200-201 E. Wakefield
. .
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765- 4626
CENSUS CODE: 555
QUARTER SECTION: 98
BUILDING PERMIT NO. BLD2005:02037
TYPE OF PERMIT CITY
Rerool
DATE: 7/1/2005
JOB ADDRESS: 201 E WAKEFIELD AVE
LEGAL DESCRIPTION: N TR 3535 LOT 1
APPLICANT: HAROLD BURGRAFF
OWNER INFORMATION: CONTRACTOR INFORMATION:
Azucena I Macias B & M PLUMBING
20772 Spindrift Ln 8431 CERULEAN DR
Huntington Beach, CA 92646 GARDEN GROVE, CA 927050000
JOB DESCAIPTION:Tear off existing roof and replace with 50 squares of 40 year composition shingles. Also resheating with 1/2" osb where necessary and
VALUATION: rePlag~3%tI'1i'8ia boards where necessary. PROCESSED BY: MSM
OWNER-BUILDER DECLARATION
I ereby a Irm u aT pena y 0 perjury t at am exempt rom the on tractor's license aw or t e 01 oWing reason ec. 7031. usrneS$ and
Proiessions Code: any city or county which requires a permit to construct, alter, 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 licensed 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 subj(lCts 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 sole compensation, will do the work, and the structure is not intended or offered tor
sale (Sec. 7044 Business and Professions Code; The Contractor's License law does not apply to an owner 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 intendedor
offered for sale. If, however, the building or improvement is sold with one year of completion, the owner~builder will have the burden of proving that he
did not build or improve for the pUlpose of sale). "
o I, as the owner of the 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 01 property who builds or improves thereon, and who contracts for such projects wnh
il-'fontractor(s) licensed pursuant totheContractor's License Law).
U I am exempt under Sec. , B & P.C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certificate of consent to self-insure for worker'scompensatloo,
as provided for by Section 3700 of the Labor Code, for the performance 01 the work for which
this permit is issued.
~I have and will maintain worker's compensation insurance, as /l3quired by Section 3700 of
e Labor Code, for the performance of the work for which this permit is issued. Myworker's
ompensation insurance carrier and policy are:
arrier: EXEMPT Policy Number. EXEMPT
~ section need not be completed if the pennij is for one hundred dollars ($1 00) or less.
I certify that in the perfonnance 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 worker's compensation
provisions of Section 3700 of the Labo CO~7') sharrJP~hwith comply w' h those provisions.
Date: 7/1/2005 Applicant: (~
WARNING: FAILURE TO SECURE ORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJEC AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED TH USAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAM GES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND A TORNEY'S FEES.
CONS RUCTION LENDING AGENCY
I hereby affirm under penalty of p, rjury that there is a construction lending agency for the
performance of the work for whi this permit is issued (Sec. 3097 .Civ.C):
Lender's Information:
ARCHITECT/ENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARATION
ere ya Irm u er pena. 0 perjury at am
licensed under provisions of chapter 9 (commencing
with Section 000) of D\rsion 3 of the Business and
Professi ns e.
7/1/2005
Date;
Contractor
NUMBER
375664
TYPE
TYPE
TYPE
EXPIRATION DATE
6/3012007
C36
C20 HT AC
B
Construcion Tvpes;
VN, ,
Fire Sprinklered?
NO
I certify that I have read this application and state that the above information is correct. I
agree to comply with all city ordinances and- state laws relating to building construction, and
hereb authorize representives of this city to enter upon the above mentioned property for
i sp 'on purpo
Date: 7/1/2005
Fees paid for Permit:
Tota/:
384.77
Signature of Applicant or gent
The p mit shllll expire by limitation and become null and void if the building or
work he passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Wa$te Pipe)
Electrical Ground Electrode/Ufer
SetbacklForm$/Trenche$ (Footin $
Do not in$tall subfloor or pour floor $Iab until the
tollowin ap licable item$ have been sl ned:
Plumbin ater Pi eJSprlnkler Valves)
Mechanical (Groundwork)
Electrical (Under round Conduit)
Pre-slab (Compactlon/Membrane Reinf.)
Underpinning (Floor Joi$t1Girdef$)
Do not cover or conceal the work below until the
following applicable items have been $igned:
1 st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathin Diaphra m1Frame)
Ma$onry (RelnfJBond BeamIPre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., fie., Mec. And Fire)
In$ulation (Sound/Energy)
Do not tape or pla$ter until the following applicable
item$ have been signed:
Drywall
Penetrations (Fire Rated) Electrical
Penetration$ (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 Bac.kflow
Water Service
. .
FINAL INSPECTIONS DATE INSPECTOR
Electrical Final
Plumbing Final
Mechanical Final
Gas Te$t
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040
Water Engineering 765-5268
Sub Li$t1Bu$ine$$ License 765-5194
Zoning 765-5139 I
Building Final (Last Inspection - Only .112.'1
After Above Complete) I .~ '^... l.,,:sV_1
PARTIAL INSPECTIONS
BuildinQ Insllections
MechanicallnsDections
PlumbinQ InsDections
Electricallnsoections