2940 E. Miraloma Ave.
CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
UNDER COVER HOME IMPROVEMENTS I NC
19562 DITMAR LN
HUNTI NGTON BEACH, CA 92646.0000
BUSINESSPHONE: 714593,9840
JOB DESCRIPTION:Tear off existin9 BUR and install 121 squares of BUR
VALUATION: .'. 19,000.00
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 dty or county which requires a permit to construct, alt~f, 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 licen;sed pursuant to the provisions of the Contractor's License Law (C~apter
9)(commencing with Section lODDef Division 3 of the Business a nd Professi~~s Gode) or that he is exempt therefrom and the basis for the alleg$d
exemption. Arty violation of Section 7031.5 by any applicant for a permit sUbJects the applicant to a evil penalty of not more than five hundred dollars
l!..500), j ,
U I, as owner of property, or my employees with wages as their sole com~nsation, wilfdo the work, and the structure" is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License ljiw 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 herow~employees, provided that such improvements are not intended or
offered for. "".le. If; hOW. ever, ,the building or improvement is sold with 0 neYe~'{Of co.,mPletion., the owner-bu ilderwill have the burden of proving that he
did not build or improve for the purpose of sale). , ," ;l. ,'-,"'.
D I, as the owner of the property, am exclusively contracting with licensed 'ntractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License'Law does not apply to an <?wner of property' ,ho builds or improves thereon, and who contracts for such projects with
tjOl1tractor(s) licensed pursuant to the Contractor's License Law),;,' ,,' , ;
lamexemptunder,Sec, ,B&P.C.forthisreason: .J, ' " ',"
Date: ' -', Owner: ' ~ __' " ^
I WORKER'S COMPENSATION DECLARATION I. I I LICENSED CONTRACTORS DECLARATION
I hereby a:fflrrn ,under penalty of pe~ury one of the following declarations: j~ I hereby affirm und~! penalty of perjury that ,am
o I ha~ and wi . tain a certificate of consent to self-insure for worker,J:compensation, licensed under provisions of chapter 9 (commencing
as provid y Section 3700 of the labor Code, for the pelformance ofth~,Work for which with Section 7000) of Divsion 3 0 the Business and
is it is issued. ' }, Professions Code.
I have and will maintain worker's compensation insurance, as required by,S'ection 3700 of 7/11/2003
the labor Code, for the performance of the work for which this permit is issued.; My worker's Date:
Compensation insurance carrier and policy are: ','
Carrier: STATE FUND Policy Number. 285212002
This section need not'be completed ifthepennit is for one hundred dOlj~~(-$10:0);or less.
D I certify that in the perfol1Tlance of the work fqr whiCh this perr~it' is issu~d~ I shall nbf
employ any person in any manner 50 as to become subject to theWbrker's Ciompensati{>n laws
of California, and agree that if I should become su .ed tothewod<et's cornpeiisation.\:_<
provisions of Section 3700 of the labor ode;'~ all"~ hWith,comply with those provisions.
... ,'-" ,0,'" ">'i.-':'.',-,- "",','","y"
\'>'-'{;.' . ~
Date: 7/11/2003 Applicant: ':'y' ,
WARNING: FAILURE TO SECURE WORK COMPENSATION CO\(EilAGE IS'
UNLAWFUL, AND SHALL SUBJECT AN EM OYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($1.0.Q,000),IN'AI?DITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVlDElYJ*"RIN SECTION 3706 OFTHE
LABORCOOE, INTEREST AND ATTORNEY'S FEES,"". " . ',:,:t. '
I CONSTRUCTION LENDING AGENCY"'..,)'
I hereby affirm under penalty of perjury that there is a construction lending-.ag)ncyfor the
--peliormance"Of-the work for-which-this permit'is issued-(Sec:3097.;-Gi~~ .,. ~-~,--*,,*-;,,,,,~
Lender's Information:
BUILDING PERMIT NO,
BLD2003-02753
,{~3~~:~;~~~I~-~~
If.<t;Z'!Y''':-,,'':'''-.....'.:,,.'l.,'~
/ol,~:r'..:)". :, '~::\',O \
l>./.,;,<:~~'-'<....::.."n:-~.-,\
CITY ~'~~~HEIM
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LEGAL DESCRIPTION: EUCALYPTUS FOREST TR LOT 20 ALL -EX'
~ TYPE OF PERMIT
Reroof
DATE: 7/11/2003
JOB ADDRESS: 2940 E MIRALOMA AVE
APPLlCANT:TOM SAWYER
OWNER INFORMATION:
Ents 0 Johdan
2940 E Miraloma Ave
Anaheim, CA 92806
I certify that I have read this Ication and state that the above information is correct. I
agree to mply wit I ordinances and state laws relating to building construction, and
hereby . representives of this city to enter upon the above mentioned property for
.insp s.
Date: 7/11/2003
19nature of Applicant or Agent
The permit shall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issuance, A
new permit is required to commence or continue work.
L.
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 131
PROCESSED BY: ODC
NUMBER
. 687961
TYPE
TYPE
TYPE
Construcion Types:
VN, , ..
Fire Sprinklered?-'
EXPIRATION DATE
2/28/2005
B
C39
HIC
NO
.c''''';;'''-
[. .~" "$' ','.' . _;','_'_.,,~\>i;'_~'-':~'-,".l' _;.. ,""
Fees paid for Permit:
Total:
329,16
~'
--
INSPECTION RECORD
,
, INSPECTION DATE INSPECTOR
Temporary Power Pole ,
Plumbi ng (Drain/Waste Pipe)
Electrical Ground Electrode/Ufer
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 n)
Pre-slab (CompactionlMembrane.Reinf.
Underpinning (Floor Joist/Girders)
Do not cover or conceal the woll< below until the
fOllowing applicable items have been signed:
1 st Floor Shear
FireSP~RoU9h)
2nd Flo ar ,
Roof U;heathin~DiaphragmlFrame) "lh<l/rfl. ?, """ -
Masonry t....'nrJBond Beam/Pre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Elec.. 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 (Brown coat)
T -Bar Electrical
T-Bar Mechanical
T -Bar Structural
Sewer
Water Engineering Backflow
Water Service
1.../
FINAL INSPECTIONS I. Date Inspector .'
Electrical Final
Plumbing Final
Mechanical Final
Gas Test .
Engineering/Grading Final 765-5126
Fire Dep!. Final 765-4040
Water Engineering 765-5268
Sub List/Business License 765-519
Zoning 765-5139
Building Final ~astlnspeclion. Only 1 ~Kf floP~I/JS
fter Above Complete) 'I 'I.,
T TI
"
1
PAR IAL INSPEC NS
BuildinQ Inspections
Mechanical Inspections
PlumbinQ Inspections
Electrical Inspections
.