610 N. Zeyn St.
.
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 71
BUILDING PERMIT NO_ BLC2005-02072-
TYPE OF PERMIT CITY
Reroof
DATE: 7/6/2005
JOB ADDRESS: 610 N ZEYN ST
LEGAL DESCRIPTION: ZEYN TR ANNEX BLK BLOT 14
APPLICANT: DAMIEN HERMAN
OWNER INFORMATION: CONTRACTOR INFORMAflON: ARCHITECT/ENGINEER INFORMATION:
Joseph J Munson HERMAN'S ROOFING
PO Box 1952 40501/2 BROTHERTON ST
Anaheim, CA 92815 CORONA, CA 917190000
BUSINESS PHONE: 909736.7757
JOB DESCRIPTION:Tear off existing and reroof 14 squares with 3D-year compl)sition shingles
VALUATION: 2,650.00
I OWNER-BUILDER JECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor'~j 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 licersed 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 subjBcts the applicant to a civil penattyof not more than fjve hundred dollars
($500).
D I, as owner of property, or my employees with wages as their sole compeflsation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License LEw does not apply to an owner of property who builds or impro\(es
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 yea:' 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 OJntractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of property Vl:ho 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.C. for this reason:
Date: Owner:
I
PROCESSED BY: JNJ
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
D I have and will maintain a certificate of consent to self-insure for worker's ;:ompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the'work for which
is ~~:mit is issued.
ave and will maintain worker's compensation insurance, as required by Section 3700 of
't e Labor Code, for the pertormance of the work for which this permit is issued. Myworker's
Compensation insurance carrier and policy are:
Carrier: NO EMPLOYEES
LICENSED CONTRACTORS DECLARATION
I hereby affirm unde~nalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Divsion the Business and
Professions ode.
7/6/2005
Date:
Contractor
Policy Number. EXEMPT
NUMBER
348265
TYPE
EXPIRATION DATE
7/31/2007
This section need not be completed if the pennit is for one hundred dollars ($1 00) (If' less.
~ I certify that in the pertonnance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the worker's compensation laws
of Califomia, and agree that if I should become subject to the wo~er's compensation
provisions of Section 3700 of the Labor Code, I shall fa th amply with tho~e provisions.
Date: 7/6/2005 Applica~
WARN ING: FAILURE TO SECURE WORKER'S COMPE OVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EM PLOYER TO CRIM INAL PENALTIES AND CI VIL
FINES U P TO ONE HUNDRED THOUSAND 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 construction lending agency for the
pertormance 'oftha YJoik for which this permit is issued (Sec.3097 .eN.C):
lender's Information:
C39
Construcion Types:
V N, ,
1 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
in~p~
( ------- Date: 7/6/2005
Signature of Applicant or Agent
The 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 issualCe. A
new permit is required to commence or continue work.
Fees paid for Permit:
Total:
160.61
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormsITrenches (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 (CompactionlMembrane Reinf.)
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
~eathina;DlaPhragm/Frame) '717M ~
Masonry (Reinf JBond Beam/Pre-Grout) I
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., EIe., Mec. 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 List/Business License 765-5194
Zoning 765-5139 / /
Building Final (Last Inspection - Only 71ti:
After Above Complete) b:> JAl.loWS\L..\
I
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections
Plumbina Inspections
Electrical Inspections