220 Monument St.
BUILDING PERMIT NO. BLD2003-04622
DATE: 12/1/2003
JOB ADDRESS: 220 S MONUMENT ST
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BUILDING DIVISION
200 S. ANAHEIM BLvD.,
(714)765.5~5'3.'
INSPECTION REQUEST LINE:
(714) 765,4626
CENSUS CODE:. 434
QUARTER SECTION: 27
TYPE OF PERMIT
Reroof
LEGAL DESCRIPTION: N TR 1940 LOT 52
CONTRACTOR INFORM;l,TION:
ROYAL ROOFING COMP:>.NY
81111 COMMONWEALTH AVE .
BUENA PARK, CA 90621 0000.
BUSINESS PHONE: 71452,-0100
',JOB DESCRIPTION:Replace BUR with new BUR. 24 squares.
VALUATION: 3,700.00 PROCESSED BY: CAL
I ' " 'OWNER-BUILDER'DECLARATION '
. I hereby affirm,under penalty.of perjury that I am exempt.from the .Contr~ctC;r',3 License Law for the folloWing reason (Sec. 7031.5 aUsine~s and
. ,Professions Code:any city or cQ.untywhic;h req~iresa permit to construct,'ai~,)r. 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 Iic'~'lsed porsuant to the proviSions oftheContractor'~ License Law'(Chapter
9)(commencing with Section, 7000 of Division 3 of the ,Business and Profess;~'ns Code) or that he is exempt therefrom and the basis for the alleged
exemption, AnyViolation of Section 703,1.5 by any'appJicantfor a permit sUb;,ects the applicant to a dvil'penalty of not more than five hundred dollars
($500). .' ..... ,; . '. . '. '.'
o I, as owner of pro party, or my-employees with wages a3 their sole comp~nsa,tion, Vlo'iII do the work. .and the,stru~ture'is no't intendedor offered for
sale (Sec. 7.044 BusineSs 3rKfF'iofeSs~ons Code: The Contractor's Ucense'Ll3wdoes not applyta an owner ofpraper:tY who. buildsor improves'
thereon, and who doeg:suchwork himself or herself,orthrough his or her owr~ employees, provided that 'such impi'OVemei".ts, are not intended_or
offerei:tfor sale. U, however, t.he buildin~ror improvement is sold with one y.:=./r of completion, the owner-builder will have the burden of proving that he
did not build or improve !orthe pUlposeof sale)'., ',,' f.,. ", -'. : .
o I, as the o)Nner of the property, amexdusively contracting with licensee; :.:ontractors to construct the_ project (See. 7044 Business and Professions
'Code: The Contractor's License La:w does not apply to an owner of prcperf.'!">,vho builds or improveS thereon,~and wh9 contracts for sudl projects with
~ontractor(s), licensed pursuar'lt to'the Contractor's liCense ~w). : '
U I am exemp~ under Sec. .' _ ,B & P.C. far this reason: ____
Date:' 'Owner: . ,_.6
I WORKER'S COMPENSATION DECLARATION
, I hereby' affirm 'under penalty ofpe~ury one of the following declarations: . i .
D- 'I have and will.maintain a certificate of oonsent'to ~If-insurefor work€.r'; c(','1pens'ation,
asprQvided for by Section 3700 of the Labor Code,Jor the performance of t~.\. work, for which .
~this permit is issued.' -:, . '
, -.' and wi~1 maintainw~lker's c?mp~, nsation.insurance, as required 0',1,: Section 3700 of
. ,e Labor Code,'for the performance of the work for which this perMit is i~s\.:..:.d. Myworker's
ompensation insurance carrier and policy are: . .L
Carrier: NA.TIONAL UNION FIRE . Policy Number. 9101121. '
APPLICANT: PAUL POWDERLY
OWNER INFORMATION:
Edmund M Quackenbush
220 S Monument St
Anaheim, CA 92804
ARCHITECT/ENGINEER INFORMATION:
NUMBER
678705
TYPE'
. TYPE
C39
HiC
EXPIRATION DATE.
