901 S. Park Rim Circle
TYPE OF PERMIT
Reroof'
., -':{:<:,,~,,', \.
L~'/~~-~_' _' ~:_, .\
CITY~'~1~~,~~HEIM
. .\({~:;~~~;~~;:~.'~;t~>;
, BUiLDING DIVISION
200 S, ANAHEIM BLVD,
(714) 765- 5153
INSPECTION REQUEST LINE
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 217
BUILDING PERMIT NO. BLD2004-03310
DATE: 8/30/2004
JOB ADDRESS: 901 S PARK RIM CIR
LEGAL DESCRIPTION: N TR 8513 LOT 12
CONTRACTOR INFORMf,TION:
H20 ROOFING
2031 E GLADSTONE # F
GLENDORA. CA917 40 OOJO
BUSINESS pHONE: 877 71J.7663
JOB DESCRIPTION Reroof with tear.off new 1/2 CDX plywood and Monier Ufo.tile (Saxony split shake 5,96 pst) ICBO#2656
VALUATION: ' 7,300,00 PROCESSED BY: DOR
,I OWNER-BUILDE:i(l;lECLARATION ~
I hereby affirm under, penalty of perjury that I am exempt from the Ccntra~0:-:s License Lzw for the following' reason (Sec. 7031.5 Business and
Professions Code: any <?ity or county which requires a permit tocQrlstruct; aUer, improve, demolish or repa,ir-a~y structure, pdorto itS is~uancd,Fllso
requires the appliCant for-such permit to file <:l signed statement that he.i3Iic\:nsed pursuant to the provisions of the Contractor's Lic~nse Law (Chapter
9)(commendng with Section 7000 of Division 3 of the_ Business and Prof.e5s~r)nS Code) or that he is' exempt therefrom and the basis for the alleged
exemption,' p..ny violation of Sec~ior. 7021.5 by any applicant for 2 pem,it su~ieGts the ap~licant to a civil penalty ornot more than five hundr'ed doilars
~~ " ", " ' "
o I. as owner of property, or my.employees with wzges as their Sol(; comp$n:-.atio:1, w\!! do t~e work, and the structure is not intended or offered for
sale (Sec. 70d4 Business and ProfE::&s16nS Code: The Cor:tractor's ,~,Jcel1~e t,3W does notapply to an owner of property who buildS Qr imprcves
thereon, and who does such work himself ,or herself 0, through his u( her. own ernpl,oyees, pro~ided that suc~ improvements are Itot intended or
offered for sale. If.,however, the building or impro~ement is solt! with 0:16 ye~~.r,of completion, the owner..buildi;;:r will have HIe burden of proving U"!Gi! Me
didr!f'Jt build or improve for !he'purpC'~e of sale), - 'l, '
o l, as theow'ler,ofthe'prot:-€r.:y;' am exclusively contrc:cti:"lg with liCt3I1<;E),j '2cr,tmctois to construct the ~.'roject (Sec.' 7044 BUSiness and Profes5ion~ '
Code: The.Contr:actor's Ucer.se Law d<,,~~ not apply to ,an owner or pmpert'/~"',l1o builds or imrrov~$ the;-eon, r.lnd who ~ntracts for such projects with
'%i-iontr-a<..i:or(s) iicensed pll~SlJan.t to tt-,r. Contractor's !..icen~ Law).
L... I am eXE-trlpt under SI')':;. _______, B&,P.C. for this reascn:, __.._.
Date: Owner:
I, WORKEltS COMPENSATiON OE~LARATICN' , ==:J I
I hereby affirm under penalty of p6!,jury onEO:' 0f the followhig dfl.cl8.rct;ons: I
[J I have at,'d,' will ma'intain- a certifi~ate of c::O!1serit to self-insure, for v.'orke:,,\compensatkm,
as ;:mJ\,'ided_forby Sectinn 3/00 ot the l.('Ibor Code, for the performance 01 t;-:.: :J0rl<'for \Ivhich
this permit is"is'sued,' ',' , I
o I have <:!pd will ma~ntajn worker's compensation insurance, as' required r~r $ec!ion 3700 of,
tile L':ibor Code"for th'e performance of the work for whi.::i1 this permit !~ isst.i~d... ,My worker's I Date:
Compensation in.surance carrier and policy are: "
Carrier: STATE FUND . Policy t.JIJmber. Zl15-04 ~,~IT 0c01832
This s,ection need not be completed if the perrott is far one hl"mcrC:d dollars (.$1Pf:} U' less,
o I certify't.hatin the. perf6rrn8!1Ce of the work for which this 'p8rmlt is 'is..C).~e:~ \,' 'shal: not '
employ any person jr:l any manner so as to become subjeCt to the wotkar's. c(;mpcn~atic;n raws
of Califomta, and agree that if I should become subject to e worker' cor:'1~'-=nsatlon I
provIsions of SeGtlon 3700 of the La~sha" fe, hWlt C iY wito U,coe proVISIO"'S Construcion Types:
VN ,
Date: 8/30/2004 Applicanr: __ Fire Sprinklered?
