1511 E. Santa Ana St.
re~O~fOF PERMIT CITY
DATE: 1/5/2005
J06ADDRESS: 1511 ESANTAANAST
LEGAL pESCRIPTION:. ANAHEIM EXT LOT 9.E 90 FT W 180 FT
",
6UILDING DIVISION
200 S. ANAHEIM 6LVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 103
BUILDING PERMIT NO. BLD2005-00014
APPLICANT: DEBRA KHANDAKER
OWNER INFORMATION:
Debra Kharidake-r
1611 E Santa Ana SI .. .
Anaheim, CA 92805. .;.
JOe DESCRIPTION:Tear off existing roof a~d replace with 40 -squares of :30 5;ear composition shingles.
CONTRACTOR INFORM",TION:
ARCHITECT/ENGINEER INFORMATION:
VALUATION: 4,000.00 PROCESSED BY: MSM
I" '. OWNER-BUILog DECLARATION .' . . ---.J
I hereby affirm under penalty of perjury that I am exempt from ,the. Contract,t)~'s License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any dty or county which requires a,perm,it to constrlic(giter,' improve, demolish or repair any structure, prior toJts issuance,i3!zo
requires the applir::ant for such permit to fife a signed statemen't that,he_is !i(.;:~nsed pursuant to t!1e provisions oftha: Contractor's license Law (Chapter'-
9)(c6mmencing with Section -7000 of Division, '3 of the Busin8$s a nd Pi'ofe~~fan:! Code) or'that he is exempt therefrom and the basis for the alleged
. exemption. Any violation of Section 7031.5 by any applicant for a permit !;t..;:~je(;tS t~ie applicant to a Civi:pena/tYQf not more than fivehuf)dred.doUars
fl$ O}. . , ..', .' . " .
, .' _', as owner. of prc~erty, or my: employees w!th wages aS1,heir sole com~\eosa.tion; will do the "York, and the structure 'is'not intend~ or 6ffe~ed for
,S E: (Sec.,!O~ Busines~ and Profes$ions Code: The Contractor's Ljcensr::}Dw does not 2Pplyto. ar, owner of property who bulld$or improves .
thereon, and who does such work hi"mself or herself or througn his ocher a\:~',ilemployees, provided, that such improvements are r.ct intended or
offered fOI sale. If; however, ,the buifding or improvement is sold with oney~':ar of completion, the, owne.r-buiiger will have the burden of proving that he
did not 'build,or.improve for the purpose ,of sale). , ., \ "
o I, as the owner ofJhe property, 3m eXClusively contracting with iicens~i(f)ntractors to construct the project(SeG. 7044 Businessand Professions
'. ~ode: TheGont~actor's License Law does not apply tc;> an owner of P!cpe:1~'~"'lho' builds or improves thereon, and who contracts for such pro;ec.i:.~. ~ith
~.J(cntracior(s~Jicel'lSed,'pursuant to the Contractor's License Law)." '
Lj.l~ exe,m t under Sec. B&, ~C for !'" ason.
Date: -OS . Owner:
-,
I , WORKER'S COM ENSATlONDECLARATlO~J ....:.___...J.
I hereby affirm und~r penalty'of perjury orie of the'following declarat!ons:
C I have and w'Wmaintain a certificate of oo-nsent to self-ins~re for worke<s cOI'Ppensation,
as provided for, by Section' 3760 of the labo'r Code, for the perfoj'mance oftr:e work for which
this permIt is lss\.l&d.. .',
D.' I 'have arid wili inaintain worker's compensation insurance, as required h:y,Section 3700 of
the Labor Code, for the performance of the work for which this permit is issu.?d. My workef's
Compensation insurance carrier'and poliCf are:
'Carri~r: . , '
LIC.ENSED CONTRACTORS DECLARATIOtti
I hereby affirm under pena!ty of oerjury that! am
}. !ice:ised under pTovision~ of chz;pter 9lcommenclng .
,: with Section 7000) of .Oivsion 3 of the Business and
Professions Code.
1!5i2005
Date:
ContractOi
i
i'Tho section need I}ot be completed if,th~ pennit is for one hundred dollars ($10q or less.
I certify that in the Pertorrn.ance of the work for which this Qermtt is isSU~d, I shall not
m loy any person in ~ny manner sQ as to become subj~ct to the worker'$.c,~m'-pensat:on laws
of Califomia, and agree that if I shoulq beco~ subject tothewurKer's comp-:msation . .
provisions of Section 3700 of the, ~abo Code, I shall forthwith c Iy' withH~de provisions.
Policy Number:'
NUMBER
EXPIRATiQN DATE
TYPE
Date: 1/512005 Applicant:
WARNING: FAILURE TO SEGUR WORKER'S COMPENSATION COVE'fAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENp,LTIES AND CiviL
FINES UP TO ONE HUNDRED 1l-JOUSAND'DOLLARS ($100.000), IN AD[iiT10N TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECT,Oi'; 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY ~,"
1 hereby affirm under penatty of perjul'y that there is a construction lending af,encyfoT tDe
performan,ce ,of the work fo~ which this permit is issued (Sec. 3097 .Civ.C):
_.Lend,er:s.Jnformatiol1'.__ - .
Cons'trucion Types:
VN, .
Fire Sprinklered?
NO
,I certify that I have read this application and-stc1tethatthe above information is correct. I
agree to.comply with all city ordinances and state laws relating to building construction, and
hereby'authoriZe repre.sentives of this city to enter upon the above mentioned property fo'r
~~~~~.
Sign;3ture of Applic~mtor Agent.
The permit shall expire by 'Iimitation and become null and void if thlibuilding 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.
Oat,;: 1/5/2005.
Fees paid for Permit:
Total:
310.05
INSPECTION RECORD
INSPECTION' DATE INSPECTOR
Temporary Power Pole . . .
Plumbing (DralnlWaste Pipe)
Electrical Ground Electrode/Uter . .
SetbacklFormsfTrenches (Footings) .
Do not install subfloor or pour floor slab until the
following applicable items have been signed: .,
Plumbing (Water Pipe.Sprinkler Valves) . , .
f.Ilechanical'(GrouOOWork)
. ,Electrical (Underground,Conduit) :
Pre-siab(Compaction/Membrane.Rei nt. ..
Underpinning (Floor.Joist/Girders)
'lJO not cove.r or conceal the workbel.ow until too
. following applicable items 'have been signed: . .
1 st Floor Shear .
Firespririkler (Rough)
2nd Fioor Shear . . ..... ~.
Roof (Shealhing/D1aphragm'Frame) -~O..';; fr'
Masonry (RelnfJBond Beam/Pre-Grout) /'")
Rough Plumbing (Top Out) . .
Rough Mechanical . .
Rough aectrical ail)
Rough Electrical .
Framing (only aher Plbg.. Elec.. MedLand Fire)
Insulation (SoundlEnergy)
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 .
Interiqr Lath. .
Exterior Lath
. GENERAL ITEMS
exterior Piaster (Brown 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 .
Gas'Tesi . .
El1gineerlng/Grading Final 765-5126
Fire Dept. Final 7654040 ..'
. .
Water Engineering 765.5268 .
Sub List/Business License 765-519 . .
Zoning 765-5139 . .
Building Final ~ast Inspection. Only (-7-5.@3 7{f1k,
fterAbove Complete) .
PARTIAL INSPECTIONS . . V
BuildinQ Inspections
MechanicallnsDections
"';:
Plumbina 'nsDections
Electrical Inspections