2352 W. Mall
TYPE OF PERMIT
Reroof. CITY.
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765- 5153
INSPEGTION REQUESTLINE:
(714) 765 - 4626
CENSUS .COQE: 434
QUARTER SECTION: 33
BUILDING PERMIT NO. BLD2004-04070
DATE: 11/8/2004
JOB ADDRESS: 2352 W MALL AVE
LEGAL DESCRIPTION: N TR 2001 LOT 18
APPLICANT: FRANCISCA CRUZ
OWNER iNFORMATION: CONTRACTOR INFORMIlTION: ARCHITECT/ENGINEER INFORMATION:
Jaime C rtlZ
2352 W Mall Ave
Anaheim, CA 92804
JOB DESCRIPTION:Tear off eXisting material replace plywood add 23 square" of 30 year shingles.
VALUATION: 3,000.00 PROCESSED BY: ENO
I" OWNER-BUILDER.DECLARA TION
I hereby affirm under penalty of perjury that J am exempt from the Contracto!'"',s License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, alt,)[, 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, li~.,e,;lsed. pu~suant to the provisions of the Contractor's License Law (Chapter
,9}(commencingwith Section 7000 of Division 3 of the Bu'siness and Professj(,r'fs Code) OC ttlat he is exempt therefrom and the basis for the alleged 0
. exemption. Any violation of Section-7031.5 by ,any appl1cant for a permit s'.Jbj'ectsthe a ppljcant to a .dvil penalty ot not more than five hundred dollars
~?)~s owner of property, or my employees with wages as their sole comp~nsauon, will do ;he.work, and the structure. is not intended 0.. r offered for
~sec. 7044 Business and Professions Code: The Contractor's License ~aw does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through hiser herow~, ~mploye~, provided that such irr,provements are not intended or .
offered for sale. If, however, the !:>uilding or improvement is sold with one Y9~ir of completion, the owner-builder- wlJlhave the burden of proving that he'
did riot builder ill1prove..lor the purpose of sale). - i .
o I, as the owner of the property, am exduslvely contracting with licensed_ ::On tractors to construct the project (Sec. 7044 Business and professions
Code: The Contractor's License law'c!oes not apply to an owner of" piOpertyl!,-,ho builds or imprqves'thereon, and whO contracts for suCh projects w~h
fl,Contractor(s) licens~pursuant to the Contrac.to~'s License Law). . ;
1..J I ani xe pt under Sec. -. , & P.C. for this reason' ,J"
...- Dale: 1\ '('; Owner: . .
\
LICENSED CONTRACTORS DEClA,RATIO~
, I hereby affirm u.nder penaltycf perjury thatJ am
licensed under provisions o.fcnaplt:it 9 (commencing
with Section 7000) of D!vsion 3 of the Business and
professions Code.
11/8/2004
Date:
Contractor
WORKER' COMPENSATION DECLARATION "
. I hereby affirm under penalty of perjury one of the followtllg declarations: ~
o I have _and will maintain.a certificate of COnsent to self-'-insure for worker',icompf:nsat!on,
as provided for by Section 3700 of the Labor Code, for the performance ofth'i;l,wo:1< for whid1
this permit'is issued. . .' . I
o I have and will r:naintain worker.'s compensation insurap.c~; as required b)~ S-7ction 3700 of
the labor Code, for the performance of the 'work for whic.h this permit is issuep. Myworker's
Com,pensation insurance carrier and policy are:' .~
Carrier: Policy Number.
NUMBER
EXPIRATION DATE
. . ,
This section need not be completed if the pennit is for one hundred dollars ($1 ocj,pr less.
MI ce~ify that in the performance of the work forwhich this permit is issue;l,1 shall .not' .
~PrbY any person in any manner so as to become subject to the worke:r's cO)::1pensat!on laws
of California, and agree that. if I should become subject to.the worker's compe;lsation
provisions 'of Section 3700 oft e Labor Cod hall forthwith comply ith ti1:-kB provisions.
oJ'
.Date: 11/812004 Applicant. ,r
WARN ING: FAILURE TO SE
UNLAWFUL, AND SHALL S JECT AN EMPLOYER TO CRIMINAL PENALflES AND CIVIL
FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDlhON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN.SECTION l706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. '
I CONSTRUCTION LENDING AGENCY .
.1 hereby affirm under penalty of perjury that there is a construction lending 3{J(:ncy fljr the
P?[tqr!"D~rice_()fJhe work for_\'Vhich_!hi_~ permit i~ i1?sue'd (Sec.3q97.qy}~):_.. ._ J
Lender's Information: '. - - ,--
TYPE
Construcion Types:
VN, ,
Fire Sprinkler.ed?
NO
, .
I certify_that I have read this application and st?lte that the above information is correct. I
agre-e to romply with all city ordinances and state laws 'relating to building construction, 'and
hereby a,:,t~orjze representives"Of this city to enter upon the above mentioned property for '
insR;' rposes.
Date: 11/812004
Fees paid for Permit:
Total:
235,33
Signature of Applicant or A
e permit shall expire by limitation a
work has not passed final inspection 5 days from the date of permit issuance. A
new permit is required to .commence or continue work.
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole .
Plumbing (DrainlWastePipe) .
Electrical GroundElectrodelUfer .
SetbacklFormsfTrencheS (Footings)
Do not install subfloor or pour floor. slab until the
following applicable items have been signed: ..
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork) .
Electrical (Underground Condu ill
Pre-slab (CompactionlMl!IT!brane.Reim.. . . .
Underpinning (Floor JoislIGirders)
Do not cover or conceal the work below until the
fOllowing applicable ilems have been signed: .
1st Floor Shear .
FiresprinkJer (Rough) . .
2nd Floor Shear . -( t
Roof (Sheathing/Diaphragm/Frane). fl-fViJ'( V :ll0-1/. V Y
Masonry (RelnfJBond BeanlPre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough electriCal (Dry Wall) .
RoughEleclrical. . .
Framing (Only after Plbg.. EJec:, Mech.. and Fire) .
Insulation (SoundlEnergy) .
Do not tape 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 .
Exterior Lath .
. .. GENERAL ITEMS
Exterior Plaster (BraNn Coal)
T -Bar Electrical .
T -Bar Mechanical .
T -Bar Structural
Sewer . .
Water Engineering Backflow .
Water Service
FINAL INSPECTIONS Date. . Inspector
ElectricarFinal ..
Plumbing Filial. . . .
Mechanical Final
Gas Test .
Engineering/Grading Final 765-5126 .
Fire Depl. Final 765-4040 .
Water Engineering 765-5268 . . .
Sub LisllBusiness License 765-519 .
. .
Zoning 765-5139 .
.
Building Final ~astlnspection. Only. tI~G,.9 v~ +~4,~
fter Above Completel
PARTIAL INSPECTIONS
Buildina Inspections.
Mechanical Inspections
. Plumbh,olnspections
Electrical Inspections