1594 Sumac Ln.
APPLICANT: AVISAG BERMUDEZ
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
AVISAG BERMUDEZ
1594 W. SUMAC LN.
ANAHEIM, CA 92802
JOB DESCRIPTION:Tear off existing roof and replace with 22 squares of 30 yetJr composition shingles.
VALUATION: 5,500.00 PROCESSED BY: MSM
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, atter, 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 pena~y of not more than five hundred dollars
~$ 00).
I, as owner oi property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for
s (Sec. 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves
th reon, and who does such work himself or herself or through his or her own employees. provided that such improvements are not intendec;:t or
offered for sale. Ii I 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).
D I, as the owner of the property, am exclusively contracting with licensed Cl)ntractors 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. . for this ason:
Date. ' - / - Owner: .
WORKER'S C MPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certificate of consent to self-insure for worker'sl~ompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
this perm it is issued.
o I have and will maintain worker's compensation insurance, as required by SectiOn 3700 01
the Labor Code, for the performance of the work for which this permit is issuecf. Myworker's
Compensation insurance carrier and policy are:
Carrier: Policy Number.
BUILDING PERMIT NO. BLD2005-01913
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TYPE OF PERMIT
Reroof
DATE: 6/21/2005-
JOB ADDRESS: 1594 W SUMAC LN
LEGAL DESCRIPTION: N TR 2903 LOT 71
ihi section need not be completed if the pennit is for one hundred dollars ($100) or less.
I certify that in the perfonnance 01 the work for which this permit is issued, I shaU not
ploy any person in any manner so as to become subject to the worker's compensation laws
01 Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Date: 6/21/2005 Applicant.
WARNING: FAILURE TO SECUR WORKER'S COMPEN.SATION COVE GE IS
UNLAWFUL, AND SHALl SUBJ CT 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 PROVI DED 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 .Clv .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 representives of this city to enter upon the above mentioned property for
ection purposes. .
Date: 6/21/2005
gnature of Applicant or A nt
e 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 Dermit is reauired to commence or continue work.
ElM
BUILDING DiVISION
200 S. ANAHEIM BLVD.
(714)765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 57
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.
6/21/2005
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Construcion Types:
VN, ,
Fire SPfinklered? NO
Fees paid for Peimit:
Total: 235.38
INSPECTION
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormslTrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been sianed:
Plumbing (Water Pipe/Sprinkler Valves)
Mechanical (Groundwork) PARTIAL INSPECTIONS
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane Reinf.)
Underpinning (Floor JolslIGirders) d
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 / /
RooflSheathinalDiaphraomlFrame) h/6/o:;: jA IJDW'5Lt. \
Masonry (ReinfJBond BeamlPre-Grout) II , MechanicallnSDections
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg.. EIe., Me<:. And Fire)
City of Anaheim
Building Division
INSPECTION RECORD
DATE INSPECTOR
Insulation (Sound/Energy)
Do not tape or plaster unlil 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 List/Business License 765-5194 I /
Zoning 765-5139 I / J//
Building Final (Last Inspection - Only ";'lYt') 'C:-~
After Above Complete)
Plumbina Inspections
ElectricallnsDectlons