2775 E. Verde Ave.
~~O~~FPERMIT CITY
DATE: 3/8/2005
'JOB ADDRESS: 2775 E VERDE AVE
LEGAL DESCRIPTION: N TR.3439LOT 41
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
INSPECTION REQUEST LINE:
(714) 765.4626
CENSUS CODE:' 434
QUARTER SECTION: 124
BUILDING PERMIT NO. BLD2005-00605 .
CONTRACTOR INFORMATION:
PLATINUM BEST VALUE ROOFING CO
22365 EL TORO RD #297
LAKE FOREST,'CA 92630 ~OOO
BUSINESS PHONE: 949770.7663
JOB DESCRIPTJON:Tear off shake, install 7/16" OSB, 301bs fell, and 25 squar,sof lifetime composition.shingles.
VALUATION: 8,000.00 PROCESSED BY: ENO
I OWNER.BUILDER DECLARATION
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 ~nd
Professions Code: any city or cOlJntywhiph requires a permit to construct, alt~r, improv~, demOlish or repair any structure,- prior to its issuance, also
requires the applicant for such permit t'o fil~ a signed statement that he is Hce:lsed pursuant ,to the provisiqns of the Contractor's License ~aw (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 sub;ects,the'applicant to a civil penalty of not more than five hundred dollars'
($500). . . .. . . : . .' ..
o -I, as owner of property,. or my employees with wages as their 'solI? comp.~r.sation, will do the work, and the structure is not intended or offered for
sale (See. 7044 Business,and Professions Code:, The-Contractor's License Law does not apply to an owner of property whobuildsor improves
thereon, and who (foes such work himself or herselfor through his Of ,her own employees. provided that such improvements are nofintended or
'offered for sale. If, however, the building or improvement .igsold with eneyea~ of oompletion, the owne~-builder Will. have the burden of proving that he
did not buUd or improve forthe pOrposeof sale).' . '. . .'
o ,; as the owner of the prope,rty, am eXdusively contracting with licensed contractors to construct the project (See: 7044 Business a'od Professions
Code: The Confracto['s License Law does not apply to anew-oer of property'J.Jho builds or Improvl;3:s thereon, and who Contracts for such projects with
~ontractor(s) licensed pursuant tothe.Contractor'sUcense Law)~
U I am exempt Onder Sec, . . , B & P,C. for this reason:
Date: Owner: . .
I WORKER'S COMPENSATION DECLARATION
I hereby. 'affinn under penalty of perjury ohe of the following declarations:
o I have and will ma intain 'a certi.ficate of wnsent to se'ff-insuretor worker':; compensation,
as provided for by Section 3700 'of the Labor Code, for th,e performance ofth;~ work for which
~i perf'!'it is issued. '. -,
, I have and will maintain worker's compensation insurance, as required b-~~ Section 2700 of
the bar' Code, Jor the. performance of the work for which this permit is issu~. Myworker's .
CompenSation insura m:e carrier and policy are: - ,
Carrier: STATE FUND Policy Number. 1733177.2004
This section need not be completed if the permit is for one hundred dollarS ($100; C,J( less.
GJ j 'certify that in the perfonnance of the work for which this permit is isSu.e.d!1 shall not
~Ioy any person in any manner so as to beco subject to the,w:orker's ccrr.pensation laws
of Califomia, and agree that ,if I should becom subject to the worker's CompE:;I,lsation '
'provisions of Section 370Q.of the l bor Cod I shall forthwith comply with th-cs~ prOVisions.
D~te: 3/8/2005 Applicant: ;g;;;;. C.
WARNING: FAILURE TO SECURE W KER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT' PL YER TO CRIMINAL PENALTiES AND CIVIL
.FINES UPTO ONE HUNDRED THO AND LLARS ($100,000), IN ADDiTION TO THE
COST OF COMPENSATION, DAM ES AS PROVIDED. FOR.lN SECTION 3706 OF THE
LABOR CODE, INTEREST AND AORNEY'$ FEES.
CONS UCTION LENDING AGENCY
. I h~r~by affirm ul'lrler penalty of ,rjury-th8t thRr~ is ~ cnnBtrur-tion Ip.nding ~{!";nr.y fnr thl'!
performance of the work for wp d1 this permit is issued (8ec.-3097.Civ,C):
Lende~slnfonnation:
APPLICANT: MIGUEL ENRIQUEZ
OWNER INFORMATION:
o J Walden
2775E Verde Ave
Anaheim, CA 92806
ARCHITECT/ENGINEER INFORMATION:
Contractor
Construcion Tvpes:
VN, ,
Fire Sprinklered?
NO
(certify that I have.re<;id this application and state that th'e 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 dty to enter upon the above mentioned property for
pe n rposes,
Date: 3/8/2005
fe~ paid for P~rmit:
Total;
160.91
19" AWli nt or ~gent
permit shall expire by limitatiOn and become null and void if the building or
ork has not passed final inspectiOn 365 days from the date of Permit issuance. A
w permit is required to commence or continue Work.
INSPECTION RECORD
. .,
... ' INSPECTION' .. . , DATE INSPECTOR
Tllmporary Power Pole ,
Plumbing (OIa/rilWaste Pipe)
Eledricat GrOund Electrode/uter '
SetbacklFormsffrenches (Footings I . .. ' ,.
Do not install subfjoor or pour floor slab until the
. following applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (GroundWork) .
Eledrical (Underground Conduit)
pre-slab (Compaction/Membrane.Reint. . .
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below unllltne
following applicable items have been signed: '
. 1 Sl Floor Shear .
Firesprtnlder (Rough) . , ,
2nd Floor Shllar "
RoOf (Shealhlng/DlaphlagmlFrame) . Mtlu O'b
Masonry (Relnf./Bond BIIamlPre-Grout) , , 1/1 ,
Rough Plumbing (Top Out) .
'Rough Mechanical,
. ROugh aectrlCaI ,II)
Rough Electrical .
Framing, (Only after Plbg." EleC..:Mech..and Fire)
InsiJlalion (SoundlEl1ergy) . ..
po nollape or pla~ler until the following applicable
.tems have belln signed: ., ' , .
Drywall " , . ,', ..
PenetrallOns (Fire Rind) Electrical ,.'
Penetrallons (Fire Raled) Mechanical
Penetrallo~ (Fire Raled) Plumbing
Inlerlor Lath :
EXtllrior Lath
GENERAL ITEMS ' . "
Exterior Plaster (Brown Coat)
T-Bar Eleclrlcal
T-BarMechanical
T-Bar Structural, .
Sewer ' . ' .' .
Water Engineering ,Backllow .'
W"'er Service . ,
FINAL INSPECTIONS
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading.Final 765-5126
Fire Oept Final 76$-4040
Water Engineering 765-5268,
Sub List/Business License' 765-519
Zoning 765'5139
Building Final ILastlnspection:,.Only
, " After Above Completel
PARTIAUNSPECTIONS'
Buildina Inspections
Date, Inspector
Mechanical Inspections
PlumbinQ Inspections
ElectricallnSDections