1110 Park Ave.
TYPE OF PERMIT .C ITY
Reroof
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST liNE:
(714) 765 - 4626
CENSUS CODE: 555 .
QUARTER SECTION: 61
BUILDING PERMIT NO.. BLD2005-00425
DATE: 2/17/2005
JOB ADDRESS: 1110WPARKAVE
LEGAL DESCRIPTION: N TR 3794 LOT 21
CONTRACTOR INFORM/,TION:
SERVICE ROOFING CO",IPANY
440 E WALNUT AVE
FULLERTON, CA 926320(00
BVSINESS PHONE: 714 52!)~4'-37
JOB DESCRIPTION: Tear off existing and reroof 31 squares with 3D-year CO!":'.'positien shinglE:
VALUATION: 3,600.00
I o.WNER-BUILDERj)ECMRA TION
. 'hereby affirm under pel)alty of perjury that' am exempt from the Cor:tracto~.t,~U'.;ense Law for the following reason (Sec. I'031.S-Business and
Professions Code: any city or countyw.hich requires a permit to.cor;:-:tru;;.t, al~bi'. improve, derT!olish or repair anystruclure, prior to its issuance, alsO
requires the app.Jicam for suclT permit to file a signed statement that.he is iiCtlfl,*-d pursuant to the pmviSiol1S of the Cont(C:lctoi'S License Law {Chapter
9)(commencing with Section 70DDof Division 3.of.the Business and Prcfess;i';l~$ Cod:::-) or that he is exemottherefrom :and the basis fer the alleged
exemption. Any violation of Section 7031.5.by any ::3pplicant for a permit f;lji):.~cts tr.e ~)pplicant to-a dvi: penalty of net mc.reth.:ln five. hundred dollar~
($500), . ' ( . .'
o !, as owner of pro.perty, or my employees Wi~h wa~es as th,eir soie CO'rr:r~ti:S8ticn; will dothe work, and the structure is not intended oroffered for
s~le (Sec. 7044 Susiness and Professions Code. The Ccntrnctor's-:"icense'~:3w does.not <"pp!ytc An own~r ofpro.perty who builds or improves'
thereon, a~d who ';tQes such work himselforh~rsetfor through his'or her O~J.!~ employees., provided that SLICh improvemel11s~rd not i,ntendw or
offered ~or'saie. If, however, the building or improvem~ilt is sold with one y,~,:;::r d corp;JJe~i(m. the ownf:r-builder w:lI tla'/0 the burclanof pro'.;ing that h~
did not build 'or improve for the purpose of sale).' , ,!t. ",. . ','
[J, I, a6 the OWf1er of,the'property. am e;<dusively contrc:lcting with Ijcel:s;ad }(.ntr:-:o.crs to cc~str!Jct the project (See. 7'C44 at:Si~'IG.sS and Prr.;t(-:ss.fons
Code: The Contr<'lctor's License Law do,es ,not apply'to an owner of proparry:p/ho b~jk!s ~r imriOV8s thereon. andwn;'; contracts for such proJec:ts with
Mcntractoi(s)'liCer}{~W purs~lar.l totheContraGtor's License Law). '.
LJ'lamexempturicler~c, ,'. ,A&I:l,C.forlhi3reasor.: .__".._~___~__,_____._~ ____
Date:. OvVner: _~___.______,~ ____
r , ,. WORKER'S CCMPENl!ATION CECLARATLQN -t--- ~_,.J r LICENSED CONTRIl,CTORS DECLARATION ~
~heroby affirm under penalty of perjury one Of th6 follOWing decldiaticrh,.! r I he:-eby c:ffirfn .u~.der penalty of perjUry that I am
L.J I have and will maintain a'certificate ot consent to self-ms!J!"€: f..,. v-;orKer't..1x'rt,pcP3at'orl I llcer.sed WIder f.m.Nls:o' ,chapter f=l (ccmmenc:ng
.5 provided for by S~ctio" 3700 of the Labor Cod~, for the perforr;.,.nce Of..thl'.'jW0f" for WI1;ch I ,n 3 ~bfth~ 8" . ~ss and
this permit is 15St,led, - . ..' . -' I ..-- _
;$...;1 have ar.d will m;3intain wo~er's compensaUon ins~iance, as reQL~Lred biSection 3-:00 of i
the L~bor.Code. for the p~riormance of the work for which this P'3rm. it is iSSl.'.p ..!\1YW"fkei"'S '1 Cant-actor"
Compensation insuranC"~ canier and polic.v are: , .. .t., '
CCtrrier: ACQRD . P'~'!icy Number: Q4600~e/\,q{)05 NUMBE EXpn~ATION !lATE
I I i~1545 1i2:1f2006
This section nee!$ll'lot be completed ifthA permit is for o!"'.e hundred dO:I~S t$10~;";Jr It..-::s, TYPE C39
~ I certify that i!1 the pertonnanceofthe work for which th!S ~ermjt;s iSS:J~t. ! sha,i not I TYPE CZ
/emPtoy any person 111 any manner so as to become sub.ect to the \""orker's c'/;-r1PEinsation laws
of C2lifomia, and agree that if I should become . ct the worker's Culll~l;~sal;on i
provL'>lons of SecUot"l3700 of the Labo ode, all rthwlth comply w. 1 r~.SA pro\'"is;ic~~ I Construdo!1 Types.
