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134 Land Ln. TYF'EOF PERMIT Reroof ElM BUILDING DIVISION 200 s, ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REOUESTLlNE: (714) 765 - 4626 CENSUS CODE: 555 QUARTER SECTION: 33 t\ BUILDING PERMIT NO: BLD2005-01571 DATE: 5/25/2005 JOB ADDRESS: 134 S LAND LN LEGAL DESCRIPTION: N TR 2001 LOT 31 APPLICANT: MARIO PINEDA OWNER INFORMATION: CONTRACTOR INFORMAT:"I.oN: Mario'WPineda. . 134S Land Ln Anaheim, CA. 92804 JOB DESCRIPTION: Tear off existing and re-root 30 squares of composition shingles.. VALUATION: 9,000.00 ARCHITECT/ENGINEER INFORMATION: PROCESSED BY' SAM OWNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the ontractor's License w or the following reason ( ec. 7031.5 Bus[ne$s and Prof~ssions Code: any city.or county which require~a'perl'flit to construct, atter, improve, demolish or repair' any structure,prior to its.issu?-nce, also requires the applicant for such permit to file a signed statement that he is licensed"pursuant to the provisions oftha Contractor's License Law (Chapter 9J(commenCing with Section 7000. of Division 3 of- the Business.and Professions Code) or 'that he i~ exempt therefrom and the basis for the allegeq exemption. Any violation of Section 7031.5 by any applicant for a permit SUbjects the- applicant to a civil penatty of n.ot more than five hundred doll,ars ~ . . . .1,85 owner of property, or my employees with wages as their'sole compensation, will do the work, 'and' the structure is not intended or offere-d for ( c. 7044 Business and Professions Coqe: The Contractor's License Law does not apply to an oWner of property '"Yho builds or, improves ' ereon, 8I1d who does such work himself or herself or-through his or her own employees, provided that such improl{S'mentsare not intended or, offered for sale. .If, howev~r, the, building or improvement is.soh:twith one year of completion, the owner-builder will havel!1e burden of proving that he igid not build or improve-for the purpose Qf sale). o I, _as the owner. of the. property, am exclusivelY contracting with licensed contractors to construct the project (Sec. 7044 Business and ProfesSions Code: The Contractor's License Law does- not apply to an owner'of property who builds or improves thereon, and who contracts for such projects with Montractor(s} lic~ed pursuant to the Contractor:s Licen~ ~w). . ; U. I am exempt under Sec.. '. ,B& _ for thi$ reason: Date: . Owner: WORKER'S S ON 0 CLAR ION I hereby affirm under pe alty of JUry one,of the following declarations: o I "have and will mai n. a certificate of consent to setf~insure for worke'r's compensation, as prov}ded for by Section 3700 of the labor Code, for the performance Of the ~/ork for which this permit is issued.. . . '... o I have andwill-maintain.worker's comp~nsation insurance, as re qui re<:i by Section, 3700 of the Labor Code, for the p~rformanceof the work forwhich this permit is issu~d., My worker's Compensation insurance carrier and policy are: Carrier: ,Policy Number. This ectiOn need nOt be completed If lhe pennlt is tOr one hundred doll.rs ($1 00) or less. , I rtify that in ,the- performance'of the' work for whichlhis_ permit-is issu'edi i shall not 10 any person in any manner so as to become subject to the. worker's compensation laws of ornia, and agree that if I should become subject to the worker" mpensation provisions of ?ectjon 3700 o~ the Labor, Cod shall forth~ith comp ith those provisions. LICENSED CONTRACTORS DECLARATION I. hereby a irm under penalty of perjury that I am. licensed under proVisions of chapter 9 (commencing with Section 7000) of Divsion 3 of the Business and Professions .Gode; , . 5/26/2005 Date:. Contractor NUMBER EXPIRATION DATE TYPE Date: 5/2612005 Applicant: WARNING: FAILURE TOSECUREW ER'SC PENSATI COVERAGE UNLAWFUL, AND SHALLSUBJEC N EMPLOYER TO CRI~INAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED OUSAND DOLLARS ($100,Ooo):IN ADDITION TO 1HE COST OF'COMpENSATlON, DAMAGES AS PROViDED FOR IN SECTION 3706 OF THE, LABOR CODE, INTEREST AND ATTORNEY'S FEES. . . CONSTRUCTION LENDING AGENCY 'I; I hereby affirm under penalty.of perjury that there is-a constructiOR lending agency for the. performance of the yjork for which this permit is issued (Sec.3097.Gi\(.C): '11- Lender's Information: -- Construcion Tvpes: VN" . ~..i&.' I cert(fy that 1_ have read this application. and state that the above information is correct.' I agree to COI1'1pl with all city ordif,Jances and state laws relating to building construction, and hereby author> _ representives of th.is c' t enter upon the above mentioned property for insp . purp,o $:' = ~ Date: 5/26/2005 Signatur of Applica or Agent permit shall expire limitation and become null and void if the building or work has not pasl;edfinal i ~ection 365 days from the date of permit issuance. A new permit is required to commence. or continue work.' Fees paid for Permit: Total: 271.49 INSPECTION RECORD . INSPECTION DATE INSPECTOR Temporary Power Pole . . Plumbing (DrainIWaste Pipe) . . Electrical Ground Electrode/uter . . Seiback/FormslTrenohes.(Footings) . Do not install subfloor orpourfloor sial until the . following applicable items haye been signed: Plumbing (Water Pipe,Sprinkler Valves) , Mechanical (Groundwork) . Electrical (UndellP'ound Conduit) . . . .Pre,slab (Compaction/MeI11brane.Reinr. . . Underpinning (l'Ioor Joist/Girders) Do not cover or conceal the wo", below until the following applicable items have been signed: . . 1st Fleior Shear . .. . . Firesprinkler (Rough) . . 2nd ~or She~ ... .. II. /.1. !l,l '. Ro~ .aphla!lmlFrame) "(t(ff) Masonry (RelnfJBondBeamlPre-Grout) Rough Plumbing (Top Out) Rough Mechanical .. i KOugn t:Iectricallury wall) . . . . Rough ElectrIcal. . . Framing (Only aher.Plbg.. Elec.. Mech...and Fire) Insulation (SoundlEnergy) po f10r rape or pla~ler until the following applicable . ,temshave been signed:. . .. .. . Drywall. . . . . PenetratlQllS (Fire Rated) Electrical Penetrations (Fire Rated) Mechanical Penetralions(Fire Rated) Plumbing . Interior lath .. . . exteriOr lath . GENERAL ITEMS ., exterior Plaster (Blwm Coal) . . . T -Bar Electrical . . T-Bar Mechanical T -Bar. Structural . ., Sewer Water Engineering Backflow . . . .. Water Service . . . .. FINAL INSPECTIONS . Date .Inspector . Electrical Final. .. . . .. Plumbing Finai ... '. Mechanical Final Gas Test .. . . . Engineering/GradIng Final 765-5126 Fire Dept. Final 765-4040 . .. . . Water EngIneering 765-5268 . . Sub List/Business LIcense 765.519 .. .. Zoning 765-5139 . . . Building Fin.al !kasllnspection- Only l:.l$f:m L -'" fler Above Complele) . -". . PARTIAL INSPECTIONS Buildina Inspections .G,.~~ . .'~"""""11"1 Mechanical Inspections Plumbina Inspections. Electrical Inspections .