1850 West St.
TYPE OF PERMIT C.ITY
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714)765- 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION:
BUILDING PERMIT NO. BLD2004-04332
DATE: 5/11/2005
JOB ADDRESS: 1850WESTST
LEGAL DESCRIPTION:
APPLICANT: DICK DUFF
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
City Of Anaheim SOUTH COAST ROOF INC
P 0 Box 3222 1132 BARKLEY AVE
Anaheim, CA 92803 ORANGE, CA 928680000
JOB DE~CRIPTION: Tear off 8r:ld re-roof 63 squares of BUR located at the Arena box office and 3 slopped coo,cession stands.
VALUATION:
9,450.00
PROCESSED BY: SAM
OWNER-BUILDER DECLARATION
I hereby affirm un er penalty 0 perjury that am exempt rom the on tractor's Ucense Law for t e 0 Jowlng reasen ec. 7031.5 Business and
Professions Code: any city or cQuntywhich requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also
requires the applicant for such perr:nit to file a signed statement that he is licensed pursu.ant to the provisions.of the' Contractor's License Law-(Chapter
9)(commencin9 with Section 7000.of Division 30f the .Bus~ness and Professions Code) or that he is exempt therefrom and the basis for the alleged
. exemption. .Any violc~.tion of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars
~W~ .. ...... .
0" I, as owner of property, or my employees with wages as their solecompensatio~, will do the work, and the structure-"is not intende'<for offered for
sale (Sec.. 7044 'Business and Professions Code: The Contractor's License Law "does not appJyto an owrier 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 fo~ sale. 'If, however, the bui'Jding or improvement is s'old with one year of completion, the owner-builder will have the burden of proving that he
did not build or improve for the pu rPose of saie). ,
o I, as the ownerofthe 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 propert'ywho builds or improves thereon, and who contracts for such projects with
ii"i.on.tractor(s) licensed pursuant'to the Contractor's License Law).
U. I_am exempt under Sec. ,B & P.C. fQr this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I her_ebyaffirm under penalty' of pe~ury one of the following declarations:
D I have and will maintain a certificate of consent to self-insure for worker's compensation,
as provided for by, Section 370001 the Labor Code, for the performance of the work for Which
this permit is issued. ' . " '
~. ..1 hav.e and will ~aintain wOry<er's compensation insurance, as required by Section 3700 of 5/11/2005.
he'Labor Code, for the performance of the work for which this permit is issued. My worker's " Date:
Compensation insurance carrier and policy are: . . .:
arri,er: STATE FUND . Policy Number. 285-2308-3
Contractor.
This section need nOt be completed if.the pennit is for, one hundred dollars ($100) or les~
o I c'?rtify that in the performance.of the work for which this permit is issued,l shall not
employ any person in any manner so ~s to become subject to the worker'~ cor.npens"ation laws
of California, and agree that if I-should become subject to the worker's,compensation
provisions of Section 3700 of the bor Code, I sh , Iy with those provisions.
NUMBE
STATE UNO
TYPE C55
TYPE C39
TYPE C43
EXPIRATION DATE
10/3112006
Date: 5/11/2005 . Applicant:
WARNiNG: FAILURE TO SECUR ER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALLSUBJE AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED OUSAND 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 ~onstruction lending agency for the
performance of the work for whidl this permi~ is issued (Sec.3097.Civ.C):-- -
Lender's Information:
Construcion Types:
VN, ,
Fire Sprinkler~d?
NO
I certify that I have read this application and stale that the'above information-is correct. I
agree to comply with all city ordinances and state laws relating to building construction, and
hereby authorize representi~es f this city to enter upqn th,? above mentioned prop"erty for
in .
Date: 5/11/2005
Fees paid for Permit:
. Total:
428.94
. a ure of Applicant or Agent
permit shall expire by limitation and become null and void if the building or
work lias not paSsed final inspection 365.days tram the date of permit issuance: A
. new permit is required to commence or. continue work.
INSPECTION RECORD
. .' DATE
INSPECTION INSPECTOR
Temporary Power Pole
Plumbing (DrainJWaste Pipe)
Electrical Ground Electrode/uter '
SelbacklFormslTrenc:hes (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork) . .
Electrical (Underground Conduit)
Pre-slab(CompactionIMembrane.Rei nt.
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed:.
1st Floor Shear . .
Firesprinkier (Rough) . ' ,
2nd Flo .
Ropl"(SheathingLliliaphragmlFrame) 11'1'1t)/O( ""'T,
M InfJBand BeamlPre-Grout)
Rough Plumbing {Top Out)
Rough Mechanical . .
, Rougn ~ectrlcal \I II)
Rough Ehlc:trical .' ,. . ,
Framing' '-(Only after PlbQ.. -Elec.. Mech.. and Fire)
Insulation (SoundlEnergy) , .
Do not tape or plaster. until the following applicable
items have been signed: . .
Drywall . .
Penetrations (Fire Rated) Electric;al ' .
Penetrations (Fire Raled) Mechanical .
Penetrations (Fire Raled) Plumbing .,
Interior Lath . ,
Exterior Lath
, . GENERAL ITEMS,
Exterior Plaster (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 Test ,
Engineering/Grading Final 765-5126 ' .
Fire Dept. Final 765-4040
Water Engineering 765-5268 "
Sub List/Business License 765-519
Zoning 765-5139 . ,
Building Final~ast Inspection. Only 5'/"...0,.'- ~ //
- ., fler Above Complete)
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical,lnspections
Plumbina Inspections
Electrical Inspections .