1254 N. Moraga St.
-z.~O~fOF P/ORMIT CITY.
DATE: 1/18/2005
JOB ADDRESS: 1254 N MORAGAST
L/OGAL DESCRIPTiON: .N TR 2288 LOT 74
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765- 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 30 .
BUILDING PERMIT NO.. BLD2005-00135
APPLICANT: VU DOAN .
OWNER INFORMATION: CONTRACTOR INFORW'.TION: ARCHITECT/ENGINEER INFORMATION:.
VU DOAN .
1254 N Moraga St
Anaheim, CA 92801
JOB DESCRIPTION:Tearoff existing foof and replace with 28 squares of 30 i. composition shingles.
VALUATION: 5.000.00
r-- OWNER-BUILDE!:LDECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractc(::: license Law for the following reason (Sec. 7031.5 Business and .
Professions Code: any dty or county which requires a permit to construct, a !le r. improve, demolish or repair aoy structure, prior to its isSuance, also
.' , . , - ,.\ .' . '.
r.equi~es the applicant for ~uch permit to ,file a signed staternent t~at he i.s :1c~~nsed pursuant to t~e provisions of.the Contractor's Licensl3Law (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
je; :;'o\;ion. Any.vio lat.ion ofSeCijon 7031.5 by an y applicant f. 0, r,,~ p.ermit S":~..i'cts thea pplican(to a. Cl 'v~ pena~yof n.ot mo re than five hundred dollars
, 'I, as owner of property, or my' employees with wages a's ttleir sole ccm~iensation, will do the work, and the structure t5 not intended or offered for
ale (Sec.. 7044 Business and Pro.fessions Code: The Contractor's License ';0<3W does not apply to an owner of property' who builds or improves .
tliereon"and who'does such work himself or herself or through his or her O'N;) employees, provided t~at such improvements are not intended or
offered for sale. If, ho~ever, the building or'improvement issold with one Vc.3r of completion, the owner-builder will nave the burden of proving that he'
did not build or impro,ve for the purpose of sale).." . ' '.
o t, as the owner. of t~e property, am exdusively ,contracting with licensE:d:contradors to cOhStruct the project (Sec. 7044-.Business' ~md. Professions
Cod.e:':'The,Contractcr's Licst:lSe- Law dQes not apply to an Dwrier of prope:ty'w~.~ builds cr !mproves thereon, and who contra~ts for-such p:"ojects w:th
~ontractor(s) Iicens~ pursuant to the Contr.act's UcenseLaw).
~..J. iflT!rl1'l!ft:~rSeG.' .:B&P.. . his eason:
~. :'Owner, -"---
I .. ..Vi!ORKER'S CO ENSATIONDECLARATION
I hereby affirm. und~r'penalty of perjury one of the following decla(ations: .
o 1 have and wlli maintain a certificate of consent to self~insure for wOrker'$ l';omper:si;:lt!or.;
asprovided'fbr ~y Section 3700 of the-labor Code, for the perfqr;nance lJf i!:~:,Ncfk for which
this permit. is issued. .
o I have and w!i! maintain w9rker'scompe~satfof1lnsurance, as requir~d;:;/ Section 3700 of
the Labor.Code, for the perfort"flanceof,the work forwhich'this permit il? iSS_L>t:d. Myworker's
Compensation insurance eanier and policy are:
Carrier:
PROCESSED BY: MSM
i
LICENSED. CONTRACTORS DECLARATION I
I hereby alfirm under penalty of perjury that I am
Ii~ensed under provisions of char,tter 9 (commencing
with Sedion 7000) of Oivsion 3 of the Business and
Profe.ssions Code. .
1/18/2005 _
Date:
Contractor
Policy Number.
NUMBER
EXPIRI(TION [)A TE
.~. Th. . section need not be completed if the pennifis for one hundred dol!ars '($1 O~,; or I~s.
I certify that in the ~rfo'nnance of the work for which this, permit is tssuei:!, I shall not .
e .ployany perso.n in'any manner SO as to become subject to theworker's c(?mpensation laws
of Cal ifo mia, and agree that if I should become su ject to the worker'scom~~rlsation
provisions of Section 3700 of the Labo C de,l sh fo!1.hwi~h comply with tn')se provisions.
Date: 1/18/2005 Applicant:
WARNING: FAILURE TO SECU WOR R'S C PENSA ION COVER-\GE IS
UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMI~AL PEN...LTIES AND CNIL
FINES UPTO ONE HUNDRED THOUSAND DOI.I.ARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIO'" 3706 OF HiE.
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of -perjury that there is a construction lend iog aGcn~y for the
perforl1!8nce of the work for which thispermft is issued (Sec.3097'.Civ.C): ;"
Lender's Information:
TYPE
Construcion Types:
VN,. ,
Fire Sprinklered?
NO
I ,certify troat !.have read this application and state that the above information is correct. I
agree to colJ1ply w' h all city ordinances arid state laws relating to bunding construction, and
'lr.e~Y aut orize re sentives of this city to enter upon the above mentioned. property for
i spection r 5
.,. Date: 1/18/2005
. Signature of Appl cant 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 perrrJt issuance. A
. new permit is required to commence or continue work.
.......,
Fees pai~ for Permit:
Total:
235.33 .
INSPECTION RECORD
INSPE;cnON .. . DATE INSPECTOR
Temporary Power Pole . . ...
Plumbing (Drain,waste Pipe) .
Electrical Ground Electrode/Ufer
SelbacklFormsrrrenches (Footings) .
Do not install subfloor or pour floor slab until the
following applicable items have been signed:
Plumbing (Water Plpe.Sprinkler Valves) .
MllChanical (GrciundWork).
Electrical (Underground Conduit)
Pre-slab (compactionlMembrane.Reinf. . .
Underpinning (Floor Joist/Girders) r .
Do not cover or conceal the work below until the.
following applicable items have been signed:
1 st Floor Shear
Firesllrinkler (Rough)
2nd Floor Shear . . I)
Roof (ShealhiIllllDiaphragm'Frame) 'L/ VI o~ /IJ MA// j,
Masonry (ReinfJBond BeamJPr&Grout) I ~/. . .
Rough Plumbing (Top Out) .
Rough Mechanical ..
KOugh ~ectrk:lIIlury nail) . .
RoUllh Electrical . .
Framing', (Oolyafter Plbg.. Elee:. Mech.. and Fire) ..
Insulalion (SoundlEnergy)
Do not tape or plaster until the. following applicable
items have been signed: . .
Drywall . I
Penetralions (Fire Rated) Electrical I
Penetrations (Fire Raled) Mechanical .
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
GENERAL ITEMS .
Exterior Plaster (Brown Coal). .
T -Bar Electrical .
T -Bar Mechanical -
T -Bar Structural
Sewer .
Water Engineering. Backflow
Water Service .
FINAL INSPECTIONS
Electrical Final
Date
Inspector
Plumbing Final
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765.4040
Water Engineering 765-5268
Sub Li.st/Business License 765-519
Zoning 765-5139
Building Final (Last Inspection. Only
.. . . After Above Complete)
. PARTIAL INSPECTIONS
Buildina Inspections
c
Mechanical Inspections
"i
. Plumbina Inspections
ElectricallnSDections