1154 W. South St.
BUILDING PERMIT NO. BLD2005-02748
TYPE OF PERMIT CITY
Reroof
DATE: 8/31/2005
JOB ADDRESS: 1154 W SOUTH ST
LEGAL DESCRIPTION: N TR 1394 LOT 10
APPLICANT: ROBERT MORENO
OWNER INFORMATION: CONTRACTOR INFORMATION:
ROBERT MORENO
1154 W SOUTH ST
ANAHEIM, CA 92802
JOB DESCRIPTION: Tear off existin9 and reroof 13 sq with 30 yr composition shingies
I
VALUATION: 2,000.00
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 64
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: MJF
OWNER-BUILDER C!ECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's;Ucense aw for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permn to construct, alterr 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 subjeQts the applicant to a civil penatty of not more than five hundred doUars
($500).
o I, as owner of property, or my employees with wages as their sole comper,satian, 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'N does not apply to an ,owner of property who builds or improves
thereon, and who does such work himself or helSelf or through his or her own (~mployees, provided that such improvements are nat intended or
offered for sale. If, however, the building or improvement is sold with one year:af 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 ccintractors 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..Qontractor(s) licensed pursuant to the Contractor's License Law).
U I . x ,YIlder Sec. B & ,.for hi lJlP:
ate: Owner: ~ e)
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 selt-insure for worker's <iompensation,
as provided for by Section 3700 of the Labor Code, for the pertormance of the :~vork for which
this permit is issued. ;:
o ' have and will maintain worker's compensation insurance, as required by :,3ootion 3700 of
the Labor Code, for the performance of the work for which this permit is issued, Myworker's
Compensation insurance carrier and polley are:
Carrier: Policy Number. ;
This section need not be completed if the pennit is for one hundred dollars ($100) J.,. less.
o I certify that in the perfonnance of the work for which this permit is issued,~l shall not
employ any person in any manner so as to become SUbject to the worker's conjpensatlon laws
of Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor~, I an rthwith comply with tho~,e prov.isions.
Date: 8/31/2005 Applicant: A
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINESUPTO ONE HUNDRED mOUSAND 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 ;s correct. I
agree to oomply with all city ordinances and state laws relating to building construction, and
hereby authorize re resentives of this city to enter upon the above mentioned property for
inspectio 0
Date: 8/31/2005
Signature of p ieant 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 permit is required 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) of Divsion 3 of the Business and
Professions Code.
8/31/2005
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Construcion Tvpes:
VN, ,
Fees paid for Permit:
Total:
170.20
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (OrainlWaste Pipe)
Electrical Ground Electrode/Uter
SetbackIFormsrrrenches (Footings)
Do not install subfloor or pour lloor slab until the
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane Reint.)
Underpinning (Floor Joist/Girders)
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 , "'"
Root (Sheathing/Diaphragm/Frame) 1/l<"'rb.1 AL /' ~
Masonry (Reint.lBond Beam/Pre-Grout) /
Rough Plumbing (Top Out) ,
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 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 LlstlBusiness License 765.5194
Zoning 765-5139 /l
Building Final (Last Inspect/on - Only /z/rj ///-,
After Above Complete)
UL IA)~ /
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbing Inspections
Electrical Inspections
TYPE OF PERMIT C
Residential Addition ITY
DATE: 8/11/2005
JOB ADDRESS: 1154 W SOUTH ST
LEGAL DESCRIPTION: N TR 1394 LOT 10
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 64
BUILDING PERMIT NO. BLD2005-02117
APPLICANT: ROBERT MORENO
OWNER INFORMATION:
ROBERT MORENO
1154 W SOUTH ST
ANAHEIM, CA 928020000
JOB DESCRIPTION;Family room addition 297 sq. ft.
VALUATION: 20,100.00
CONTRACTOR INFORMbTION:
ARCHITECT/ENGINEER INFORMATION:
f!
