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200 N. Pageant BUILDING PERMIT"NO. BLD2005-01252 TYPE OF PERMIT CI.TY Reroof DATE: 5/2/2005 JOB ADDRESS: 200 N PAGEANT ST LEGAL DESCRIPTION: N TR 4476 LOT 86 APPLICANT: STEVE GLAZER OWNER INFORMATION: Ma rtha J Leber 200 N Pageant St Anaheim, CA 92807 CONTRACTOR INFORMATION: GLAZER ROOFING 1915 BALBOA . NEWPORTBEACH, CA 92663 0000 BUSINESS PHONE: 714612-8260 JOB DESCRIPTION:Tear off existing. roof and replace-with 18 sqaures of 30 year composition shingles. VALUATION: 3,000.00 PROCESSED BY: MSM. OWNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that' 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,' a tte'r, improve, demo/ish or repair any structure, prior to its issuance, also requires the applicant for such permit to file ~ signed.statement.that he is licer:'lsed pursuant tq the provisions of the Contractor's License Law {Chapter 9)(commencing with Section 7000 of Division 3 of the 8usin~ssand Professions Cooe) 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 SUbjefcts the applicant to.a civil penalty of not more than five hundred dollars -~. . .. . o I, as owner of property, or my employees with wages as their sole compe(lsation, will do the work" and the structure is not intended or offeredior 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 intendedo.r offered for sale.. If,.however, the building <lr.improvement is sold with one yea\ of completion, the owner-builder will have the burden of proving that he did not build or improve for the pUlpose of sale). ,',_ . D I, as the owner of the property, am exclusively contracting with licensed cO'n-tra.ctors to construct the project (Sec. 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner.of propertywh6 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: WORKER'S COMPENSATION DECLARATION I hereby affirm under pena,lty of perjury one of the following declaratipns: D I have and will maintain a certificate of consent to self-insure for worker's_compensatjon, as provided for by Section 3700 of the L.;lbor Code, for the perfqrmance.of the work for which ~iS ermit is issued. have and will maintain worker's compensation.insurance, as required by Section 3700 of e Labor Code, for the performance of the work for which this permit is issued. Myworker's Compensation 'insurance carrier and policy are: Carrier: '" -. lOliCY Number. This section need not be completed if the pennit isJor one hundred 01 ~ I certify that in the performance of the wor lor, ich this p r i . issued,l shall not loy any person in any manner so as to' om ubject to t.e o~ el's co~pensation laws of Califomia, and agree that if I should bec, e su . ct tothe er' ,c mperi~tion provisions of Section 3700 of the Labor C d I forthwith c wit those"provisions. Date: 5/2/200!? Applicant: WARNING: FAILURE TO SECURE COMPENSAT N COVERAGE IS UNLAWFUL; AND SHALLSUB-JEC AN E OYER TO CfllMINAL PENALTIES AND CIVIL FINES UPTO ONE HUNDRED n;OUSA DOLLARS ($100,000), IN ADDlllON TO THE COST OF COMPENSATION, DAMAGES S PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES.. CONSTRUCTION LENDING AGENCY r hereby affirm under penalty of perjury that there ,is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097 .Civ .C): Lender's Information: ' e that the above information iscorr.ect. I te laws relating -to building construction, and on the above mentioned property for Date: 5/2/2005 ature of Applicant or gent I expire by Iimi1atio and become null and void if the building or work has not assed fi 001 inspection 365 days from the. date of permit issuance. A new permit is required to commence or continue work. ElM BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 . CENSUS CODE: .655 QUARTER SECTION: 162 ;)Jr. ARCHITECT/ENGINEER INFORMATION: 5/212005 Date: " NUMBER -739156 TYPE C39 TYPE HIC Construcion Types: VN, , Fire Sprinklered? NO Fees paid for Permit: Total: 160.61. INSPECTION RECORD . .. INSPECTION, . DATE INSPECTOR Temporary ,Power Pole 'Plumbing (DraintWaste Pipe) Electrical Ground Electrode/uter SelbacklForms(Trenches (Fooiings) Do not install subfloor or pour floor slab until the following applicable items have been signed: Plumbing (Water Pipe.Sprinkler Valves) Mechanical (Groundwork) . . Electrical (Underground Conouit) Pre-slab (Compaction/Membrane,Remf. . Underpinning (Floor Joist/Girders) Do'not cover or conceal the work below until the, following applicable ilems have been signed:, , 1 st Floor Shear .. Rresprinkler (Rough) 2nd Flo!lJ:..Sb.ear . , . , ,I' /) III! 1. Roof ($healhiOOlDlaphragm'Frame) 5/'1,//"5" I L..- Masoni'YtRilinfJBond BeamlPre-GlOIlt) RoLigh Plumbing, (Top Olit) Rough Mechanical . Rough ElectrICal Rough Electrical . , ' ,I . 'Framing (OnJyafter Plbg."Elec.. Mech.. and Fire) Insulation (SoundlEnergy) Do. not tape Or plaster until the following applicable . items have been ,signed: . Drywall. . " Penetrations (Fire Rated) Electrical . . Penetralions (Fire Rated) Mechanical Penetrations (Fire Rated) Plumbing .. Interior Lath. . Exterior Lath, . GENERAL ITEMS Exterior Plaster (BlOWn Coal) . T -Bar Electrical T-Bar Mechanical ., T-Bar Structural . Sewer ' ' . Water Engineering Backflow ' Water Service' ' FINAL INSPECTIONS, , Date Inspector Electrical Final . ,. Plumbing Final Mechan,ical Final . , Gas Test , . Engineering/Grading Final 765-5126 Fire Dep!. Final 765-4040 . . Water Engineering 765-5268 Sub list/Business license 7~5-519 '. Zoning 765-5139 ' , . Building' Final ~ast Inspection- Only I q~/'7 j} (it- I.C' . fter Above Complete) . PARTIAL. INSPECTIONS Buildina Inspections Mechanical. Inspections Plumbina Inspections . , Electrical Inspections TYPE; OF PERMIT Reroof ElM BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 ~ 5153 INSPECTION REQUEST LINE: (714) 765 - 4626 CENSUS CODE: 555 QUARTER SECTION: 162 .BUILDING PERMIT NO. BLD2005-01252 DATE: 5/2/2005 JOB ADDRESS: 200 N PAGEANT ST LEGAL DESCRIPTION: N TR 4476 LOT 86 CONTRACTOR INFORMATiON: GLAZER ROOFING 1915 BALBOA NEWPORT BEACH, CA. 92663 0000 BUSINESS PHONE: 714612-8260 JOB-DESCR1PTION:Tear off exi~tirig foof and replace with .14 squares of 30 year composition shingles and four squares of torch down roof. APPLICANT: STEVE GLAZER OWNER INFORMATioN: Ma rtha J Le ber 200. N Pageant Sf Anaheim, CA 92807 ARCHITECT/ENGINEER'INFORMA TION: VALUATION: 3,000.00 I OWNER-BUILDER DECLARATION I hereby affirm.under penalty of perjury that I am -exempt from the Contractor'sLicense Law fOf. the following reason. (Sec. 7031.5 Business and professions.Code:' any city or co.untywhich requires a permit to const~uct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant fo.rsuch permit to file a signed statement that he is licen5:6d pursuant 'to the provisions of the Contractor's License Law (Chapter 9}(commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fQr a permit subjects the applicant to a civil' penalty of nof more thari five hundred dollars ($500). '. .' . .' ' :. . , . D i, a,s oWner of property, or my employees with wages astheir sole compensation, wi,lI do the work, and the structure is not intended or offered 'for sale (Sec. 7044 Business and Professions Code: rhe Contraotor's License Law does not apply to an owner of property who buildsor improves thereon, and who does such work himseff orhers.elf 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). I D I, as the owner of the prop-arty, am exclusively contracting with licensed. cOntractors to construct the project (Sec. 7044 Business and Ptofe,ssions 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 contr,,!