840 S. Sylvan
TYPE OF PERMIT CIT.'Y
Reroof .
ElM
BUILDING DIVISION.
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTlINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 21.
BUILDING PERMIT NO. BLD2005-01723
DATE: 617/2005
JOB ADDRESS: .840 S SYLVAN st
LEGAL DESCRIPTION: N TR 1951 LOT 72
APPLICANT: OTTO DUARTE
OWNER INFORMATION: CONTRACTOR INFORMATION:
otto Duarte
840 S Sylvan St
Anaheim, CA 92804'
J,OS DESCRIPTION: Tear off existing and re-ro<?f 15 squares composition shing!es;
ARCHITECT/ENGINEER INFORMATION:
VALUATION:
6,000.00
PROCESSED BY: 'SAM
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. 7:031.5 Bt,lsiness an
Profe.ssions Code: any city or county which requires a permit to construct, alter, improve, demolish or repair any strUctur~. prior to its issuance, also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to the pl'Ovisionsof the Confractor's License Law (Chapter
9)(commencing with S~ction 7000 of Division 3 of the Business and Professions Code) or.that he is exempt therefrom and ~he 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 n6t more than five "hundred dollars
~$5 0).' .....
. as owner of property, or my employeeswithwages.as their sole compensation, will do the work, and the structure is not intended oroffered for
al Sec. 7044 Business and Professions Code: The Contractor's License L8w does not apply to an owner of p'ropertywho builds or improves
thereon, an\! who does such work hlmsen 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 oompletton, the owner-builde'r will have the burden of-proving that he
did not buUd or improve for the pUIp'ose of sale). . . _ .
o I, as the owner of th~ property, am exclusively contracting with licensed contractors to constructthe project (S~.. 7044 Business and Professi9ns
(fade: The Contractor's License Law does not"apply .to an owne~ of property who builds or improves thereon,' ang who contracts for such projects with
,a..qontractor(s) licensed pursuant to the C,? ~r or's License La ! . '
U I am e t under Sec. . . for i' " . .
Date; ( . 0 Owner:
WORKER'SC P NSATION DECLARATION
1 hereby affirm under penalty of perju one of the following di9clarations: '
D. 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 perl'flit 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 issued. Myworker's
Compensation insurance carrier and policy are: .
Carrier: . PoliCy Number.
This section neEd not be CX?'"ple:ted if the pennit is for one hundred dpllars ($100) or lesS.
~certify that in tlle performance of the work for which this permit is issued, I shall not
e "" y any person in any manne~ so as to become subject to the worker'S compensation laws
o arifomia, and agree' that if I should beco bject to, the worker's compensation .
provisions of Section 3700 of the Labor C allort ith comply. se provisions.
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed,u nder proviSions of chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and
Professions Code.
6/7/2005
Date:
Contractor
NUMBER
EXPIRATION DATE
TYPE
Date: 617/200r; Applicant:
WARNING: FAILURE TO SECUR KER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALLSUBJE EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINESU P TO. ONE HUNDRED iH CUSAND DOLLARS ($10'0,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVI DED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTI()N LENDING AGENCY
I he;rebY,affirm under penalty of perjury that there is a, construction lending agencyforthe
performance of the wo'rk for whic.h this permit is issued (Sec.j097.Civ.C):
Lender's Information: '
Construcion Types:
VN, ,
I certify that I have read this applic~tion and state that the above information is correct. I
agree to camp wit II city ordinances and state laws relating to building construction, and
~ereby:autho Ii: iv s of thiScity~oe . r upon the above mentioned pr.operty for
msp lonp - .
) . Date: 6/7/2005
Signature of Applica,nt 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 permit is required to commence or continue wOrk
Fees paid for Permit:
Total:
160.71
-
INSPECTION RECORD
INSPECTioN . DATE INSPECTOR
Temporary Power Pole . .
Plumbing (OrainlWaste Pipe) I
Electrical Grqund.ElectrodelUfer . .
Setbac;kiForl11SfTrenches (Footings) . ..."".05 7, {0cs:;/1
Do not install subfloor or pour floor slab until the
following applicableilems have been signed: .
PlUmbing (Water Pipe.Sprinkler Valves) ..'
Mechanical (Groundwork) ./
Electrical (underground Conduit) /' ..
Pre-slab (CompactionlMembrane.Rei~ .
Underpinning (Floor Joist/Girdersy .
Do not CQver or CQnceal th~e~eIOW until the
following applicable jlems ha been signed: . "
1 st Floor Shear / .
,
Firesprinkler (AouJlIJY
2nd Fio 1/ . . ... " .
Roof'iSheathi~aphragm'Frame) 1-1.<j."f (Z.; fv.redT
Mas "" . ond BeamlPre-Grout) . "
Rough Plumbing (Top Out) . .
Rough Mechanical.. . .
Rough 8ectncaJ all)
Rough Electrical" . .
Framing (Only after Plbg., Elec...t,,1ech.. and Fire)
InS\ll.ation (SoundlEnergy)
Do not tape or plaster until the following applicable
items have been signed: . . ..
Drywall
Pen.etralions (Fire Rated) Electrical. " ..
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath . . . .
Exterior Lath
GENERAL ITEMS .
Exterior Piaster (BlOWn Coal) .
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. I .
Gas Test . .
Engineering/Grading Final 765-5126 ..
Fire Dept. Final 765-4040 .
Water Engineering.765.526.S . .- . -
.. ..
. Sub List/Business License 765-519 ..
Zoning 765-5139 ." ..
Building Final ~ast Inspection. Only" . -.He
fter Above Complele) I/O.u.o, '-".... __6Y___
PARTIAL INS. TI T-
PEe ONS
Buildina Inspections
MechanicallnsP9ctions
. Plumbina Inspections
ElectricallnSDections .