888 S. State College Blvd.
CONTRACTOR INFORMATION:
FERNANDO'S CLEAN UP
1504 E BIRCH ST
ANAHEIM, CA 928050000
BUSINESS PHONE: 714772-6507
JOB DESCRIPTION:Reparce existing roof with 18 squares of 30 year composition shingles to house and 4 squares of Built up roof to patio cover attached
VALUATION: to hO~~:1'OO.oo PROCESSED BY: ENO
I 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, 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 subjer.:ts 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 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 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 contractors to construct the project (Sec. 7044 BUSiness and Professions
Code: The Contractor's License Law does not apply to an owner of propertywno 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. ,8& P,C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one oi the following declarations:
o I 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.
~ I have and will maintain worker's compensation insurance, as required by Section 3700 of
1'heLabor Code, for the periormance of the work for which this permit is issued. My worker's
Compensation insurance carrier and policy are:
Carrier: STATE FU NO
BUILDING PERMIT NO. BLD200S-03228
TYPE OF PERMIT CITY
Reroof
DATE: 10/6/2005
JOB ADDRESS: 888 S STATE COLLEGE BLVD
LEGAL DESCRIPTION: N TR 2350 LOT 86
APPLICANT: FERNANDO QUIROZ
OWNER INFORMATION:
MONICA CUELLAR
888 S STATE COLLEGE BLVD
ANAHEIM, CA 928060000
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 114
ARCHITECT/ENGINEER INFORMATION:
Policy Number 1663643-2002
~ section need not be completed if the pennit is for one hundred dollars ($100) or less.
~ertify that in the performance of the work for which this permit is issued, I sharr not
employ any person in any manner so as to become subject to the w.orkers compensation laws
of Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 01 the L bor Code, I shall forthwith comply with those provisions.
Date: 10/1112005 Applicant:
WARNING: FAILURE TO SECUREW KER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT N EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED USAND DOLLARS ($100,000). IN ADDITlON TO THE
COST OF COMPENSATION, 0 AGES 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
periormance 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 authorize epresentives of this city to enter upon the above mentioned property ior
in ion pur ses.
Date: 10/11/2005
Signature of Applicant or Agent
The per It 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 issuooce. A
new permit is required to commence or continue work.
LICENSED CONTRACTORS P!:C, ,':". ~,r.I()N
I hereby a jrm under pt'r. ',:./0f perjury that I am
licensed unde provision::.; of chapter 9 (commencing
with Section ad) of Divsion 3 of the Business and
Professions C e.
10/11/2005
Date:
Contractor
NUMBER
804913
TYPE
EXPIRATION DATE
3/31/2006
C39
Construcion Types:
VN, ,
Fire Sprinklered?
NO
Fees paid for' Permit:
Total:
244.87
City of Anaheim
Building Division
INSPECTION RECORD
DATE
INSPECTOR
INSPECTION
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground ElectrodelUfer
Setback/FormslTrenches (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:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear I I
Roof (Sheathlng/Dlaphragm/Frame) li./7 I." J.4" AN" (
Masonry (ReinfJBond Beam/Pre-Grout) I ( I
Rough Plumbing (Top Out)
Rough Mechanical
Rough Eleelrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg" EJe., Mac. 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 LislfBuslness License 765-5194
Zoning 765-5139
Building Final (Lasllnspecllon. Only ~~ I~.,--
After Above Complete) I i-
n
~
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbing Inspections
Electrical Inspections