938 N. West St.
TYPE OF PERMIT
Reroof
;~~)i~'~ . ~;~:\ '
CITY QIi~N'~HEIM
, "\\~~~~~".:~l~~l '
BUILDING DNISiON:,
200 $, ANAHEIM BLVD,
(714) 765.5153
INSPECTION REQUESTUNE:-
'(7.14) 765. 4626
CENSUS CODE: 555
QUARTER SECTION: 61
,BUILDIIIIG PERMIT NO. BLD2004-03221
DATE: 8/2312004
JOB ADDRESS: 93'8 N WEST S1
LEGAL DESCRIPTION: ANAHEIM 'EXT LOT 39 P'OR OF LOT
APPLICANT: GUADALUPE MARTINEZ
OWNER INFORMATION:
G'uadalupe' Martinez
938 N West'St
. Anahefm," CA, 9280.1 .,'
JOBDESCRIPTIONRer06f With tear-off new compo. roofing (exist'g residence):.
CONTRACTOR, INFORMATION:
1
ARCHITECT/ENGINEER INFOR'MA TION:
VALUATION: 2,000,00 i PROCESSED BY: DOR
_,c..
I OWNER-BUIl.OER;OECLARA Tl0N
I hereby affirm under penalty of perjury that'! am exempt from the Contra~\)r'.t.Ucense Lawf.orthe following reason (Sec: 7031.5 Busir~essa)1d'
Professions Cqde. any oty oruounty which req~ires a pe:-mit' to construct, ~jt<:'t; imDrDl/'G; demOlish or repair cny stn..1Gture, pr;or to jts.i.ssuance,aiso
requjres -the'~pplicantfor such perrnitto fire a s;gf~ed statE:~nent that he isl~_~..::':..:'~d pursuant, to the pfovisioll.$ of the' Contracto(s' License Lav, (CI)apt:er
9){commenclng with Sectio'n 7000 of Di\lision3'of the Busin~ss and Profcssk:!1S Code) o(,thathe: is exemptthel"l3from and the basis for the allegep
ex;mption. An'}- violation of Se?tlon 7031,.5 ~y any ap.plici:!nt fo(a permit s~~C~f_~ts ~t,e a pp-lfCun.t to, a dvil p~nal'tyof not more than five !11"llidred dol!a~~ .-
($~OO), ' ,," '" , " ,,''f " ' ,',' '",,'
CJ ,'_, ascwner of property, or'my el11p1oyees wii:h WEll;J93- as their ,sole ct'mpt~i'j.Sjtio~, wi!! oot11e '/Iork.. and thE; struc~ure is not In tend erJ cr 6ffere,d for
sale ~Se~. -rOM BUS:iness and.ProfesS!9r.=: God~: The Gontmc~(;r;s UCf.;.s~pi\v..'does not apply to 3n' QW!lcr of pr?p'erty-who. builds'or improves .
thereon, and wh<? does, such_ \jVork,him:::.<:!f c-r h~:se!f or ~hrolJg-!111is or h(~r o"\'r'~b((lpjoyees,PioV[deo that such hnp-ro'v:;ments are not intended or
offer~d for .sale. If, oow-evel'"the. building ori.mproverr:ent,is ~vrd with Cl:,,\P,..~i,:4 ,.)f oompleUon, the owner-builder wHllH:lVe the burdennf pi0ving thiJ,t h>i:-
did !let huifd o/improve for the purpose of sale),. '_,j), - ". ' ,
C 1,- as'the owner otthepr,operty, arn.:exclusive:Y~~ntradlr'9 with !i9t:nsc~~ ~/ntractors, ~o cor.stn.:ct ;h,\:: project (Sec., 7044 Busine~s,~md P.rofe~iQn$ -.
C,OC~: The contr, a" ctor\s L,i_cen, se',L::3W d~e$ rlO,t ?PP,ly to. an, o\':n~r,Of proP(2' '''./f,',/:0 builds or h:nproves tl1,er,eO,n,' awl v"'''o CC~ltrH,C:ts fOr SU,ch ::,rojects Wlt:~' .
f:jontracto,rCs} Hc~nsed pur~uanU~-t,he Contlactor~sycense LDW).,' ',':.1 ,'r2I .' ,/ ~ '.. " _,. , (7. "_~, .' ,,' , , '::, '.' - ..'
Dalel:mexemPl ur,d~r se~wner: ',=- B & ~!..;' fo, this r~dSl'~~ ~ __.;:t~~sat q:~~__....: _===;:::~_
,c=----'--' , WORKE~'S CO~~PENSAt:()N DECLAPAUQ.N. -. _L, -7-:--J ,! ,LICENSED CONT~~ DECLAl?J\T.iON ]
, .,1 he~eby zffil'rn under penalty of perjury'one of thefO\:owiPg:'J~Clarati::-ns::.,~;". - ~. 1 h,er~byaffirm und<.::~,pei~2Ity cf !?eriury'~h<:t.i am ,
o I have _mY.i "'1in mzinta'in a certificate of O');1sent 'fo-s,::i-inD;)re for t'.;o,'k.;:;,,':t~oi'T.,.)~:-::;~tion. ' In<:ensed und~r provisions of ch~pt!3f 9 (cor.:lITi,en.;ing ,
,~s. provided 'fer by. Sectbn_ 3"700 of-the Laber Code, forthe periontlz::no-.:: (.f t:~5~'::;l; fer Whic""l with Se?tion 70~0; of ~jvS;on-3 of the Business ar;d "
this'permit is issued. , ". ), I Pr::>fesslcO$ Coo€-. .
o I.hs\it:,.;- and will rnair.tain,wol'ker's.compensation ~nsl;ran\,;e, ::ls':equited b~;';:3ecj!o;) 37nOof '8/2.3/2004, __~___.__~___....__
the Lab0r Code, fot the- perfon:nznce of the work for whicfl thj~ permit it: is~u-,;;fJ. My workcc's Date: Gorr~ro:ctor
Cornpen'Szt:on insurance carrie; and pon'cy are: .