. I VN, ,
Date: 2/17/2005 I
WARNING: FAILU'RE TO SECURE 0 ,ER'S COMPEN TION COVER::~.Gl<tS .1
. UNLAW. fUL, Ai,D SHALL SIIBJEC .EMPLOYER TO CRIMINI'l. PEN'''-'.rIES. ANI) CIVil II
fiNE:,? UPTO ONE HUNDRED TH. USAND DOLLARS ($100,000),:1'1 ADo.DOi'J TO Tf-lE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION .~.70" OF THE
,(~,:: ::,~:",,',::::~:j~~€~?~~;'~~~~!~':~~:~~':::'~~_"':Y.'0' ;;;=1
performan'ce 'oHhe work for which this permit is issued '(Sec. 3097.Civ.C):
Len.der's Information: '
APPLICANT: RONY LOPEZ
OWNER INFORMATION:
John F Troglio
'11 JO W Park.Ave
. Anaheim, CA 92801
ARCHITECT/ENGINEER INFORMATION
PROCESSED BY: JNJ
I
I certify.that I have read this application .and state that the above information is correct. I
. agr~e to comply wi ity ordinances and state laws relating to building'construction, and
hereb'~uthor" r re ntives of this city to ter upon the above mentiona~ property for
..sP ction p s
Fee~ paid for Permit:
Total:
310.05
Dat~: 2/17/2005
$ignature of Applicant or Agent
t shall expire by limitation and becOI11e null and void if the building or
wor as not passed final inspection 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 (DrainIWaste Pipe). . .
Eledrical GrOllnd.ElectrodelUfer ~
Slllback/FormsfTrencheS (FQOtings) .
Do not install ~ubfloor or pour floor ~Iab until the
following applicable items have been signed:
Plumbing (Water P1pe.Sprinkler Valves)
Mechanical (Groundwork) . .
Electrical (Underground Condu it)
Pre-slab (Compaction/Membrane.Reinf. .
Underpinning (Floor Joist/Girders) . .
. Do not cover or conceal the work below until tne ..
following applicable items have been signed:
.1 st Floor Shear
Filesprinkler .(Rough)
2nd Floor Shear .. . . . .~
Roof (SheathinalDiaphra!lm'Frame) IIf r, '-'.JJ I /-
Masonry (RelnfJBond BeamlPre-Grout) ,
Rough Plumbing (Top Out) .
. Rough Mechanical all)
Rough Bectrlcal .
Rough Electrical . . . .
Framing -. (Only-after Plbg:; EJec;. Mech'.. and Ftre)
Insulation (SoundlEnergy) ,
Do not tape or plaster until the fOllowing applicable
items have been signed: . .
Drywall
Penetrations (Fire Ratlid)Electrical
Penetnitions(Fire Rated) Mechanical .
Penetrations (Fire Rated) Plumbing .
Interior Lath .
Exterior Lath . .
. GENERAL ITEMS
Exterior Plaster (Brown Coat) . .
T -Bar Electrical . .
T-Bar Mechani.cal . . .
T -Bar Structural
Sewer I.
Watilr Engineering Backflow
.Water Service
FINAL INSPECTIONS . . . Date Inspector
Ele.ctrical~inal . . . .
Plumbing Final ..
. ..
Mechanical Final . ..
Gas Test .
. ..
Engineering/Grading Final 765.-5126
Fire Dep\. Final 765-4040 . ..
.
Water Engineering 765-5268
Sob List/Business License 765-519
Zoning 765-5139. . , . , ~I I I J I
Building Final It"st Inspection-Only . f.lb~f6q ( ! V'~/:UVi1< I
fter Above Complete)
PARTIAL INSPECTIONS .
Build/na InsDections
. MechanicallnsDectidns
Plumbina InsDections
ElectricallnsDections