permit is issued. Myworker's
Compensation insurance carrier and policy are:
Carrier:
PROCESSED BY: SAM
Policy Number. EXEMPT
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) f]f 'vsion 3 of the Business and
Professions Code. fX__ ~
7/13/2005 ~ u....g::: ~.....--
Date: ('-7 Contractor
NUMBER EXPIRATION DATE
395452 11/30/2006
TYPE C39
This section need not be completed jf the pennit is for one hundred dollars ($100) or less.
o I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the worker's compensation laws
of California, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code aU fort ith TP'Y with those provisions.
Date: 7/13/2005 Applicant: ~
WARNING: FAILURE TO SECURE W COMP SATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT P OYER TO CRIMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED SAND DOLLARS ($100,000), IN ADDlllON TO THE
COST OF COMPENSATION, MAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm unde r penalty of perjury that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec,3097.Civ.C):
Lender's Information:
Construcion Types:
VN, ,
I certiiy that \ 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 representives of this city to enter upon the above mentioned property for
inspection purposes.
.'\ Date: 7/13/2005
Signature of Ap Icant or Agent
The p mit shall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new Dermit is reauired to cammence or cantinue work.
Fees paid for Permit:
Total:
235.37
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/uter
SetbacklFormslTrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane Reinf.)
Underpinning (Floor Joist/Girders)
Do not cover Of conceal the work below until the
following applicable items have been signed:
1 st Floor Shear
Firesprinkler (Rough) .
2nd Floor Shear I /
Roof (Sheathing/Diaphragm/Frame) 11 //11., . ./AtJ. W':>u \
Masonry (Reinf./Bond Beam/Pre-Grout) ,/ /
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele" Mec. And Fire)
Insulation (SoundlEnergy)
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 Backflow
Water Service
FINAL INSPECTIONS DATE INSPECTOR
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Depl. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-5194
Zoning 785-5139 /
Building Final (Last Inspection. Only 1~1S"
After Above Complete) ..I A",olA)'Slt.1
7
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbing Inspections
Electrical Inspections