Cartier: POlk,y Number: ",~ "'UMBER EXPIR.A,TiCN, DATE
'.\
"This section need not'be cOmplete,d ifthepenr,it is for one l~undr3d colla,:; {.s~u::;i"r !es~. TYPE
o I, c.ertifyth?t in theper'iorma(lceofthework'fOr,whfci1 ~h!~perrrii1 :s,i~::;9,'Jli;:_L$ha!l npt '
,emP10,'Y8ny person in, any m~nner so, ",S ~O,be::;cni~.SUbject,to t;;ew9rk~(~,:r,:~.?~nrG~Sati'~H11<.I'~S I
of Califoml'a, and~gree- thi:!t if I s-hould. beco,rr.t! suoJed to the worl<er's c0~~e!l5;:l:hOj) ,
prOVi$iO, ns of Section ;3700 of the L3bOade, I shal fO,rthwith cO(T1plywilii t':'!,'~"e Wov;sions,.- 8o~strU(;iCln Types:,
Date: ef2.3f2004' Applicant: ^ 0 . t:. (1 4~~_~ Fi(e'S~rjnklsrsd?
WARNING: FAiLuRE TO SECUR[~RKER'S COMPENSATION CQ\lER:,(~" IS ,', I
LlNL,AWFUL, AND SHALL SUBJECT,AN EMPLOYER, ,TO. CRIMINA,I- PEN...I.",ES Ai',':;' C1V, 'L'I '
FINES UP TO. ONE HUNDRED THOUSAND DOLLARS (S100,OO,O), IN ADO:";ON fC! THE
COST OF COMPENSATION, DAMAGES AS PROVfPED FOR IN SECllCN 370d OFTHE
LABORCODE,'fNTERESTANP ATTORI~EY'S FEES,' ,', "":'. ' 'I'"
I :,' "'CONSTRUCTION LENDING AGENCY " , " ,
,lhereby (l,iirrrrU,nd.er penalty of. perjury that there is a. constn.;ction,lenCing ?Q::.r.cy T()r the I
performance ofthp. work. for which this permit IS i~sued(Sec.3097 .C_iv.C);
Le'nder's tnformat!on: . ".______ -- __1-
NO
(
, certifY that I have read' this a'pplication and state that tt)e above informatlo,n is correct: . ~
agree,to comply with all city ordinances arid state laws relating to building corstruction,_ and
hereby authorize representives of this city to enter upon the above mentioned prppertyfor
ins~ect(N;;s~~~"a~~ Date: R/23/2004
1"(. : Signature of Appli ant-or Agent
The permit shall expire by limitation and become null am! void if the building'or
work has notpassedfinaUnspection 365 day!! from the date of permit issuance. A
new permit is required to commence or continue work.
Fees paid for P~rmit:
Total: ,
160.61
. INSPECTION . . DATE '. INSPECTO~
'.
temporary Pow<irPole . . ....
Plumbing (DrainlWaste Pipe). . . . . .' . ..,
. .' . .
ElectriCal. Ground ElectrodeJUler . .
SelbacklFormsfTrenches (Footings) .
Do not install subflooror pour floor slab until the . I'
,following applicable items have been signed:' ' .' . :., .
. Plumbing (Water Plpe.Sprinkler Valves) : F
Mechanical (GrolindwQrk) . . I.
. . .
. Electrical. (Underground Condu it) '.
. Pre-slab (CompactionlMembrane.Reinf. . , S
Underpinning (Floor Joist/Girders) . Z
Do not cover or: conceal thewor!< below Ont,l the . , B
followingapp.licable ifems have been signed: . .
. 1st Floor Shear '. .
.' Flresprinlder (Rough) .' . .' >'
.' ~Shear . . . ". ..... './- . B
Ro athin" hraam'Frame)', , ~" .../
Masonry (Remf.JBond BeamlPre-Grout) . ..'
Rough Plumbing (Top Out) '.'
Rough Mechanical . .' . . . .
.' , l"COug!l F;lettrlcal (Dry Wall) - ", .'
Rough Electrical .' ' .
. Framing (Only after Plbg., EJec.. Mech and Fire)
. Inwlation (SoundlEnergy) , .
... M
po not.lapeor pla~ter' until the following appllcab]e. ,
Items h~ve been ~Igned:, . .. " :
Drywall . .... .. .' .'. . :.."
PehelratiollS (Fire Rated) EleCtrical .
PehetratiollS ("'ire Rated) Mechanical '. . .
Penetrations (Fire Rated) Plumbing . . .
, Interior Lath . .
Exterior Lath , '. PI
, .... GENERAL ITEMS . . , . . .
ExteriorPIastl!r (Brown Coat)
. T .Bar ElectrIcal ' . ...:
T-Bar Mecl)anical . . . .
. . .
. T .BarStructural . . '.
Sewer .. , '. ' .. .
Water Engineering Backflow . , . : EI
Water Service '. . -
. INSPECTION RECORD
FINAL INSPECTIONS
Electricalf'inal
Plumbing Final
MeChanical!,inal
Gas Test
EngineeringlGracling Final 165.0126
ire Dept. Final 165-4040
Water Engineering 765-5268
uti List/Business License 765-519
0"ing765-5139
uilding Final IlasflnspectiQn- (y
. . Aller Above Com lelel
-PARTIAL INS
uildina Inspections
Date'
Inspector
~
echanical Inspections
ombina Inspections
ectrical Inspections