1265 N. Manassero St.
TYPE OF PERMIT CITY
Reroof
DATE: 6/9/2005
JOB ADDRESS: 1265 N MANASSERO ST
LEGAL DESCRIPTION: P BK 239 PG 48 PAR 1
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 166
BUILDING PERMIT NO. BLD2005-01753
CONTRACTOR INFORMATION:
A-1 ALL AMERICAN ROOFING, INC.
22029 S FIGUEROA
CARSON, CA 90745-0000
BUSINESS PHONE: 3103200224
JOB DESCRIPTION: Tear off existing and reroof 163 squares with BUR
VALUATION: 26,895.00
I OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or county which requires a permit to construct, after, 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 Business and 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 civil penalty of not more than five hundred dollars
($500).
o I, as owner of property, or my employees with wages as their sole compen..c;ation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License Lal.!\; does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold with one year of completion, the owner-builder will have the burden of proving thatllS"
did not build or improve for the pu rpose of 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
~ontractor(s) licensed pursuant to the Contractor's License Law).
U I am exempt under Sec. , B & P.C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
D I have and will maintain a certificate of oonsent to self-insure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work. for which
this permit is issued.
1:f"i have and will maintain worker's compensation insurance, as required by Section 3700 of
the Labor Code, for the performance of the work for which this permit is issued. Myworker's
Compensation insurance carrier and policy are:
Carrier: VIRGINIA SURETY COMPANY Policy Number. 00500024467
APPLICANT: DA VE RYBUS
OWNER INFORMATION:
Catellus Development Corp
201 Mission St #2
San Francisco, CA 94105
ARCHITECT/ENGINEER INFORMATION:
PROCESSED BY: JNJ
LICENSED CONTRACTORS DECLARATION I
I hereby affirm 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 Qode. ~_
6/9]2006- --s:-- ----
Date:
Contractor
--
This section need not be completed 11 the pennlt is for one hundrec:l dollars ($100) or less.
o I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the worker's compensation laws
of Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I shan forthwith comply with those provisions.
Date: 6/9/2005 APP~emr: ---- ~
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UPTO ONE HUNDRED 1l-IQUSAND DOLLARS ($100,000), tN ADDITION TO THE
COST OF COMPENSATiON, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
r CONSTRUCTION LENDING AGENCY
! hereby affir!'l'\ t:(!der penalty of perjury that there is a construction lending 8ap_p~yfor t"'e
performance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
NUMBER
642945
TYPE
EXPIRATION DATE
4/3012006
C39
Construcion Types:
V N, ,
I 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 construction, and
hereby authorize representives of this city to enter upon the above mentioned property for
~pu~ses. _
---= _ _, ~ Date: 6/9/2005
, Signature of Applicant or Agent
The permit shall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuMCe. A
new permit is required to commence or continue work.
Fees paid for Permit:
Total:
966.31
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
Setback/FormslTrenches (Footings)
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water PipeJSDrinkler Valves)
Mechanical (Groundwork)
Electrical (Underground Conduit)
Pre-slab (CompactionlMembrane Reinf.)
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below until the
following applicable items have been signed:
1 st Floor Shear
Firesprinkler (Rough) I
2nd Floor Shear 1 1
Roof (Sheathing/DiaphragmIFrame) 7111105 jA\lCW'S1l..\
Masonry (ReinfJBond Beam/Pre-Grout) II 1
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ele., Mec. And Fire)
Insulation (Sound/Energy)
Do nol tape or plasler 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 (Brown Coat)
T -Bar Eiectrical
T -Bar Mechanical
T -Bar Structural
Sewer
Water Engineering Backflow
Water Service
FINAL INSPECTIONS DATE INSPECTOR
Electrical Final
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765.4040
Water Engineering 765-5268
Sub List/Business License 765-5194
Zoning 765-5139
Building Final (Last Inspection - Only I J
After Above Complete) 7) if or Tnv~
PARTIAL INSPECTIONS
fk~
....
Mechanical InsDections
Plumbina Insoections
Electricallnsoections
~- :;, Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92B03-3520
~ . (714) 999-2188
~II (714) 520-5741 FAX
CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
NOTICE: The gO-day period in which you may protest the fee described herein will begin on the date this fee is
paid. However, if the fee was imposed by the City or County as a condition of approval for your project, and you
have received the requisite notice, the 90-day protest period began at the time your project was approved.
Receipt No:
"'$01
Owner Information:
Name:
Address:
Phone Number:
Applicant Information:
Name:
Phone Number: (
Property Information:
Address of Project:
Development Type:
Project Name:
Type:
Commercial:
Total Square Footage:
Multiplied by Current Rate:
ee:
Fee Waiver:
Fees Waived:
Yes
Ele~ry District:
High School District:
Anaheim Union High School District
)
<<' c!.
(7 ht<:--<-Jp
/~~ -/37
1 Residential - New [
lL &.
''',
s
Residential - Room Addition
1 CommerCial
1 Single Family [ :Xl
/~.
MUlti-Family Condos/Apartments - # of units:
$
=$
=$
-$
Residential:
[ ] Level 1 [ ] Level 2 - ACSO Only [ 1 Level 3- ACSO Only
Total Square Footage: jff. / //
Multiplied by Current Rate: Elem. $ 1. /V =;].0 ,-.3~. c.f
J .~-!
H.S. $ ./ V - ~.8Sf.
Equals Total Fee: $ r::(;;{ <I - $ I/o, 7/(,. '8
[XkNO
If yes, reason:
Acknowledgement:
The above representations as to square footage are true. Developer/Applicant agrees that if it is later determined that such
representations are not true, Certificate shall automatically terminate and the appropriate City/County shall be notified.
Developer/Applicant Signature:
<::::::-c
L
Certification:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code
Sections 53080 and 65995.
?/8hs:-
Date { (
v~
nion High School District
~
cX6 -3s;8. ~ f
O!.h . "<-'js-%. ~JL
I '
Check No.
Check No.
i~~
$
$
Distribution: City/County - Developer - Accounting - Elementary District