915 S. Park Rim Circle
TYPE OF PERMIT CITY
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BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765.5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 217
BUILDING PERMIT NO. BLD200S-02220
DATE: 7/15/2005
JOB ADDRESS: 915 S PARK RIM CIR
LEGAL DESCRIPTION: N TR 8513 LOT 15
CONTRACTOR INFORMATION:
HOYT ROOFS INC
1809 N ORANGETHORPE PARK
ANAHEIM, CA 92801 0000
BUSINESS PHONE: 714773.1820
JOB DESCRIPTION: Tear off existing and re-roof 20 sqaures of ~West Tile Featherstone-; ICBO#3984; 5.9Ibs.
APPLICANT: JOSEPH GI LLlS
OWNER INFORMATION:
HOWARD D STAEBLER
915 S PARK RIM CIR
ANAHEIM, CA 92807
ARCHITECT/ENGINEER INFORMATION:
VALUATION:
9,000.00
PROCESSED BY: SAM
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's l..icense Law for the following reason (Sec. 7031.5 Business an
Professions Code: any city or county which requires a permit to construct, after, improve, demolish or repair any structure, prior to its issuance, arso
requires the applicant for such permit to file a signed statement that he is licenred pursuant to the provisions of the Contractor's License Law (Chapter
9){commencing with Section 7000 01 Division 3 of the Business and Profession$ Code) or that he is exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant 10r a permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).
o I, as owner 01 property, or my employees with wages as their sole compensation, will 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 01 completion, the owner.bullder w1l1 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 Ucanse Law does not apply to an owner o~ property who builds or improves thereon, and who contracts for such projects with
llJ(ontractor(s) licensed pursuant to fhe Contractor's License Law).
U I am exempt under Sec. , B & P.C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pe~ury one of the following declarations:
o 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 \IIork for which
~hiS ermit is issued.
have and will maintain worker's compensation insurance, as required by Section 3700 of
bor Code, for the performance of the work for which this permit is issued.: My worker's
.Compensation insurance carrier and policy are:
Carrier: STATE RJND Policy Number. 1700471.02
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Di ion 3 of the Business and
Professio
EXPIRATION DATE
12/3112006
This section need not be completed if the pennit is for one hundred dollars ($100) or less.
o I certify that in the perfollT\ance of the work for which this permit is issued,l shall not
employ any person in any manner so as to become subject to the workers compensation laws
of Califomia, and agree that if I should become subject to the worker's compensation
provisions of Section 3700 of the Labor Code, I orthwith co Iy with those provisions.
7/15/2005
Date:
/
NUMBER //
606111
TYPE
C39
Date: 7/15/2005 Appll
WARNING: FAILURE TO SECUREWOR R'S OMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECTA MPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED TH SAND DOLLARS ($100,000), IN ADDITlON TO THE
COST OF COMPENSATION,ji AGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
'hereby affirm under penalty of perjury that there is a construction lending agency for the
pertormance of the work for which this permit is issued (Sec.3097 .Civ.C):
Lender's Information:
Construcion Types:
V N, ,
I certify that I have read this application and state that the above information is correct. I
agree to comply with all city ordinances and state laws relating to building construction, and
hereby authorize representives of this city to enter upon the above mentioned property for
inspection purpo s.
Fees paid for Permit:
Total:
161.01
Date: 7/15/2005
"'-....../ ~~ Si nature of Applicant or Agent
The p""~t shall expire by limitation and become null and void if the building or
has not passed final inspection 365 days from the date of permit issuance. A
new Dermit is required to commence or continue work.
City of Anaheim
Building Division
INSPECTION RECORD
INSPECTION DATE INSPECTOR
Temporary Power Pole
Plumbing (DrainlWaste Pipe)
Electrical Ground Electrode/Ufer
SetbacklFormslTrenches (Footings)
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 Conduit)
Pre-slab (Compaction/Membrane Rein!.)
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)
2nd Flojilr Shear
Roof f.fheath~/Diaphragm/Frame) " AA'''' ,
Masonry (Reinf./Bond Beam/Pre-Grout) .
Rough Plumbing (Top Out)
Rough Mechanical
Rough Electrical (Dry Wall)
Rough Electrical
Framing (Only after Plbg., Ete., Mec. And Fire)
Insulation (Sound/Energy)
Do not tape or plaster until the following applicable
items have been signed:
Drywall
Penetrations (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Interior Lath
Exterior Lath
GENERAL ITEMS
Exterior Plaster (Brown Coat)
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 765-5194
Zoning 765-5139 I
Building Final (Last Inspection - Only I~~
After Above Complete) JA l\lo<.c)S(L.I
I
PARTIAL INSPECTIONS
Building Inspections
Mechanical Inspections
Plumbing Inspections
Electrical Inspections