630 S. Pathfinder Trail
TYPE OF PERMIT CITY
Reroof
DATE: 4/29/2005
JOB ADDRESS: 630 S PATHFINDER TRL
LEGAL DESCRIPTION: N TR 9751 LOT 30
ElM
BUILDING DIVISION
200 S, ANAHEIM BLVD,
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
CENSUS CODE: ,555
QUARTER SECTION: 193
'3>3
BUILDING PERMIT NO. BLD2005-01232
i
CONTRACTOR INFORMATION:
, ABOVE IT ALL ROOFING'
537 NEWPORT CENTER DR 1/ 116
NEWPORT BEACH, CA 926600000
BUSINESS PHONE: 949673-3222
JOB DESCRIPTION:Tear off exlstin9 roof and replace with 37 sqaures of 7 pound ea91elite tile ICBO# 7665,
VALUATION: 13,000.00 ,', PROCESSED BY: MSM'
I OWNER-BUILDER DECLARATION I
I hereby affirm under penalty of perjury that I am exempt from the Contractor's:Ucense Law for the following reason (Sec. 7031.5 Business and
. Professions COde: a"ny city or county which requires a permit to construct, atter. improve; demolish or repair any structure, pripr to its issuance. also
requires the applical')t for such permit to file a signed statement thathe is lice~\3ed pursuant to the provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3. of the Business and Professio~s Code) or that he is exempt therefrom and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permitsubj$bts the applicant to a civil penalty of not more than five hundred dollars
~~, . ... . ~ ... . .
D I, as owner of 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~w does not 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'~'lmployees, provided that such impro~mentsare not intended or
offered for sale. If, however, the building' or improvement is sold with one year 'of .completion, tne owner-builder will 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 61ntractors to construct the project (Sec. 7044 Business and Professions'
Code: The Contractor's License Law does not apply to an Qwner of propertYVJho builds or improves thereon, and who COntracts for such projects with
a c0ntractor(s) licensed pursuant to'the Contractor's License Law). 'ji .
D lamexemptunderSec. '. jB&P.C.'forthisreason: . 'J
Date: Owner: '.
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
D .1 haveand will maintain a certificate of-consent to self-insure'fOrWOrker'g'qompensation,
as provided for by Section 3700 of the Labor Code, for the performance of the work for which
this perm it is is'sued. ,:
f{j: I have and wi.11 maintain worker's compensation insurance, as required byS ection 3700 of 4/29/2005
Labor Code, for.the performance of the work for which this permit is issued. Myworker's Date:
ompensation insurance carrier and policy are: .;'
Carrier: STATE,FUND ' Policy Number. 0002065-2005 .
APPLICANT: MI KE ALLEN
OWNER INFORMATION:
Masafumi Ota'
630 S Pathfinder Trl
Anaheim, CA.92807
ARCHITECT/ENGINEER INFORMATION:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of periury that I am
licensed under provisions chapter 9 (commencing
with Section 7000) of i 3 of t siness and
Professions C
Qontractor
This section need not be completed if the pennit IS for one hundred dollars ($100) or less. .
o I certify that in the performance of the work for which.this permit is issued,l sha~1 not
employ'any person in any manner so as to become subjectto the worker's compens&ti6n laws
of Califomia,_and agree that if I should become s 'ect to the worker's compensation
provisions of Section 3700 of fhe Lab~r Cod a with comply with those provisions,
NUMBER
765842
TYPE
EXPIRATION DATE
7/31/2005
C39.
Date: 4/29/2005 Applicant:
WARNING: FAILURE TO SECUR WORKER'S COMPENSATION COVERAGE is
UNLAWFUL, AND'SHALL SUBJE T AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL
FINES UP TO ONE HUNDRED TI'IOUSAND DOLLARS ($100,000). IN ADDlllON TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE
LABOR CODE, I NTEREST AND ATTORNEY'S FEES,
CONSTRUCTION LENDING AGENCY
I h~reby 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,Clv,C):
.~Lender's Information: . .
Construcion Types:
VN, ,
fire Sprinklered?
NO
--'.......'
I certify that r have read this application and state that the above information is correct. r
agree to comply with all city ordinances a ate laws relating to building construction, and
hereb . authorize r pre tives of . City to enter upon. the above mentioned property for
sP -ion r.
Date: 4/29/2005
Fees paid for Permit:
Total:
610.64
Sign pplicant or Agent
The permit shall expire by limitation and become null and void if the bUilding or
work has not passed Ii 001 inspection 365 days Irom the date 01 permit issuance. A
new permit is required to commence or continue work.
. INspeCTION DATE . INspeCTOR Electrical Final . '. ,
Temporary Power Pole '. . Plumbing Final .
Plumbi ng (Drain/Waste Pipe) . Mechanical Final . .
Electrical Ground Electrode/uter . .
SetbacklFormsfTrenches (Footings) G"sTest
Do not install subfloor.or pour floor slab until the . Engineering/Grading Final 765,5126
following applicable items have been signed: . Fire Dept. Final 765-4040 . . . .
Plumbing (Water Pipe.Sprinkler Valves) .
Mechanical (Groundwork) Water Engineering 765-5268 . .'
Electrical (Underground Conduit) Sub List/Business License 765-$19
P,e-slab (Comp~actionlMembrane.Rei nf.; .
Underpinning (Floor Joist/Girders) Zoning 765-5139
Do not cover or conceal the work below until the Building Final ~ast Inspection- Onl~..G ~-b..5 zJ /T
foUowing applicable items have. been signed: fter Above Complete
1 st Floor Shear PARTIAL INSPECTIONS'
Firesprinkler(ROugh) .
2nd Floor Shear . ~ Buildina Insoections
ROof (SheathiIl!llDiaphragmlFrane) ..0:; " . .'
Masonry (ReinfJBond BeanlPre-Grout) . .
Rough Plumbing (Top Out) . '. .
Rough Mechanical . . .
ROugh ElectrICal (Dry Wall) . .' . .
. . .
Rough Electrical .
! . . --
Framing (Only after Plbg.:. Elec.. Mech., and Fire)
Insulation (SoundlEnergy) . , MechanicallnSDections
Do not tape or plaster until the follOWing applicable
items have been signed: . . " . .
Drywall I .
Penetrations (Fire Rated) Electric:al
Penetrations (Fire Rated) Mechanic:al . . '.
,
Penetrations (Fire Rated) Plumbing .
. .
Interior Lath
Exterior Lath Plumbinq Insoections
. . GENERAL ITEMS .
Exterior Plaster (Brown Coat) . . .
r;Bar Electrical .
r -Bar Mechanical .'
r -Bar Structural . . . . . . .
Sewer . .
Water Engineering Backflow Electrical insoections
Water Service .' . -
. INSPECTION RECORD'
FINAL INSPECTIONS
Date
Inspector