'ii
i I
PROCESSED BY: FAN
OWNER-BUILDER DECLARATION
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, alt)r, improve, demolish or repair any structure, prior to its issuance, also
requires the applicant for such permit to fite a signed statement that he is Iice)sed pursuant to the provisions of the Contractor's License Law (Chapter
9){commencjng with Section 7000 of Division 3 of the Business and Professkns 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 sub;,9ctS the appficant to a civil penalty of not more than five hundred dollars
~~~. .
o I, as owner of property, or my employees with wages as their sole comp{nsation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License Lft~oes 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 owl1employees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one ye...:r of completion, the owner-builder will have the burden of proving that he
did not build or improve for the purpose of sale). . L
~ the owner of the property, am exclusively contracting with licensed (.en tractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of propertY\;/ho builds or improves thereon, and who contracts for sum projects with
~ontractor(s) licensed pursuant to the Contractor's License Law). ~
U I am t [l~EJ.t--Sec. ,C. f this eason:
Date:' / J Own~
WORKER'S COMPENSA ION DECLARATION I
I hereby affirm under penalty of perjury one of the foJJowing declarations: (
~have and will maintain a certificate of consent to self-insure for worker's',compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the'work for which
this permit is issued.
o I 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 issuel'. My worker's
Compensation insurance carrier and policy are: '
Carrier: Policy Number.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
Professions Code.
8/11/2005
Date:
Contractor
NUMBER
EXPI RATION DATE
This section need not be completed if the pennit is for one hundred dollars($100) 9r less.
[l I certify that in the performance of the work for which this permit is issued: I shall not
~ploy any person in any manner so as to become subject to the worker's co~pensation laws
of California, and agree that if I should become subject to e worker's compeT)Sation
provisions of Section 3700 of the Labor e, hall f wi h camp y wi thoSe provisions.
Date: 8/11/2005 Applica~ ~
WARN ING: FAILURE TO SECURE WORKER'S COMPENSA ION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDIllON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR COD E, I NTEREST 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):
Llilnd.gr's lnforrr'!ation:
TYPE
Construcion Types:
VN, ,
Occupancy Groups:
S3, , , ,
LivinQ Area: 297
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 authorize representives of this city to enter upon the above mentioned property for
inspection pur
Date: 8/11/2005
Fees paid for Permit:
Total: 854.95
i ature 0 Applicant or Agent
The permit shall expire by limitation and become null and void if the building or
work has not passed fi nal inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue wor'"
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION
INSPECTOR
DATE
Temporary Power Pole
Plumbing (DrainlWaste Pipe) '_
Electrical Ground Electrode/Ufer ,...4710. ~ r L 7" ~
SetbacklFormsfTrenches (Footings) I" '" ) .
Do not install subfloor or pour floor slab until the II'
following applicable items have been signed:
Plumbing (Water Pipe/Sprinkler Va,lves)
Mechanical (Groundwork)
Electrical (Underground Conduit) /"'-
Pre-slab (Compaction/Membrane Reinf.) '!~' ;C J :::7
Underpinning (Floor Joist/Girders) /
Do not cover or conceal the work below untillhe
following applicable items havepe!!n signed~
1st Floor Shear ''1hs1~ A, Y
Firesprinkler (Rough)
2nd Floor Shear I />
Roof (Sheathing/Diaphragm/Fraine) fi' \ \ ; L ~ x:. ~
Masonry (ReinfJBond BeamlPre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
A
h V
1't11(
Framing (Only after Plbg., 'ele., Mec. And Fire) A 11( , c:. ____
Insulation (Sound/Energy) ~k?j ~r ',,( f ~ -_
Do not tape or plaster until the following apPlica~
items have been signed:
Drywall ~/h~s .;'.1 /" ~
Penetrations (Fire Rated) Electrical /
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
---
-
19koG'S/':/ .~
GENERAL ITEMS l/ /'
Exterior Plaster (Brown Coat) /0." . /,
T-Bar Electrical /'
T-Bar Mechanical
T-Bar Structural
Sewer
Water Engineering Backflow
Water Service
DATE
ECTOR
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 List/Business License 765-5194 ":' SS1c
Zoning 765-5139 '
Building Final (Las' Inspection . Only il.'''" ~,L)(), -i
Alter Above Complete) 'l ro Iff'>/} ~
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
---------------
Plumbinl;llnspections
ElectricallnSDections