300 N. Lakedale Dr.
TYPE OF PERMIT ,C ITV
Reroof
ElM
BUILDING DIVISION
200 S, ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST CINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 167
BUILDING PERMIT NO. BLD2005-01382
DA T,E: 5/12/2005
JOB ADDRESS: 300 N LAKEDALE DR
LEGAL DESCRIPTION: N TR9482 LOT '7
APPLICANT: TODD WALLACE
OW'NER INFORMATION:
. Robert C Dean
300 N Lakedale Dr
Anaheim, CA 92807
ARCHITEP/ENGINEER INFORMATION:
CONTRACTOR INFORMATION:
MILES ABOVE ROOFING
2479 SANTA ANA AVE
COSTA MESA, CA 92627
BUSINESS PHONE: 949642-7812
JOB DESCRIPTION: Tear off existing and reroof 30 squares with 50~year asp~ait shingles
VALUATION: 11,400.0.0
I ' OWNER.BUILDERIJECLARATION
. I hereby affirm _under penalty of perjury that I am exempt from, the Contractor's Ucense Law for the following reason (Sec. 7031.5 Business and
Professions 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'Hu.sinessand 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 subjects the applicant to a civ'if penalty of not more than five hundred doliars
~~ ' , ' " '
o 1, as owner of property, or my employees with w~ges'.as their Sole compensation, will do the work, and the structure is not intended or offered for
sale (Sec..7044 Business and Professions CDl;1e: The Contractor's "License Law does not apply to an owner of property who builds 'or improves
thereon, and who does such workhimself or helSelf or through his or her own "employees, provided that such improvementS'are not in.tendedor ~,
offered for sale. If, however, the building or improvement is sold with one year of completion, the owner-buiider will have the burden of proving-that he
did not build or improve for the purpose of sale). .. -
D I, as ttie o...yner of th'e property, am exclusively contracJ:ing with"licensed cOntractors to construct the project (Sec. 7044 Business and Professions.
Code: The Contractor's License Law does not apply to an oY./ner of property who builds or improves thereon, and who contracts for such projects with
a contractor(s) licensed pursuant to the Contractor's Lice'nse Law). '
D I am exempt under Sec. , B & P.C. for this reason:
Date: Owner:
I ' WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pe~ury oneof the following deciarations:
D. I have and-will maintain' a certificate of cOrisent toself~insure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the'y.;ork for which
this permit is issued. " . . '
~ have a'nct will maintain worker's compensation insurance, as required by Section 3700 of,
the Labor Code, for the pertormance of the work for which this permit is issued. Myworker's
Compensation insurance carlier and policy are: '
Carrier: NO,EMEPLQYEES' Policy Number. EXEMPT
PROCESSED BY: JNJ
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I al}l
licensed under provisions of chapter 9 (commencing
with S'ection 7000) of Divsion 3 of the Business and
profession~.~ ~ ',' .
5/12/200:; ~ '~
Date: Contractor
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
Zl I certify t~at in the'pertormance of the'wo;k for which this permit is issued,'l shall not
employ any person in any manner so as to become'subject to the worker's compensation laws
of Califo'mia, and agree that if I should become subject to the'worker's compensation,
provisions of Section 3700 of the Labor' Code, I shall forthwith comply with those provisions.
" ,'~'
Date: 5/12/2005 Applicant: ~', "
WARNING: FAILURE'TO SECURE WORKER'S COMPENSATION COVERAGE IS
UNL:AWFUL, AND SHALLSUBJECT.AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OFCOMPENSATION, 'DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction tending agency ior the
performanCe of the work for whiCh this permit is issued (Sec.3097.Civ.C):
I,:ender's Information:
NUMBER
,763165
TYPE
TYPE
EXPIRATION DATE
, 5/31/2005
C39
Hie
Construcion Types:
V,N, ,
t 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 c,?nstruction, and
herel:1y authorize representivl3sof this city to-enter upon the above mentioned property for
inspeqtion purposes. ~ "
Ii? ~..e'd ~ ----- " Date: 5/12/2005
Signature of Applicant or Agent
, Thl! pEll'mit Shalll!xpirl! by limitation andbElCoJrenull and void if the building or
work has not passed final i nspElCtion 365 days from the datl! of pl!rmit iSSUalCl!. A
nl!W pl!l'mit is rl!quirl!d to co"!menCl! or continul! work.
Fees paid for Permit:
Total:
235.97
. . INSPECTION RECORD
. . . INSPECTOR -
. . . INSPECTION . DATE .
Temporary Power Pole' .
plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/lifer .
SetbacklFormslTrenches (FoOtings)
Do not installsubfloor. or. pour floor slab until the .
. following applicable.items have. been signed: .
Plumbing (Water Plpe.Sprinkler Valves) .
Mechanical (Gr\)U ndwork) . . '. , .
.Electrical (Underground Conduit) .
Pre,slab {Cornpaction/Membrane.Reim..
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until too.
following .applicableitems have been signed:
15t F.loor Shear . .
Firesprinkler (Rough) ..~
2nd Fleior Shear . VIP'
Roof l.8heathl aphragrnlFrame) "I' -~~.... .'
Masonry (HlllnfJBond BeamlPre-Gl'Ollt)
Rough Plumbing (Top aut) .
Rough Mechanical' . . -
KOUSn t:IectrlClII(ury wall)
Rough Elecirical
Framing (Only after Plbg., Elec.. Mech...and Fire).
Insulation (SoundlEnergy) . . . . .
Do noltape or plaster until the following applicable
.items have been signed:' . . .'
Drywall . '. ". .
Penetrations (Fire Rated) Electrical .
Penetrations (Fire Rated) Mechanical .
Penetrations (Fire Rated) Plumbing . .
Interior Lath. I
Exterior Lath . .' . .
'. '. . GENERAL ITEMS'
Exterior Plaster (Brown Coal) .
T -Bar Electrical . . ,
T~Bar MeChanical ."
T -Bar Structural ".
Sewer . . ,
Water Engineering Backflow . .
Water Service .
FINAL INSPECTIONS ". . . Date . Inspector
Electrical Final . .
Plurnbing Final . '
Mechanical Final.
Gas Test '.
.
Engineering/Grading Final 765:S126 . .
Fire Dep!. Final 765-4040 . '.
,. .
Water Engineering 765-5268 ',' .
Sub List/Business License 765-519 .... .
Zoning 765-5139 . . .
. .
Building Final ~ast Inspection- Only v/;',j .Pk-W
fter Above Complete) "7/ qT'
PARTIAL INSPECTIONS
Buildina InSDections
MechanicallnSDections
Plumbina InSDections
Electrical InsDections