221 Monument
BUILDING PERMIT NO. BLD2003-04623
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 7(>5'- 5153
'INSPECTION REQUEST LINE:
(714) 7(>5 - 4(>2(>
CENSUS CODE: 434
QUARTER SECTION: 27
~~~~F PERMIT CITY
DATE: 12/1/2003
JOB ADDRESS: 221 S MONUMENT ST
. LEGAL DESCRIPTION: N TR 1940 LOT 48
. .
CONTRACTOR INFORMArION:
ROYAL ROOFING COMPAttY
811 ~ '~ COMMONWEALTH A \,E\,.
5UENA PARK, CA 90621 OC;OO~.
8USINESS PHONE: 714521,0100
JOB DESCRIPTION:Replaee existing BUR wilh new20 >,,,ar c"mp. 6 squares (Gerage Only).
. . ,
VALUATiON: 1,200.00 . PROCESSED BY: AEM
I OWNER'BUILDER :JECLARATION _ _
I hereby affirm. under penalty of perjury that' am exempt from the Contractor'< Ucense_Law for the following 'reasor:, (Bee. .7031..5 3usine~s and
Professions Code: any dty or county which req'uires a permit to construct,attt'!r, improv,e;demotish or rep~ir ~ny structure, prior to its issua,nee, also
requireS the .applicant for such perli11tto file a signed statement that he islice;.~'$ed pursl..l~ntto the pm:'/i$ions oftheCcntractor's License Law (Chap~er
. 9)(commencing with Section 7000 of Division' 3 of the Business and Prcfessic:1~ Code},or that he is 19xempt t,herefrom and the-b~sis for the alleged
exemption.. Any violation of Section 7031.5 by any applicant for a permitsUbj.)cts the a ppJicant to a civil penalty of not mortl than five hundred dollars-
($500): '. .', ".' '. .... . . .
o I, as owner ofproperty,_or my employees with wages. as their sole ccmpe;hsation. will do the wo.-k, and the structt.:re is nut intended or offered for
"sale (Sec: 7044 Busj'nes~and Piofes~ions Code: The Contractor's, LiceriS'3L!I""I. doe~'i1ot a~plyto,an owner of property who, bllilds or improves '
thereon, and who does such work himself or herself or through his or her c'''J'''~-'''mploY-ees. provided that such improvements are not intended or
Qfferedfor sale: If, however, the building or improveri1~nt is sold with one'y~:d' of o:)mpJetion, the owner-builder will have the burden of proving ,that he
did not build or improve fOi the purpose of sah~) , . _,! .
'0 I, as the owner of the property: am,exclusively contracting with I!cen'~ed (:Cntraciors to c'onstructthe project (Sec. '7044 Business and ProfesSions' '
Code:' The Contracto'r'sUcense law does not apply tean owner- of proPEtr'ty-";~flo builds or improves thereon, and who contracts for such projects with
~ontractor(s) licensed pursuant to the Coritractor's liCense, law). ,) , '. .'.' , -':
L.J I, am e~empt Ullde.r Sec.' -.'- " B & P.C. for this reason: ----.,;._-: .- .
Date: Owner:
L. WORKER'S COMPENSATION DECLARATlml
I hereby affirm under penalty of perjury one of the, following declarations:
.0 I have and will maintain a c-ertificate of oonsent to. -setf~insure'for worker'i c01"J1'p~nsation.
.asprov' for by Section, 3700 of the Labor Code, for the performance of (n~ work for whim
hi rmit is ~sued. . ~
I have,and will maintain wo'rker's compensation insurance, as required (-yi,Section 3700 of
abar Code,Jor the'performance of the work for which this ~rmit 5 isS;Jn>. My worker's
Compensation insurance earlier and policy are: ,,-. .
C..rrler: NATIONAL UN~9NFIHE Policy Number. 9101121'~t.
This section need not be completed II the pelTlllt Is for one hundred dollars ($1 Ot; ',..Iess..
o I certify thatintheperfonnance of the work for which this permifis iSsuel,;., ~~i('~~l ' .
elT!plo.y an~person in any ~nnerso as to become.sub~ect orK~r'~;.co.:n_~~.~sat!~n laws
of Catifomla,'and agree, that if' ~nQ!J.ld become subject to t eworke comperl~tiOI1.~-'"
provisions of Section 3700 ofthe~or de,l shall fJ rthwi 'comply'; jth,tpc:s~ jJrovisions.
