310 N. Muller
J;;,;O~?FPERMIT.. CITY
DATE: 3/21/2005
JOB ADDRESS: 310 N MULLER ST A
LEGAL DESCRIPTION: N TR 5693 LOT 17
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 434
QUARTER SECTION: 46 .(.
BUILDING PERMIT NO. BLD2005-00764
CONTRACTORINFORMhTION:
CONEX ROOFING COMpANY
2011 N BATAVIA ST
o RAN GE, CA 92865 0000:
BUSINESS PHONE; 714520-5207
-JOB DESCRIPTION:Tear off capsheet, install 2 layers of 151bs felt and 55'Squeres of 30 year GAF Timberline composition shingles to entire apartment
VALUATION: com.pJed'oo 00 PROCESSED BY: ENO .
I OWNER-BUILDER.!:lECLARATION .
I hereby affirm under penalty of perjury that, am exempt from the ContraGto(s Ucense Law for the following reason (Sec. 7031.5 Business and
Prufessions Code: any city or county which requires a permit to construct. altk 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 lict.=h-:;ed pursuant to the provisions of the, Contractor's license Law (Chapte~
9)(commencing with Section 7000, of DiVision 3 of the Business and Prcfessj(;n~ Code) or tha~ he is exempt_ therefrom and the basis for t"1!3 alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit 8ub;;ucts t:'e applicant to a civil penalty of nc't more than five'hundred dollars
($500). . .' {" . . .
D. I, as owner of property, or my employees with wages as their sole cO!TlJ~nsetion, will do the work; and the structurei~ .not inteflded or offered,for
sale (Sec: 7044 Business a nd Professions Code: The Contractor's license 4=:w does not apply to an owner of property who b~ilds or improves
thereon, ,and who does such work himself or herself.or through his Or her ow':! eMployees_ provided that suqh improvements are not intended or
offered'for sale'. If, however, the building or improvement is sOld \.yith one ye~~rbf co rnpl et!on, tile owner-builderwill have the burden of proving that he
did not build or' improve for the purpose of S:8le). . ,.! .,....
o I, as the owner of the property, am exdusively ccnt:-acting wlth Ucensed;:;:Cl1tractors to construct the project (Sec. 704--+ Business and Professions.
Code:. :rhe Contractor's License law does not apply to an owner of prC';:>erty[,~'hO tuildsor improve~ thereon, and who oo..~tractG for such I?roJect& vvith
fiQontractor(s) licensed pursuant to the C,?ntractor's.Ucense Law). :
LJ 1 am exempt under Sec.. ,8& P.C. for tt"1is reason: .,..._,_,--""_~.", ;,."
Date: Owner:
r WORKER'S COMPENSATION DECLARATION .t~._--~
I h~reby afrirrp under penalty of perjury,o"ne of the following declarations: l
o I have and wjll maintain a certificate of consent to' se~-insure fo.-r work~r'j; ,,,;ornpensatio:1.
as provided for by Section 3700 of the labor Code, for the performance of u-j;; work fqr which
this permit is issued.
~ I have and will maintain worker's campensation insurance, as.requirec: b:r--Section ~700 of
the Labor Code, for the performance of the wark for which this permit is issuE'c. Myworker'3
Compensation insurance carrier arid Policy are: . , i
Carrier: STATE COMPENSATION INSURANCE Policy Number. 1799501-:!004
APPLICANT: AL SOUZA
OWNER INFORMATION:
Rosalia-T Kersch
310 N MullerSt #A
Anaheim, CA 92801
ARCHITECT/ENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARAT~ .
I hereby affirm under penaity af perjury thFlt I am
licensed ncIer provisions of c.hapter 9 (commencing
with Secti 7 of Oivsion 3 cf the Business and
. Professions od'?0 P' !1
312112005 U"7...~ - ~f"-'
u
Date: Contractor
This section need,not be completed if the pennit is for one hundred dollars ($1QC:} {.'f less.
~ I certify that in the perfonnance of the work for which th!s peri-nit is is's~€'~,.1 shail nqt
employ any person in any manner so as to become subject to. thewarker's-::::l"~;-npensation laws
of Califomia,_ and a,gree that if" I auld "me subject to the worker's,com~~!1sat:an
provisions 9f Section 3,700 of the b Cade, I shall~' rthwith comply with tr.i;;se provisions.
NUMBER
753053
TYPE
EXPIRATION DAT~. .
8/31/2006
C39
Date: 3/21/2005' Applicant:
WARNING: FAILURE TO SECU WOR ER'S COMPE SATION COVE~".GE IS ,
UNLAWFUL, AND SHALL SUBJ CT AN' EMPLOYER TO CRIMINAL PENALTIES AND CJVIL
FINES UP TO ONE HUNDRED OUSAND DOLLARS ($100,000), IN AppillON TO THE
COST OF COMPENSATION, 0 MAGES AS PROVIDED FOR IN SECTlO<'j')7Ge OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. "'l\
L '.' ..... . CONSTRUCTION LENDING A(3ENCY '~:l1 .
~-i nerec,y:affi~e'i-Peil"C1-it.Y-:Ol".-pei1ury,that'there-'is~-'~vjCl~t(u.3.ati..ef:t"",ldifrg-~!;i'u;;:;'y fVi-' it'oS
performance af the work lar whidl this permit is issued (Sec. ,3097 .Civ.C):
Lender's Infarmation:
Canstrucion Types:
VN, , .
Fire Sprinklered?
NO
I certify that I have read this application and state that the above information.is correct. I.
agree t rom ply with all city ordinances and state laws.relating to building construction, and
rebauthorize representives,of this city to enter upan the above mentioned property for
ins ion purpo~s~
_/It _ Date: 3/21/2005
Signature of Appr nt ar Agent
The ermlt 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.
Fees paid for Permit:
Total;
460.39
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole . . .
Plumbing (DrainlWaste Pipe)
Eledrical Ground Electrode/uter
SetbacJdFormsrrrenches (Footings)
Do not install subfloor or pour floor slab until the.
following applicable items have been signed: . .
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Groundwork) '.
Eledrical (Underground Conduit)
Pre-slab (Compaction/Membrane.Rei nt.
Underpinning (Floor ;Joist/Girders)
Do'not cover or conceal the work below until the ,
following applicable items have been signed:
1st Floor Shear . .
Firesprinlder (Rough) ..
2nd Floor Shear A/7
Roof (Sheathing/Diaphragm' Frame} -Fh
Masonry (RelnfJBond BeamlPre-Grout)
Rough Plumbing (Top Out)
Rough M.echanical
Rough l:lectrlCaI all)
Rough Electrical
Framing (Only afterPlbg., Elec.. Mach. and Fire) .
lilsulation(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
Ex;terior Plaster (Brown Coat) .
T-Bar Electrical .
T -Bar Mechanical . .
T -Bar Strudural
Sewer
Water Engineering Backflow .
Water Service
FINAL INSPECTIONS Date Inspector
Electrical Final .. ,
Plumbing Final .
Mechanical Final
Gas Te,st
Engineerin!JIGrading Final 765-5126 . .
Fire Dept. filIal 765-4040 .
. .
Water Engineering 765-5268 .
Sub List/Business License 765-519 .
Zoning 765-5139
Building Final ~ast Inspection- Only' 4l r>f or C-/~
fter Above Completer
PARTIAL INSPECTIONS ,"~e-
. BUildin: Ins;ections. , . . '. L.~'1. I...~..
~/dJ ~ 4~JI'9~ '.
Mechanical Inspections
Plumbina Inspections
. Electrical Inspections