1/31/20Q5
Date:' 12/1/2003. Applicant'
WARNING: FAILURE TO SECU TION COVER'\GE"IS :'..',.
., JJ..",."
UNLAWFUL, AND SHALLSUB CT EMPLOYER TO ,IMINAL PENAlTIESA!'l,D CIVIL
FINES UPTO ONE HUNDRE lHOUSAND DOLLARS ($100,000), IN ADD,nOf;li,T~iJE'
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3'/0\FOI"1'IIIE;'
LABOR CODE, INTEREST AND ATTORNEY'S FEES. :i;\.";~'"
L ' , . CONSTRUCTION LENDING AGENCY _L~'''u:,-- .
,1 hp:r:o::bY::!ff::f.'1 :..:r.Jcr P":i;~tt~"oft::i;:}:"',"tth;.:.t t~tro is ti-':;;:;;I~t,;j(A;....n.l~i~U;;ifj-i<if.:l'~{CY:i;j~.:-~,~-,,--
performance ofthe work for which this permit is issued (Sec.3097,Clv:C):
Lender's Information: .
ConstrUcion Types:
VN, ,
-~ '. .
and State laws r~lating to buHdlng constructioni'and
'ty, to enter upon the above mentionee property for
Fees paid for Permit:
Total:
124.85
" c............. Date: 12/1/2003
Signatu 0
The permit shall expire limitation and become null and void if the.building or
work has not passed finallnspectlon 365 days from the date of permit issuance. A
neW permit IS ~equired to .commence or continue work.
INSPECTION RECORD
~.
. . INSPECTION . . DATE INSPECTO~
.' Temporary Po'!Ver Pole . . .
Plumbing /DlajnlWaste Pipe) - .
Electrical Ground Electrode/uter
SetbacklFormsfTrenches /Footings)
Do not install subfloor or pour floor slabuntil the
following applicable Items have been signed: . .
Plumbing /Water Pi pe.Sprinkler Valves) .
. Mecl)anical (Groundwork) . . .
I t:lectrical (Underground Conduit).. . .'
Pre-slab /Compaction/Membrane.Reinf.
Unclei"pinning (FI~ Joist/Girders) . .
Do not coverQr conceal the work below until the
following applicable items have been signed:
1 st Floor Shear .. .
Firesprinkler(Rough) . .
2nd Floor Shear . .j} ,
Roof (Sheathing/DiaphiallmlFrlme) I~ ~ -)-{J~ ;;;?,.i/ '- &
Masonry (Reinf.iBoncI BeamJPre-Grout) .' .
~ough Plumbing /Top Out) .
Rough Mechanical . ....
. Rough Electrical (Dry Wall) . .
Rough Electrical . .
Framing (Only after Plbg.. Etee.. Mech.. and Fire) . .'
Insulation (SouncUenergy) . . '.' .
00 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 CC-'
Exterior Plaster (Brown Coat)
'T-Bar Electrical . '.
T -Bar Mechanical .
'T -Bar Structural I.
Sewer . .
Water Engineering Backflow . .
Water Service . :.
I.
FINAL INSPECTIONS Date' Inspector ,
Electrical Final "., . . .
Plumbing Fin.al . . .. .
.Mechanical Final . ". ;,....... I . . . .
Gas Test '. .
Engineering/Grading Final 765'5126 . . '. .
.
Fire Dept. Finat' 765-4040 . '. . " .'
.
Water Engineering 76$-5268. '. . .
Sub .List/Business License 765-519 '. '. ^ .
Zoning 765'5139 . . J. ......
Building Final ~ast Inspection. Only ~I a
fter Above Complete) . I} 1 " ,..
PARTIALlNSPECTIONS . '. '. '\j
. . .
BUlldma Inspections
Mechanical Inspections
Plumbina Inspections
Electrical Inspections .