- ' "'.'" ,',-
:..
Date:. 12/1512003 Applicant: . .........Q , .'''.
WARN ING: FAILURE TO SECUR RKER'S C ENSATlON COVER)~ IS. /."
UNLAWFUL, AND SHAL.L SUBJ CT AN EMPLOYER TO CRIMINAL.PEi'l4lnE.~. . DCIVIL
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN AD.lJ~"lO,N TOTHE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR INSECTIOI!J ^7.'.),6.0F THE
LABORCOOE, INTEREST AND ATTORNEY'S FEES.. . . ;;.J' '[J; . .
I ._~
. . ..' ...... CONSTRUCTION LENDING AGENCY . . L__}~.r '
I hereby affirm unc1erpp.naltyofperjury tharthere is a.corrstructir)'nleJl(til"'qai!~n:%H~M\'"n:l,_
-pe,10rUlance orme,w6rl< jar Whld1 this permit is iswed (Sec.-S097.Civ.C):
Lender's Information:
APPLlCANT:PAUL POWDERLY
OWNER ~NFORMATION:
Robert C 0 l'es-sen
.221 S Monument St
. Anaheim. CA 92804
ARCHITECT/ENGINEER INFORMATION:
I
l.,ICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
'.icens~~ . ions of ch commencing
With eclian 7000) of ' i\'Sian 3. Ithe Bu 'ness and
Profess.-...... A '~
12/15/200 . .e-Q' .'
Dat~. , , ",,' ntractor .'
NUMBER
678705
TYPE
TYPE
EXPIRATION DATE
1/31/2005
C39
HIC
Construcion Types:
VN" .
Date: 12/15/2003
Fees paid fOI: Permi,t:
Total: 58,45
Signature of lieant or Agent
The permit shall expire by limitation and become nun .anold if the building or
work has not p~sed final inspection 365 days from the date of permit issuance. A
ne'N permit is required to commenCe or continue work.
INSPECTION RECORD
INSPf;CTION . DATI; INSPf;CTOR
..
.
Temporary Power Pole
Plumbing (DrairilWaste Pipe)
EleCtrical Ground Electl'OdelUrer I .
SetbacklF.ormsfTrenches (Footings)
- -00 not install. subfloor or pour floor slab unlilthe .
following applicable ilems have been signed: .
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (GroundWork)
. Electrical (Underground Conduit) . - .
Pre-slab (CompactionlMlll11brane.Reint
Underpinning (Roor Joist/Girders) ..
00 not cove. ot conceal the work below until the . ,
forlowing appli!'able items h~ve been signed:
1st Floor Shear . .
Flresprinkler (Rough) .. .. . ..
2nd Floor Shear . . ..
Roof (SI1i!a!hinglDlaphragrn'Frame) .
Masonry (Reil1fJBond BeamlPre-Grout) .
Rough Plumbing (Top Out)'
Rough Mechanical .
Rough .Bectrk:a1ILlrY vvall) ..
Rough Electrical
Framing (Only afterPlbg.. Elec.. r,,'1ech.. and Fire) ,.'
Insulation (SoundJEnergy)
Do not tape or plaster untillhe follOWing applicable
items have been, signed:. ' .'
Drywall .
Penetrations (Fire Rated) Electri.caf .
Pen!!lrations (Fire Rated) Mechanical
Pen~OfIS(Flre Rated) Plumbing
Interior Lath . . .
Exterior Lath . .
. GENERAL ITEMS ,.
Exterior Plaste. (BraNn ClJlIl)
. 'r .Ba. Electrical . .
T-Bar MeChanical .
T .Ba. Structural. , .
Sewer . .
Wate. Enginee.ing Backflow .
Wate. Service .
.-
FINALIN~PECTIONS Date . Inspector-
Electrical Final . . .
.
Plumbing Final . .
Mechanical Final .
Gas Test . .
