1583 Sim Pl.
BUILDING PERMIT NO. BLD2005-01983
TYPE OF PERMIT CITY
Reroof
DATE: 6/27/2005
JOB ADDRESS: 1583 W SIM PL
LEGAL DESCRIPTION: N TR 4417 LOT 5
APPLICANT: LEE PEERY
OWNER INFORMATION:
Eleanor T Daughtry
1583 W Sim PI
Anaheim, CA 92802
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 59
CONTRACTOR INFORMATION:
CIRALLI CONSTRUCTION
735 FARAD ST
COSTA MESA, CA 926270COO
BUSINESS PHONE: 949548-6547
JOB DESCRIPT10N:Tear off existing roof and replace with 36 squares of 40 year composition shingles and 30 lb. felt.
VALUATION: 10,500.00
I OWNER-BUILDER tlEClARATION
I hereby affirm under pena~y 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 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 01 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 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 yeal 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 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
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: MSM
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
D I have and will maintain a certificate of consent to setf-insure for worker's compensation,
as provided for by Section 3700 of the L.abor Code, for the performance of the work for which
this permit is issued.
RJi I have and will maintain worker's compensation insurance, as required by Section 3700 of
iRe Labor Code, for the pertormance of the work for which this permit is issueo. My worker's
Compensation insurance carrier and policy are:
Carrier: STATE FUND Policy Number. 1508945
This section need not be completed if the permit is for one hundred dollars ($100) or less.
o I certify that in the perfonnance 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 Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor e, shall forthwith comply with those provisions.
1l~~~
Date: 6/27/2005 Applicant:
WARNING: FAILURE TO SECUR WORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED 1HQUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION lENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
I certify that I have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to building construction, and
hereby aut representives of this city to enter upon the above mentioned property for
i spectio ses.
Dale: 6/27/2005
Signature of Apphc or Agent
The permit shall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance. A
new oermit is reauired to commence or continue work.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) ~ion 3 of the Business and
::;~;;tJCode.v~ ~6
Date: ( Contractor
NUMBER EXPIRATION DATE
698771 11/30/2006
TYPE C39
Construcion Types:
VN, ,
Fire Sprinklered?
NO
Fees paid for Permit:
Total:
310.60
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Orain/Waste Pipe)
Electrical Ground Electrode/Ufer
SetbackIFormslTrenches (Footings)
Do not install subfloor or pour floor slab until the
. following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pr....slab (Compaction/Membrane Reinf.)
'Underpinning (Floor JoisUGirders)
Do not cover or conceal the work below until the
, following applicable items have been signed:
1 st Floor Shear
Firesprinkler (Rough)
'2nd Floor Shear / . 1/1/,1/
. Rooft(sheath;l,alDiaphragm/Frame) F/?i/ J) I~~
IMlI$onJ'VlReinfJBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
I Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. 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 Backflow
Water Service
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub LisUBusiness License 765-5194 ,
Zoning 765-5139 , I/!,I /J II
Building Final (Last Inspection - Only rt I~/'/IC GA::: .-vA J
After Above Complete) 'fir> L--.~
DATE
INSPECTOR
PARTIAL INSPECTIONS
Buildina Insoections
Mechanicallnsoections
Plumbina Insoections
Electricallnsoections