1645 W. Palm Ln.
TYPE OF PERMIT CITY
Reroof
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE:. . 434
QUARTER SECTION':, 56
BUILDING PERMIT NO. 'BLD2005-00934.
DATE: 4/6/2005
JOB ADDRESS: 1645 W PALM LN
. LEGAL DESCRIPTION: ANAHEIM INVESTMENT CO TR LOT 24 S
APPLICANT: JERRY BOLT
. . I,"~
OWNER INFORMATION: CONTRACTOR INFORMATION:
Barcelona LId Anaheim' . CELOSEAL ROOFING, IN'C
PO Box 19528 2323 N BATAVIA I'
Irvine, CA 92623 ORANGE, CA 928650000 "
. '. BUSINESS PHONE: 71499812990
JOB DESCRIPTiON:Tear off existing material to Carports #5.24 and install 36 ~uares of 3 ply built up roof.
VALUATION: . 8,000.00.... . Ii" . PROCESSE'D BY: ENO
I .'. '.' '. OWNER-BUILDER !)ECLARATION .... . .
I ~ereby affirm under penalty of pl';1'rjury that I',am exempt from th'e Contractor'~ Lie,ense Law for the following reason (Sec. 7031.5 Business and
'Professions. Code: any city or county which requires a permit to construct, attElr~- improve;-demolish or repair any structure, prior to its issuance, also
requires t~E:l.applicant for such permit to file a signed statement that he is liceq~d pur,suant to the provisions of the ContraGfor's License Law (Chapter
. 9)(commencihg with-Section 7000 of Divi.sion 3 of the Business and Professibl1sCode) or that he is exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by. any ~pplicant for a permit SUbjfts the.applic~nt to a..civil penalty of not ~o~e than five ~undreddollars
($500). ..' .'1 '. .'
D I, as owner Of property, or my employees with wages as their sole compBflSation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044 Business and ProfeSSions Code: The Contractor's Ucense Lclw 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~mployees, provided that such improvements are not intended' or
offered for sale..!f,- however, the building or improvement is sold with'one yeal;of completion, the owner-builder will have the, burden of proving that he
did not bu.ild ~r. improve for the purpose of sale!. ... ~ ' '. , . .... '.' ,
o I, as the owner of the property,'ar:n exclUSively ,contracting With IlCen~ed cj>ntrqctors to construct the project (Sec. 7044 Busmess and ProfeSSions
Code: The Contractor's License Law poes not apply t9 an owner of propertywl1o bUilds. or improves. thereon, and who contracts for such projects with
a contractor(s) licensed pursuant tothe 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 th~ following declarations: ' ,j
D, I have and will maintain a certificate ob;:onsent to self-insurefo(worker'spompensation, .
as provided for by Section.3700 of the Labor Code, for. the performance of thelwork for which
this perm it is is'sued. ' , ' i '
. ~I have.and will maintain WOrk.er's compensation, insurance, as required ~Yi.13eCtiOn,37000f
.ftle Labor Code,for the pertormanc~ of the work for which this permit is isSued. Myworker's
Compensation insurance carrier and, policy are: lJ
Carrier: STATE FUND Policy Number. 467-0000$14
ARCHITECT/ENGINEER INFORMATION:
LICENSED CONTRACTORS .DECLARATION
I hereby affirm under penalty. of perjury that I am
licen~ed under proVisions of chapter 9 (commencing
with, ection 70 of Divsion 3 of the Business and .
profess s e. '
. , ~I..
This seCtion n~ed not be CQrnpleted if the permit is for one hundred 'dollars ($1 00) i>r less. .
~~'~ertify that in the perfonnance of the work for which this peOrmit isissueJ!,f, shall not. ' '
~y any person in a'ny'manDei" so as to become subject to the worker's 66.~pens.ation ,laws
of Califomia, ,and agree that if I hould bee eject to the worker's c9mpehsation
provisions of ~ction 3700 of the r de, all forthwith co ly with th05:' provisions.
. EXPIRATION DATE
11130/2005 .
C39
B
Date: 4/6/2005 Applicant: .
WARNING: FAILURE TO SECUR ORKE 'S COMPEN ATION COV RAGE IS
UNLAWFUL, AND SHALLSUBJ T AN EMPLOYER TO CRIMINAL PENALTIES AND CIViL
FINES UP TO ONE HUNDRED OUSAND DOLLARS ($100,000), IN ADDIl!ON TO THE
COST OF COMPENSATION: AMAGES AS PROVIDED FOR IN SECTION 3106 OFTHE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.! .
I CONSTRUCTION LENDING AGENCY
1 hereby ),lffirmunder penalty oLperjury that there is,a construction lending ag~~_:c-yfor.thg
p"ertormance of the work forwhich this permit is issued (Sec.3097.Civ.C):
'Lender's Information:
CoristrucionTypes:
VN, ,
Fire Sprinklered?
NO
I ce.rtify that I hays read this appltcation and state that the above information is correct. I
agree to romply with all city ordinances and state laws relating to building construction, and
herebyauthoriz: epresentives of this city to e ter upon the above mentioned property'for.
. "actio 0 s.
Date: 4/6/2005
Fees paid for Permit: '
Total:
267.65
INSPECTION RECORD
INSPECTION . DATE INSPECTOR
Temporary Power Pore . .
Plumbing (DraiillWaste Pipe) ..
Electrical Ground. Electrode/uter ..
SetbacklFormsfTrenches (Footings)
. Do not install su.bfloor or pour floor slab untHthe
following applicable Hems have been' signed: . . .
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (Grou ndwork) .
Electrical (Underground Conduit) ...
Pre-slab (Compaction/Membrane.Rei nf.:
Underpinning (Roor J.oistlGirders) . .
I !J(l not c;over. or conceal the work below until the.
following applicable items have been signed:
1st Floor Shear
Firesprinkler(Rough) .
2nd Floor Shear . . ... . ,-.,.. .
Roof (Sheathing/Diaphragm/Frame) ~/;zbr ./
Masonry (ReinfJBond BeamlPrll-Grout) . ./
Rough Plumbing. (Top Out) . .
Rough Mechanical
Rougl! ElectrIC ,..all) . .
Rough Elec;trical .
Framing (Only aftef Plbg" Elec.. Mech..and Fire)
Insulallon (SOIindlEnergy)
po not. tape or pla~ter until the following applicable
Items have been signed:, .
Dryw"n ... , .
Penetrations (Fire Raled) Electrical . .
Penetrations (Fire Rated) 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 Date Inspector .
Elec.trical Final
Plumbing Final.
Mechanical Final . : .
Gas Test .
.
Engineering/Grading Final 76505126 ' ,
.
Fire Oepl. Final 765-4040 ..
Water Engineering 165.5268 .. ..
.
Sub ListlBusiness .License 765~519 . . . .. .,
Zoning 765.5139 .
,.
Building final ll:ast Inspection- Only r/-wir iY'# .?
Iter Above Complete) . ".
. PARTIAL INSPECTIONS ;Vt.~
. . .
Burldma Inspections
Mechanical Inspections
. ,
, Plumbina Inspections.
Electrical Inspections