WARNING' FAILURE TO SECURE ,', KER'S OM e;~ 16. OVER:\GE IS ~
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER 1: CRIMINAL PENAI.Ti;oS AND CIVIL
FINES U PTO ONE HIJ~,IDRED lHOUSAND DOLLARS ($,,00,000),,' it~,AD"n,)'TION, TO THE I
COST OF COMPENSATION, DAlvlAGES AS PROVIDED FOR IN "'O'c:TION 03706 OF THE '
LABOR CODE, INTEREST AND ATTORNEY'S FEES, " ' ,." "
I" 'CONSTRUCTION LENDINGAGENCY" ,_~,~:'
I hereby.affJrm und.er p'enaJfy of,perjury that there, i~_<:l, constructionJerJd~l'lg _ilG~nc~.!:o.rthe1
---1':2~' 0-r-:'!"'h,}:''!-_:''~~ _' 0/ 'th0'/,',:::"k,-~"" ~'w~:!''8.~ ,ti"';: :';;.:.~:- ,~i',! t': i,;' ;:: s:..:o d {~;;;;:2C~?: >':;-;v-'.'Gr: -,,:,'
Lender's Information:' . ,
APPLICANT'
OWNER INFORMATION:
J:>utron L De
901 S Park Rim Gir
Anaheim, CA 92807
ARCHITECT/ENGINEER INFORMATION:
NUMBE'R
829291
TYPE
EXPJRATION DATE
12/31/2005
C3~
NO
I certify that 1 have read this application and state that the above information i~ correct. I
agree to comply with all' inances and state laws relating to building cor,struction, and
herebyauthoriz ,P sentlve 0 I city to. enter upon the above mentioned property for
in eGtion p
Fees paid for Permit;
Total:
160.89
Date: 8/30/2004
, ' Sign re f\pp n or Agent _
The permit shall expi e by limitation and become null and void if the building or
Work has not passed final inspection 365 days from the date of permit issuance. A
new permit is required to commence' or continue work.
INSPECTION RECORD
.
. '. . IN$PECTION DATE. . INSPECTOR
T em'porary Power Pole
. Plumbing (DrainlWaste Pipe)
. Electrical Ground Electrod.e/Ufer
. SetbacklFormSrrrenches (Footings).
Do not install subfloor Or pour floor slab until the
fOllowing applicable items have been signed: .
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (GroUndwork}
EIe.ctrical (Underground Conduit)
. Pre-slab (Compaction/Membrane.Reinf. . .
Underpinning (Floor Joist/Girders) .
Do not cover or conceal the work below until. the
following applicable items have been signed:"
1 st Floor Shear . ~
FireSprinkler (Rough) . ....
2"d Floor Shear . . . . iJl'l~
Roof (SheathingDiaphragm'Frame) :j.IL.~'
Masonry (ReinfJBond Beanl/Pre'-Grtl\It) . '.
.
Rough Plumbing (Top Out)
'. Rough Mechanical .'
Rough E1ectriCalTDry-wail) ;c-
Rough Electrical . . . .
. Framing (Only afterPlbg,. Elec" r..lech and Fire)
Insulation (SoundlEnergy) . ,
Do not tape or plaste.r until the following applicable
. items have. been: signed: . ' ".
Drywall .' .' . . .
'. Penetrations (Fino Rated) Electrical .
Penetrations (Fire Rated) Mechanical .
Penetrations (Fire Rated) Plurnbil19
Interior Lath ~ .
Exterior Lath . .' . .
'. . GENERAL ITEMS .
Exterior Plaster (Brown Coal) ~
T -Bar Electrical . .'
.T -Bar Mechanical .
T -Bar Structural
Sewer "
W!'lerEngineering Backflow .~ '. .
Water Service
FINAL INSPECTIONS Date Inspector
Electrical Final . . I.
. I:
Plumbing Final I
Mechanicai Final.
Gas. Test . .
Engineering/Grading Final 7.65-5126 .
.
Fire Dept. Final 765'4040 .
Water Engineering 765-5268 I.
Sub List/Business License 76s:.519
Zoning 765-5139 .
Building Final ~astlnSpection_OnIY . I~~~ '.
fter Above Complete)' ~^)')~~I
PARTIAL INSPECTldNS
Buildina InSDections
MechanicallnsDections
. ,Plumbina InSDections
. ElectricallnSDections