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5889-5891 Mountain Loop Trail TYPE OF PERMIT CITY Reroof ElM BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 CENSUS CODE: 555 QUARTER SECTION: BUILDING PERMIT NO. BLD2005-03725 DATE: 11/23/2005 JOB ADDRESS: 5889 E MOUNTAIN LOOP TRL 4 LEGAL DESCRIPTION: CONTRACTOR INFORMATION: BIENEK ROOFING CO 22622 LAMBERT ST #303 LAKE FOREST. CA 92630 0000 BUSINESS PHONE: 949951-3798 JOB DESCRIPTION:Tear oft existing. replace 112" OSB as needed. and reroof 28 squares with Ealgelile liie ICBO 4660 @ 5.8; Includes Ihe address range VALUATION: of 58~;6881>bMounlain Loop Traii PROCESSED BY: JNJ I OWNER-BUILDER DE,CLARATION 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 city or county which requires a permit to construct, alter, 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 licensed pursuant to the provisions of the Contractor's License Law (Chapter 9)(commencing with Section 7000 of Division 3 of the Business and ProfessionsCode) or that' he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). o I, as owner of property, or my employees with wages as their sole compensation, wlll do the work, and the structure is not intended or offered for sale (Sec. 7044 Business and Professions Code: The Contractor's License Law 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 her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold with one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). o I, as the owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044 Business and ProfeSSions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law). D I am exempt under Sec. , B & P .C. for this reason: Date: Owner: I WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: D I have and will maintain a certificate of consent to self-insure for worker's compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which ~rmit is issued. g-rnave and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Myworker's Compensation insurance carrier and policy are: Carrier: STATE FU ND APPLICANT: PAUL GREG ROW OWNER INFORMATION: PAUL N CHMIEL 5889 E MOUNTAIN LOOP TRL ANAHEIM, CA 92807 ARCHITECT/ENGINEER INFORMATION: Policy Number. 1691621-2003 NUMBER 651509 TYPE 7 ThiS section need not be completed if the pennit is for one hundred dollars ($100) or less. o f certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the worker's compensation laws of California, and agree that i I should become su tt 0 the wo r's co ion provisions of Section 3 0 f the 0, aU hwith c Iy Jth those provr' s. C39 Dale: 11/2312005 A WARNING: FAiLURE TO SEC RKER'S CO UNLAWFUL. AND SHALL SUBJECT AN EMPLOYE FINES UP TO ONE HUNDRED THOUSAND DOLL COST OF COMPENSATION. DAMAGES AS PROVi ED FOR I SECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097 .Civ.C): Lender's Information: Construcion Types: VN. , Date: 11123/2005 Fees paid for Permit: Total: 244.93 plicant 0 Agen mitatio nd become null and void if the building or spectio 365 days from the date of permit issuance. A mmence or continue work. City of Anaheim Building Division INSPECTION RECORD INSPECTION DATE INSPECTOR Temporary Power Pole Plumbing (Drain/Waste Pipe) Electrical Ground Electrode/Ufer 'SetbacklForms/Trenches (Footings) Do not install subfloor or pour floor slab untilthe I following applicable items have been signed: Plumbing (Water Pipe/Sprinkler Valves) IMechanical (Groundwork) Electrical (Underground Conduit) Pre-slab (Compaction/Membrane Reinf.) Underpinning (Floor Joist/Girders) I Do not cover or conceal the work below until the following applicable items have been signed: ,1st Floor Shear 'Firesprinkler (Rough) ,2nd Floor Shear IRoof (Sheathing/Diaphragm/Frame) 1\\1JllO(" '1" . Ac.KooV- Masonry (Reinf./Bond Beam/Pre-Grout) IRough Plumbing (Top Out) Rough Mechanical IRough Electrical (Dry Wall) Rough Electrical IFraming(onlY after Plbg., Ele., Mec. And Fire) 'Insulation (SoundlEnergy) I Do not tape or plaster until the following applicable items have been signed: ,Drywall Ipenetrations (Fire Rated) Electrical Penetrations (Fire Rated) Mechanical I Penetrations (Fire Rated) Plumbing Interior Lath I Exterior Lath GENERAL ITEMS I Exterior Plaster (Brown Coat) 'T -Bar Electrical ,T-Bar Mechanical 'T.Bar Structural Sewer IWater Engineering Backflow Water Service FINAL INSPECTIONS DATE INSPECTOR Electrical Final Plumbing Final Mechanical Final Gas Test Cross Connection Control (714)7654280 Engineering/Grading Final 765-5126 Fire Dept. Final 765-4040 Water Engineering 765-5268 Sub List/Business License 765.5194 Zoning 765-5139 ' ~ Building Final (Last Inspection - Only ~1 ~t I@V~ After Above Complete) c.. PARTIAL INSPECTIONS Buildin!llnsoections Mechanicallnsoections Plumbina Insoections Electricallnsoections