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2413 W. Marian Ave. TYPE OF PERMIT CITY Reroof ElM BUILDING DIVISION 200 S. ANAHEIM BLVD. (714)765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 CENSUS CODE: 555 QUARTER SECTION: 27 BUILDING PERMIT NO. BLD2005-01989 DATE: 6/28/2005 JOB ADDRESS: 2413 W MARIAN AVE LEGAL DESCRIPTION: N TR 2393 LOT 28 APPLICANT: JOSE GOMEZ OWNER INFORMATION: JOSE GOMEZ 2413 W MARIAN AVE ANAHEIM, CA 92804-2265 JOB D!i'SCRIPTION: Tear off existing and re-roof 26 squares of 30 year composition shingles. VALUATION: 6,500.00 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 cOl1struct, 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 Business and Professions Code) or that he is exempt the refrom 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 compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044 Business and Professions Code: The Contractor's Ucense Law 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 that he di t build or improve for the purpose of sale). I; as the owner of the property, am exclusively contmcting with licensed contractors to construct the project (Sec. 7044 Business and Professions od . The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects w~h ontractor(s) licensed pursuant to the Contractor's License Law). I am empt der Sec. C. f this re on: Date: 6-<5 Ow WORKER' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: D I have and will maintain a certificate of consent to self-insure for worker's compensation, as provided for by Section 3700 of the Labor Code, for the pertormanoe of the worK tor which this permit is issued. o 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: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION: PROCESSED BY: SAM LICENSED CONTRACTORS DECLARATION 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 Code. 6[28/2005 Date: Contractor POlicy Number: NUMBER EXPIRATION DATE TYPE Date: 6128[2005 Applicant: WARNING: FAILUR TO SE UNLAWFUL, AND SHA BJECT MPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDIllON TO THE COST OF COMPENSATION, 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 the!'"e is a constructicillonding agenoyfor the performance of the work for which this permit is issued (Sec. 3097.Civ.C): Lender's Information: laws relating to building construction, and n t e a~ove mentioned property for Date: 6[28[2005 Fees paid for Permit: Total: 235.48 '-- 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 reauired to commence or continue work. City of Anaheim Building Division INSPECTION RECORD INSPECTION DATE INSPECTOR Temporary Power Pole Plumbing (DrainlWaste Pipe) Electrical Ground Electrode/Ufer SetbacklFormS/Trenches (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 Conduit) Pre-slab (Compaction/Membrane 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) 2nd Floor Shear I / Roof (Sheathing/Diaphragm/Frame) '"Ikloo; .\,l\IJavJ'5V- I Masonry (ReinfJBond Beam/Pre-Grout) I ( Rough Plumbing (Top Out) Rough Mechanical Rough Electrical (Dry Wall) Rough Electrical Framing (Only after Plbg., Ele., Mt:c. And Fire) Insulation (Sound/Energy) 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 (Brown Coat) T -Bar Electrical !T -Bar Mechanical !T-Bar Structural Sewer IWater 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 1fPPI 0)'.; '7" After Above Complete) PARTIAL INSPECTIONS ections \\ ll. r ,:.,. \ ls \w" ~ e (.U<.l ~ Mechanical Inspections PlumbinQ Inspections Electrical Inspections