1750 W. La Palma Ave.
1YPE OF PERMIT CITY
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aWi..DlNG PERMIT NO. BLD2003-04520
BUILDING DiVISION
200 S. ANAI-IEIM BLVD. '
(714) 765 - 5153
INSPECTION REQUEST LINE: .
(714) 765 -.4626 '
CENSUS CODE: 555
QUARTER SECTION: 45
DATE: 11/19/2003
'JOB ADDRESS: 1750 W LA PALMA AVE
, LEGAL DESCRIPTION: SEC 8 T 4 R 10 POR N1/2 NE1/4 NE1/4
CONTRACTOR INFORM/'TION:
JOHN & JIM'S ROOFING
13739 CULLEN ST
WHITTIER, CA 90605 QOe"
, ' BUSINESS PHONE: 562 3~:;-8116
JOB DESCRIPTION:Replaceexlstin9 capsheet with new cap sheet.
VALUATION: 14,000.00
I OWNER-BUILDEF: DECLARATION
I hereby -affirm under penalty of perjury that I am exempt from the Contracto;~'; license law-for the following reason {Sec. 7031.5 ausiness arid
Professions Code: any dty or county which requiresa permit to construct, a~..~r. improve, demolish' or repair"any structure, prior to its issuance,.also"
requires the applicantfor such permit to file a signed state~nt that heis licfO!Ll&edpursuant to th3 provisions ofthe Contractor's Lic'E!nse Law (Chapter
9)(commencing with Section 7000,ofDivision 3 of the Business and Plof~s;:n3 Code) or that he is exempt therefrom ~rd the baSIS for'the alleged
exemption: Any violation of Section 7031.5 by any applicant for a permit sut'Jf.!cts the applicant to a civ~-penaltyof not,more t.han five hundred dollars
~~ ,'. ' . ' ",'. "
o I, as owner Of_property, or my employees with wages as their sole com~,':sation, will do the work,- ana the-structure is not intended O( offered for.
sale (8ec.7044 Business and Professions Code: The Contractor's License ,_-JW does not apply to an OWr)C;" 61 property wilo puildsor improves .
thereon, and Who ,does $udtwork himself or herself or through his or her oW" employees, provided that such improvements are not inten9edor
offered for sale. If, however, the building or improvement is sold with oney€ -:!" ohx>mpletion, the owner-bu,ilder:will h.:.ve the burden of proving ,that he
did not build or improve 'for the pUrP_ose of sale),' '.' . . .
O' I, as the owner ot the prop'erty, am exdusively ,contracting withlicensE'c iontractCis to construct the project(Sec. 7044 Business ar:d Professions
Code: The Contractor's License'Law does not apply to an owner of property'vho b:.iilds or improves thereon, and who contracts for sudl.projects with
.a..yo.ntrador(s) licensed pursuant to the. Contractor's L.ic:ense Law). .
UI am exempt under Sec. _' ; B & P .C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION .. --
I h~reby affirm under penalty pf perjury one of the .following d.eclarations:
o r have and will.maintain ~ certificate of consent to seff-insure fOiworker'~ .;ompensation,,"
as proviqed for by Section 3700 of the Labor COde, for the performance oftr,:'! work for which
this permit is issued. !
o I have and will maintain'worker's compensatidli,insl,lrance, as requireci b; Section 3700 of
the Labor Code, for the-performance of the work for which this perrnit is iSSU.--1. Myworker's
Compens,ation insurance.carrier and policy are: .
Carrier: Policy Number. EXEMV'.. '
APPLICANT: JIM REYES
OWNER INFORMATION:
Italian R Bruno's
1750 W La Palma Ave
Anaheim, CA 92801
ARCHITECT/ENGINEER INFORMATION:
..-.,......""~
PROCESSED BY: CAL
LICENSED CONTRACTORS DECLARATION
I hereby;j; Irm under penalty of perjury that I am
licensed Linder provisions of chapter 9 {commencing
with Seotio!17000 f DiVSion7(o he Busi~ess, and
Professions. 'l.. "." .
rt'l1912003 A- .A---
Date: Contra or
, ,
, ,
:This,S on ne~, not .~ completed if the pe,nnit is for one hundred dollars ($1 O~~ -?" less.,
I certify that in the performance of the work for which this permit is iSsUE;d. I sha,1I not
lay any person in any man.r.ter SQ as to);lecome subject to the worker's c:Il'!1pen~ation laws
lifomia, and agree that if J should become subject to theworkei"'s comptH'lsatipn
provisions of Se:ction 3700.ofthe leibor C e.1 shall fort . h comply with U.....:sa.provisions.