Enginee.ing/Grading Final 765-5126 . ..,
" .
Fire Dept. .Final 7654040 . .
Wate. Engineering 765.5268 .-
Sub List/Business License 765-519 .. .
Zoning 765,5139 .
Building Final \tast Inspection. Only . IIJif5Li.. C J.. A
. ... fter Above Complete) -
PARTIAL INSPECTIONS
Buildina Inspections.
Mechanical Inspections
Plumbina Inspections
ElectricallnsDections .
BUILDING PERMIT NO, BLb2003-04623
ElM
BUILDING ONISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE:. 434
QUARTER SECTION: 27
TYPE OF PERMIT CITY,
"Reroof
DATE: 12/1/2003
JOB ADDRESS: 221 S MONUMENT ST
>
.;i<
'APPLlCANT: PAUL POWDERLY
OWNER INFORMATION: . CONTRACTOR INFORMATION:
Robert C Dressen ROYAL ROOFING COMI?;NY
221 $ MonumentS! 81111COMMONWEALTHA\i= .'
Anaheim, CA .92804 .' BUENA PARK. CA' 906~'1 0<;00
. BUSINESS PHONE: 714521.0100
JOB DESCRIPTION:Replape exisling BUR with new BUR. 6'squares (Garage 9nly).
VALUATION: . 1,~00,OO . i
.1 OWNER-BUILDERJlECLARATION
I hereby ~ffirm under penalty of perjury that I am exempt from the: Contracto~';~ License, law for the following reason (Sec. .7031.5 Business ~nd
Professions Code: any city or county.which requires a permit to construct. ar~l.improve, demolish or repair any str:ucture, prior-to' its issuance, also
requires'the applicant.for such perinit to file a signed statement that he is lic(1flsed pursuant tethe provisions of the Contractor's.Licens~ Law (Chapter
9)(commencing with Section 7000 of Division :3 of the 'Business and Professle:bs Code) or that he is exempt the~fromand the basis for the alleged
exemption. My violation of Section-7031.5 by any applicant for a permit su~!~ctS the, applicant to advil penalty of not more than five'hundred dQllars
~O?)~s' ~~ner of property, or my ~mPIOyeeS with wages a!> their sole compi'{nsation, ~HI do the ~ork, .and the,structure ~ not intend'ed orgffered for
sale (Sec.-7044 Business a nd Professions Code: The Contractor's UcenSeL.~w does not apply to an owner of property whO builds ,or-improves .
thereQn,' and who does.such work himself or herself or through his or h~r ow~{~mpJoyees, pr9vided that such improvements are not 'jntended'or
offeredfor~le., If, however, the building or improvement is sold with one yeii' of completion, U:le owner-builder will have the,burden.'Qf proving that he,
did notbuRd or improve for the purpose of ~!e). '4 " .
o I;-as the owner of the prop-erty,am exdusively contracti'ng with licensecl (klltraclors to construct th_e' project {Set: 7044 Business,and Professions
Code: The Contractor's license I.:awdoes not apply to 'an owner of property\yho builds.'or improves thereon, and who contracts for such projects w.-it~ -
~ontTactot(s) licensed pursuant to"~he Contractor's -License' Law). :." . ,
U I am exempt under. Sec. " , B & P.C. for this reason:
Date: OWner: j
I WORKER'S COMPENSATION DECLARATION r, .
I hereby affirm under- penalty c)f perjury one of the following declarations: ,
o I h~ve and willmclintain a certificate' 9f consent to self-insure for worket'slcompensati'on;
as.provided for by Section 3700 of-the _Labor C6de, for tlie performance ofth~iwo,rk.forwhich
is' Permit is isSlled: . \'
'1 ' nd will m.aintain worker's compensation'insurance, as ,required b.j Section 3700 of
labor Code, for the performance of ,the work for which this permit is issu~~l ,My worker's
.Compensation insurance carrier and.poney are:
Carrier: NATIONAL UNION FIRE Policy Number. 91011~'
This section need not be compIetedlf lIle .,ennills for one hundred dollars ($lokJ:'jes~,
01 certify that-in the perfonna~ce of the ,work for which this ermit is iss".l;I1~I;f_!/sh~an not
employ-any person in any manne o.as_ to become s 1ect to th orketscG';J.P:t3:,nsation laws
o(Califomia. a!1dagreetha' lshou eCol't1esubje othewo e(scorri<"'~'ls~tion
provis!ons of Section 3700 the La. code. I, ~haJl rt ~ C~mPIYWith._"i, '. ovisions.
