6911 Michigan Circle
. BUILDING PERMIT NO. BLD2004-04046 .
i:,~O~?F PERMIT CITY
DATE: 11/4/:1004. .
JOB ADDRESS: 6911 E MICHIGAN CIR
LEGAL DESCRIPTION: N TR 8377 LOT 17
APPLICANT: MICHAEL HOLLEY
OWNER INFORMATION: .
Margaret E Beyer
6911 E Michigan Cir
Anaheim,CA ~807
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153 .
INSPECTION REQUEST LINE,
(714:) 765 - 4626
cE)ilSUS.CODE: 555
QUARTER SECTION: 211
CONTRACTOR INFORMATION:
SO GAL ROOFING COMPANY
23881 VIA FAVRICANTE #521
MISSION VIEJO, CA 92691
BUSINESS PHONE: 949360-0670
JOB DESCRIPTION:Tear off existing roof and replace with 7/16" osb, 2 layers of 30 lb. felt and 30 squares of Eaglelite tile (ICBO# 4660).
VALUATION: 14,500.00 PROCESSED BY: MSM
I OWNER-BUILDER DECLARATION . . . J
I hereby affinn 'under penalty of pe~ury that I am exempt from the Contractor's License Law for tile following reason (Sec. 7031.5 Business and Professions
Code: any city or county which requires a permit to cOnstruct, alter, "improve, denfolish or. repair any slruc,ture, prior to its issuance, also require"s the applicarit.
for such permit to file a signed statement that heis Iirensed pursuant to the prov!sions of the Contractor.'s License"Law (Chapter 9)(rommencing 'With Sedion
7000 of Division'3 ofthe BusineSs and Professions Code) or that he is exempt ll;erefrom and the basis for the alleged exemption. Any violation of Section
7031,.5 by-any applicant fora permit subjecis the applicant to 3 civil penalty of nG;t more than five hundred dollars ($500).
ARCHITECT/ENGINEER INFORMATION:
o I, as owner of property, or my employees with wages as their sole compensation, wiil do the 'NOr'I\, and the structure is not intended or o,ffered for sale
(S.ec.7044 Business and Professions Code: The ContraCtor's License Law deed not apply to an owner of property who builds or improves the~n. 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 improvementis sold lNith one year of completio~, the owner-builder w:!: have the burden of proving that he did not build orlmprove forthe purpose
~s~e~.. i .
D I, asthe owner of the property, am exclusively contracting with iicen~d CO;1'~actors to con5lruct the project (Sec. 7044 Business and ,Professions Code:
. .The Contractor's License Lawdoes not apply to an owner of property who bi.;i:d~~)cr improves thereon,.,and who oontracts for sudl projects with a contractor(s)
.licf:nsed pursuant to the Contractor's License Law). - I ' . .
U I am exempt under Sec. "-, B-& P;C. for this reason: _.:
Date: ' Owner:
{
-:
__~_J
WORKER'S COMPENSATION DECLARATION
I hereby affinn under pen~lty of perjury one of the following declarations:
o I have and will maintain a certificate of oonsent to self-insure tor worker's ccmpensation, as
provided for bY Section 3700 of the Labor Code, for the performance of the work for which thi.s
permit i~ issued.
~' I have and wilJ"maintain worker's oompensation insurance, as required by S~ction 3700 of the
r Code,'for the performance of the work for which this permit is issued. My '.Vorl'~er's '
mpensation insurance carrier and policy are: :.
Carrier: STATE FUND Policy Number: 285-0223.4~03
This section need not be completed ifthe permit is for one hundred dollars ($100) or less.
D I certify that in. thE;! performance of the work for whic~ this permit is, iSSUed,!lSh~irnot employ
any person in a.ny manner so as to become subject to the worker's compensatiq!i la~-,ofCalifomia,
and agree that if I should become subject to the worker's compen . . io safS' dio." 370
of the Labor Code.,1 shall forthwith complywilh Ih proyisio. '
11/4/2004
Date:
NUMBER
797707.
TYPE
Construcion Types:
Vt\!,',
Fire Sprinklered?
Date: 11/4/2004 Applicant.
WARNING: FAILURE TO SECURE W
AND SHALL SUBJECT AN EMPLOYE TO CRIMINAL PENALTIES AND CIVIl. IN SUP TO.
ONE HUNDRED THQUSAND DOLLARS ($100,000), IN ADDITION TO THE C COp..
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THi; LABOR CODE,
INTEREST AND ATTORNEY'S FEES.
'--1
I CONSTRUCTION LENDING AGENCY
I here~y affirm ut:1~er-penal~y?fpe~ur'y that there is a constructi~\ending agen9Y fu~ tha,
p~n6rrnancetrrrne-work-forwnictl-misperm1tjs issued (Sec.309l.Grv.C):' '-'"- ----:-.~------
Lender's Information: -
,/
Date: 11/4/2004
. Signature of Ii nt or Agent
The permit shall expire by limitation and com null and void if the building or work has
not passed final inspection 365 days f (fate of pennit issuance. A new permit is
required to commence or continue. work. .
J
ill,
EXPIRATION DATE
7/31/2005
C39
NO
Fees paid for Permit:
. Total:
236.28
INSPECTION RECORD
INSPECTION. . DATE INSPECTOR
Temporary Power pole
Plumbing (DrainlWaste Pipe) .
Electrical Ground Electrode/uter
SetbacklFormslTrenches (Footings)
Do not install subfloor or pour floor slab unt; I the
following applicable items have been signed:
Plumbing (Water Plpe.SprinklerValves)
.Mechanical (Groundwork) .
Electrical (Underground Conduit)
Pre-slab (CompactiOillMembrane.Rei nf.
Underpinning (Floor Joist/Girders)
Do not cover or conceal the wOrk below until the
follOwing applicable items have been sign'ed: .
1 st Floor Shear. .
Firesprinkler' (Rough)
2nd Floor Sliear
Roof (Sheaihing/Oiaphragrn'Frarne) .
Masonry (ReinfJBOnd BearnlPre-Grout) . .
Rough Plumbing (Top Out) .
.Rough Mechanical . .
Rough BilCtricallOry wall) . . ~
Rough EleCtrical
Framing (Only after Plbg., Elec.. Mech. and Fire)
Insulation (SoundlEnergy) .
Donat tape or plaster. unlilthe following applicable
items"tiave been signed: '".
DryWall
Penetrations (Fire Rated) Electrical .
Penetrations (Fire Rated) Mechal'li.cal
Penetrati.ons (Fire Rated) Plumbing . .
Interior Lath '. .
Exterior Lath .
. GENERAL ITEMS
Exterior Plaster (BraNn Coat)
T -Bar Electrical '.
T -Bar Mechanical "
T -B.ar Structural . .
Sewer. . .
Water EngineerIng Backflow
Water Service .
FINAL INSPECTIONS Date Inspector
Electrical Final . .
Plumbing .Final .
.Mechanical Fimil
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 Final ~ast Inspection- Only .
. fter Above Complete)
PARTIAL INSPECTIONS
Buildinalnspections
. Mechanical Inspections
PlumbinCl Inspections
Electrical Inspections
PERMIT EXPIRED
INSPECTION
NOT COMPLETED
DATE: W~V~4\OV