462 S. Paseo Real
BUILDING PERMIT NO. BLD2005-01332
APPLICANT: GEORGE PRINCE
OWNER INFORMATION: . CONTRACTOR INFORMATION:
Burnettie Runberg SERVICE ROOFING COMPANY.
462S Paseo Real 440 E WALNUT AVE :
Anaheim, CA 92807 FULLERTON, CA 926320000,
. BUSINESS PHONE: 714625-4232
JOB DESCRIPTION: Tear off existing and rerool-25 squares with hot mop and crdshed rock
.. . . . .
VALUATION: 6,000.00 :
I. OWNER-BUILDER DECLARATION
I hereby affirm underpenatty of perjury that J am exempt from the Contractor's Ucense Law for the following reason (Sec. 7031.5 Business.and
Professions Code: any city or countywhich"requiresa permit to construct, after"lmprove, demolish or repair any structure; prior to itS issuance, also
requires the applicant for:- such permit to file a signed statementthat he isJicensiJd pursu~nt to the provisions of the Contracto~'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 forthe alleged
exemption. Any violation of Section 7031.5 by any applicant for a permft' sUbjeCl's the applicant to a civil penatty ~f not more than fiv~ hundred dollars
($500). . .. . .. . .. ..
D I, as owner of property, or illy employees with wages as their sole compen~ation, will do the work, and the structure is not intended or offered for
s~le (Se<:;. 7044 'Business-and Professions Code: . The Contractor's License Law doesnot apply to an owner of property who builds or improves
thereon, and who dOes such work himself or helSelf or through his or her own e(nployees, provided t.hat such irTlprovementsare 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 pUlpose of sale). . . :' .,' .-
o _ I, as the owner of the property, am exclHsively contracting with licensed cory tractors to construct the project (Sec. 7044 Busi':less and Professions
. Code: -The Contractor's License Law d,oesnot apply to an owner of property who builds or improves,thereon, and who contracts for such projetts with.
~ontract?r(s) licens-ed pursuant to the Contractor's License Law). .
U. I am exempt under Sec. , B & P.C. for this reason:
Date:' Owner:'
I
TYPE OF PERMIT CITY
Reroof
DATE: 5/9/2005
JOB ADDRESS: 462S PASEO REAL
LEGAL DESCRIPTION: N TR 8220 LOT 67
ElM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSIJS CODE: . 555
QUARTER SECTION: 198
ARCHITECT/ENGINEER INFORMATION:
. PROCESSED BY: JNJ
WORKER'S COMPENSATION DECLARATION
I herebY,affirm under penalty of perjury one .of the following declarations: 1'.
o I have' and will maintain a certificate of consent to self-insure f(jr worker'scbmpensation,
as provided for by Section 3700 of the labor Code, for the performance of the Viork for which
this permit is issued., '{
~have and will maintain worker's compensation insurance, as required by Section 3700 of
:...the Labor.Code, for the penormance of the work for which this permit is issued. Myworker's
Compensation insurance carrier and policy are:
Carrier: ACORD Policy Number. 046000819005
. ,
This section need not be completed if the pennit is for one hundred dollar:s ($1 00) of less.
o I certify that in the perfo~ance of the work for which this per"lit is issued,j shall not
employ any person'in any manner So as to become subject to the worker's compensation laws
of.Califomia, and agree that if I shoUld become subject -to the wolke' compensa,tion
provision'S of Section 3700 of the Labor Code, I shan forthwith c with thos~ pro~isions.
Date: 5/912005 Applicant:
WARN ING: FAILURE TO SECU E WORK IS
UNLAWFUL, AND SHALL SUBJECT AN EM OYER TO CRIMINAL PENALTIES AND CIVIL
FINES U P TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the
periormance of the work for which this.permit is issued (Sec.3097 .Civ.C):
Lender's Information:
I certify that I have read this application and state that the above information is correct. f
agree to comply with all city ordinances and state laws relating to building construction, and
hereby authorize representives of thi ity enter upon the above mentioned property for
insp~ion purposes.
Date: 5/9/2005
ature of A p Icant or Agen
permit s I expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the dilte of permit issuance. A
new permit is required to commence or continue work:
. LICENSED CONTRACTORS DECLARATION
I hereby attirm under penalty of perjury that 1 am
licensed under provisions of chapter 9 mmencing
with Section 7000) of Divsion 3 of slness and
.professions e
5/9/2005
Date:
Contractor
NUMBER
131545
TYPE
TYPE
EXPIRATION DATE
1f.l1/2006
C39
C2
Construcion Types:
VN" .
Fees paid for Permit:
Total:
214.08
INSPECTION RECORD
..
INSPECTION DATE INSPECTOR
Temporary Power. Pole
Plumbi ng (DrainlWa$le Pipe) ..
Electrical Ground Electrode/lifer' . .
. SelbackiFormsfTrenches (Footings)
Do riot install subfloor or pour floor slab unlilthe .
foll6wing applicable items have been signed:
Plumbing (Water Pipe.Sprinkler Valves)
Mechanical (GroundWork) .
Electrical (Underground Conduit)
.Pre-slab (Compaction/Membrane.Reinf.j
Underpinning (Roar Joist/Girders) .
Do not cover or conceal the work below until the
foll.owirtg.applicable items have been signed:
'1 st Floor Shear '.. . .
Firesprinkler (RougI1l
2nd Floor Shear /
Roof (Sheathing/D1aphragm/Framel ,,-
Masonry (ReinfJBond BeamlPre-GroUt)
Rough Plumbing' (Top OuJ)
Rough Mechanical . .
I Rough aectrlCallDrv waU) .
Rough Electrical.
Framing (Only after Plbg., Elec.. Mech.. and Fire) . ..
Insulation (So\JndlEnergy) .
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 Pl;Ister (Brown Coat) .
T .Bar Eleetrical
T.BarMeehanlcal . . .. ..
T -Bar Structural
Sewer ,
Water Engineering .Backflow . .
Water Service' . . . .
FINAL INSPECTIONS . Date . Inspector
Electrical Final .
Plumbing Final .
.
Mechanical Finat
Gas Test . .
Engineering/Grading Final 765-5126 . . .
Fire Dept. Final 765-4040 .
~ater Engineering 765:5268
Sub List/Business License 765.519 . . . .
Zoning 765-5139 .
Building Final ~a$t Inspection- Only 8ltJo( "f-'f'JNV
fier Above .Complete) ..
PARTIAL INSPECTIONS
BuildinalnSDections
MechanicallnsDections
Plumbina InsDections .
ElectricallnsDections