-ctor(s) licensed purs!Jant 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 ohe of the following dedarations: 01 have and will maintain a certificate of consent toself~insure for worker's compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work. for which this permit is issued. . ' 111 have al1d 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. My worker's Comp~nsation insurance carrier and policy are: . . Carrier: Policy Number: EXEMPT PROCESSED BY: JNJ 5/5/2005 Date: - This section need not be completed if the pennit is one ndred dollars ($100) or less. ~ertify th~tin the 'pertonnance of the. war or . h-this permit is'issued, I sha~1 not , employ any person in 8:ny manner so as to b m 5 jeet to the worker's compens.ation laws of Califomia, and agree that if I should beeo . to the wo .er's compensation provisions of Section 3700 of the Labor Co rthwith c Iy with those provisions, Date: 5/5/2005 Applicant: WARNING: FAILURE TO SECU R R' COM ATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN OYER TO CRIMINALPENALTiES AND CIVIL FINES U P TO'ONE HUNDREDTHOUSA DOLLARS ($100,000): IN ADDITION TO THE COST OF COMPENSATION, DAMAGES S PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I hereby affirm, under penalty of perjury- fuat there is a construction lending agency for the performance of the w0fk for which this permit is issued (Sec. 3097 .Civ.C): Lender's information: NUMBER 739156 TYPE TYPE EXPIRATION DATE 8/30/2005 C39 HIC .Construcion Tvpes: VN, , Fire Sprinkl~red? NO d at that the above information is correct. I sta laws relating to building construction, and o e er"uporl the abov.e mentioned property for Date: 5/5/2005 Fees paid for Permit: Total: 160.61 Sign re of App icant or Agen The permit shall pire by limitation ;md becoinenull and void if the building or work has not passed final inspeciion 365 days from the date of permit issuance. A new permit is required to commence .or continue work. INSPECTION RECORD INSPECTION " , DATE INSPECTOR Temporary PoWer Pole Plumbing (DrainlWaste Pipe) Electrical Ground Electrode/Ufer SetbacklFormsfTrenches (Footings) , Do not install supflOO,r or pour floor slab until the following applicable items have been signed: Plumbing (Watet Pipe.SprinklerValves) Mechanical (Groundwork) Electrical (Underground Conduit), Pre-slab (Compaction/Membrane.Rei nf. Underpinning (Floor JoistlGirders) , Do not cover or conceal the wotk belowuntu the ' following applicable items have been signed: 1st Floor Shear " Firesprinklet (Rough) 2nd Floor Shear Ro,of ISheathillg/Diaphralim'Fr;me) . Masonry (ReinfJBonclBeamlPrll'Grout) , RQugh Plumbing (Top Out) Rough Mechani,cal' KOugn t:IectrlClII ,IU<Y ..all) , ' Rough Electrical Framing (Only after Plbg., Elec.. f0ech.. and Fire) Insulation (SoundlEnergy) po' not tape or pja~ter,until the following applicable Items have been Signed: .' Drywall, , , Penetrations (Fire Rated) Electrical Penetrations (Fire Rated) Mechanical Penetrl!lions (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 " Date Inspector Electrical Final Plumbing Final Mechanical Final ' Gas Test , Engineering/Grading Final 765-5126 , Fire Dept. Final 765-4040 , Water Engineering 765.5268 Sub ListlBusiness License 765.519 , , ZOfling 765.5139 " Building Final ~ast Inspection- Only Sj\(m f}k liS fter Above Complete) PARTIAL INSPECTIONS Buildina Inspections " Mechanical Inspections Plumbina Inspections Electrical Inspections :