Date: 1211/~003 -""
. WARN.lNG: FAILURE TO SECURE'WORKER'S'C ENSATION COVER., ~IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALnES AND CIVIL
FINES UP TO ONE HUNDRED TMOUSAND DOLLARS ($100,000), IN ADCiDON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTI0!\i:J706 OFTHE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. . .1,
I.. '. ~O~STRUCTION LENDING AG~NC:.,.D '
1 r,c;::O~7 <:tifl[;Yi';;.+,";:~r p-~lu::i,~Y vi ':;'':'iJi.i'J''- .-t;'c.t i.t,;;:;...;; .~,b'",vl'l;;;,t"t.i""f;;;'-lll.;.'n.l"'-~ ;;'t.::-:,,',(.y-.f;;-l'.{{i~
. performanCe of the work forwhich-this-permit is issued (Sec.3097,Civ.C):
lender's Information: '. '
. ARCHITECTIENGINEER INFORMATION:
PROCESSED BY: CAL
NUMBER
678705
TYPE
TYPE
EXPIRATION DATE
'" 113112005
C39 '\,
HIC "
Construcion Types:
VN, ,
"
, ,"
".',
'on and state that the above information is correct. I
and state laws relating to bu~ding COIlstruction, and
ty to enter upon the aboVe mentioned P,roperly for
f:ees paid ,for Permit:
Total:
58,45
Date: 12/1/2003
. Signature plicant or Agent '. '
Till! 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 comm~nce or continue work.
, INSPECTION RECORD
INSPECTION , DATE ' INSPECTOR
I
Temporary Power Pole 1
Plumbing (OrainM'aste Pipe) " ,
Electrical Ground Electrode/l)fer
SelbacklFormsfTrenches (l;ootings)', ,
Do not install subfloor,or poudloor slab until the
followir)g applicable items have been s,igned:
Plumbing (Water Pipe~Sprinkler Valves) I,
Mechanical (Grou ncIwork) ,
Electrical, (Underground Condu it)
Pre-slab (Compaction/Membrane.Rein!; ,
Underpinning (Floor Joist/Girders) .
Do not cover or conceal the woll< belOW, untIl the
following, applicable items have been signed: ,
1st Floor Shear ,
Firesprinkler (Rough) , I
2nd Floor Shear " ,
Roof ISheathing/DiaphragmlFrame)
Masllnry (ReinfJBoridBeamlPre-Grout) ,
Rough Plumbing (Top Out) "
Rough Mechanical
Rough ~ectrical (Dry Wall)
ROUllh Electrical "
Framing {Only after Plbg" Elec.. Mech.. andFire" ,
,
Insulation (SoundlEnerav) ,
Do not tape or plaster until the following applicable
items have been signe:d: ", " .':
Drywall ' , " '
Penetrations (Fire Rated) Electrical , , '
Pllnetrations (Fire Rated) Mechanical' ,
Penetrations (Fire Rated) Plumbing , ,
Interior Lath "
Exterior Lath
GENERAL ITEMS
Exteri!>r Plaster (Brown Coat) , ,
T -Bar Electrical .
T-BarMechanical
T -Bar ,Structural
Sewer
Water Enginf/ering Backflow
Water Service , , ,
FINAL INSPECTIONS " Date Inspector
Electrical Final " ,
Plumbing Final ,
Mechanical Final ' ,
Gas Test , ,
.' ,
Engineering/Grading Final 765-5126 ~ I ' ,
-. .
Fire Dept. Final 765-4040 "
,
Water Engineering 765.5268 ,
Sub List/Business License 765.519 , " ,
Zoning 765-5139 ,
, ,
Building Final ,l}ast Inspe,etlon- Only !I tt/u4- ,
" fter Above Complete) ,
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections
Plumbina Inspections
Electrical ,Inspections