~. . ",
Date: 1111912003' Applicant: ' '
WARNING: FAILU'RE TO SECU KER'S COMPENSJyrJON,COVEi':.e,.qE'jS '
UNLAWFUL, AND SHALLSUS' EMPLOYER to CRIMINAL PEN.:\'.nESAND CIVIL
FINES UPTO ONE HUNDRE ' SAND DOt.LARS ($100,000), IN ADe:'loN TO THE
COST OF COMPENSATION, 0 AGES AS PROVIDED FOR IN SECTICN 3706 OF THE
LA!!OR CODE, INTEREST AND ATTORNEY'SFEES.. :',., i,
I ' _ CONSTRUCTION LENDING AGENCY .un
I p~rebv ==-ffinn undAr pp.nalty ~f pe:jl.l'v tMt tI-,,!$OorA r. ~ rl"l!"\$'trtl..._~i..-v.:! !~I>dk'--:.,,::<~~..'~,~=~_f0 tr..:;o"
performance of the work. for which this. permit is issUed (Sec.3097 .Civ.C): -
Lender's Information:
EXPIRATION DATE
C3D
HIC
Construcion Types:
VN" '
.~~..;
I certify that fhave re~d thisapplication'~nd state that the above informaticnil.'; correct. I
agree to com'ply with all city ordinances and state Jaws relating to building cOTlstructi9n, and
hereby au ize representiveU. , .s city.to enter upon the above mention6<. .property for
inspect. pu sas. or. . .
, ,'--z-. Date: 11'1912003
Signature of Applicant r Agent
shall expire by limitation and becortle null and void if the bUilding or
not passed final il)Spection 365 days fromt~ date of permit issuance. A
mit is required to commence or continue work., '
Fees paid for ,Permit:
Tolal:
268.09
.' INSPECTION RECORD
,INSPECTION ' , DATE INSPECTOR
Temporary Power, Pole ,
Plumbing (DrainlWaste Pipe) " ' ,
Electrical,Ground Electrode/uter
SlllbacklFormslTrenches (Footings) , , , ,
Do not install subfloor or pour floor slab until the
followin(!applicable items have been signed:
Plumbing (Water Plpe.Sprinkler Valves)
MechaniCal (Grouildwork) ", ,
Electrical (Underground Conduit)
Pre-slab (Compactlon/Membrane.Reinf.
, Underpinning (F1llOr JoistlGirtlers) , ,
Do not cover or conceal the work below ,until the, "
following applicableilemshave been signed: " , ,
1st Floor Shear ,
Firesprinkler (Rough) : , ,
2nd Floor Shear " ~
Roof (Sheathing/Diaphragm/Frame) 1//'ttlo3
'Masonry (ReinfJBondBeamlPre-Grout) "
Rough Plumbing (Top Out) , , ,
Rough Mechanical
Rough ElectriCal (DrY Wall) .
Rough Electrical ,
Framing' (On!y after Plbg., Elec.. t.,,1ech.. and'Fire) "
Insulation (SoundlEnergy) , , .
po not tape or plaster until the fallowing applicable
.tems have been Signed: ' , '
Drywall " , ' , ,
Penetrations (Fire Rated) Electrical ,
Penetrations (Fire Rated) Mechanical,
Penetrations (Fire Rated) Plumbing , .
Interior Lath' ,
ExteriorLath ,
, " . GENERAL ITEMS,
Exterior Plaster (Brown Coat)
'T .BarElectrlcal
T -Bar Mechanical "
'T -Bar $tr!lctural' ,
Sewer' ,
Water Engineering Backflow ' ' ,
Water Service
.
FINAL INSPECTIONS' D'ate Inspector '
Electrical Final , ,
Plumbing Final " ,
,
Mechanical Final . ,
Gas Test ,
Engineering/Grading Final 765-5126
Fire Dept. Final 765-4040 , ,
Water E'ngineering 765-5268
Sub List/Business License 765-519
Zoning 765-5139 ' ,
"
Building Final ~ast InspeCtion- Only " ' /~f 0 i b
fler Above Complele) 1t-11''''f
PARTIAL INSPE:CTIONS
Buildina Inspections
Mechanical Inspections
Plumbina hi,spections
Electrical Inspections '