679 S. Pathfinder Trail
TYPE OF PERMIT CIT.V.
Reroof
ElM
BUILDING DIVISION.
200 S. ANAHEIM BLVD.
(714) 765 - 5153
.INSPECTION REQUEST LINE:
(714) 7.65 - 4626.
. CENSUS COD.E: 434
QUARTER SECTION: 187
BUILDING PERMIT NO. BLD2005,01689
DATE: 6/6/2005
JOB ADDRESS: 679 S PATHFINDER TRL
LEGAL DESCRIPTION: N TR 9750 LOT 34
APPLICANT: MIKE ALLEN
OWNER INFORMATION:
Teodor Przymusinski
679 S Pathfinder Trl
Anaheim, CA 92807
CONTRACTOR INFORMATION:
ABOVE IT ALL.ROOFING
537 NEWPORT CENTER DR , 116
NEWPORT BEACH, CA 926600000
BUSINESS PHONE: 949 673-9222 .
JOB DESCRIPTION:Remove wood shake: install 7116" OSB (2) layers of 301bs. ASTM felt paper and.28 squares of eagle lite tile 7.21bs per tile ICBO#7660.
VALUATION: 13,000.00 PROCESSED BY: ENO
ARCHITECT/ENGINEER INFORMATION:
OWNER-BUILDER DECLARATION
.I.hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5 Business and
Professions Code: any city or. county which requires a permit to construct, a tte r, -improv~, demolish or repair any structure, prior to its issuance, ~Iso
requires the applicant for such perm}tto file a signed statem,ent that he is Jicensed.pursuant-to the provisionsoHhe Contractor'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 for the.alleged
exemption. Any violation of Section 7031.5 by any applicarit fo'r a permit subjects the applicant to a civil penaftyof not more than five hundred dollars
($500). . .....
D I, as owner of property, or my ,employees with 'wages as their sole compe/"lSation; 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 qwner,of property who builds or improves
thereon; and who does sl:lch work himself or herself or through his or her own employees, provided that such improvements are not intended o'r
offered for sale-. If, however, the building or impr6vem!3nt 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 purpose of sale). , .
D I, as the owner of the propertY, am exclusively contracting ~ith licensed cOntractors to construct the project (Sec. 7044 Business and Professions
Code: The Contractor's License Law does not apply to an owner of property who builds qfimproves thereon" and who contracts for su~ projects with
a contractor(s) licensed pursuant to the Contractor's License Law). - '
o I am exempt under Sec. . . , B & P.C. for this reason:
Date: Owner;
I WORKER'S COMPENSATION DECLARATION
J hereby affirm under penalty of perju.rY one of the following,declarations:'
D I have and_will maintain a certificate of consent to self-ins'ure for worker's compensation,
as provided for by.Section 3700 of the Labor Code, for the performance of the work for which
this perll'!-tt is issued. .
~ I have and will maintain worker's compensation insurance, as re'quired by Section 3700 of
The-LaQpr Code, for the periormance of the work for which this permit is issued. My worker's
Comp_ensatiori insUrance canierand polioy are:
Carrier: STATE FUND.
Policy Number. 0002065-2005
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penally of perjury that I am
licensed ~~er.provis' of hapter 9 (commencing
with Secti 7000) Di io of t e Business and
Profession Cod . . . . ,
6/6/2005 ,. .
Date: '" " contract~r
NUMBER ~PIRATION DATE
765842 7/31/2ll05
TYPE C39
~section need not be completed ifthepennit is lor one hundred doilars ($100) or less.
I certify that in the perionnance of the work for which this permit is issued, I shall not
employ' any p~rson in any manner so as to become subject to the worker's compensation laws
of Califomia, and agree that if I should become ubject to t worker'_s comp'ensation
provisions o~ Section 3700 of th~~, C , I sh f h \tli omply with t ose pr<?visions.
Date: '6/6/2005 Applicant:
WARNING: FAILURE TO SECURE ORKEFts..coMPENSATION COVERAGE IS
UNLAWFUL; AND SHALL SUBJECT, AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL.
FINES UP TO ONEI-iUNDRED 11-j SAND. DOLLARS ($100,000), IN ADDITlON TO THE
COST OF COMPENSATION, DAMAGES AS PROVI DED FOR IN SECTiON 3706 OF THE
LASOR COD E, I NTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty-of, perjury that there is_a const~uction lendi09_ager,cyfor the
performance of the work for which this permit is issued (Sec.3097-.Civ.C):
Lender's. Information:
Construcion Types:
VN; ,
Fire Sprinklered?
NO
e: 6/6/2005
. Signature of Applicant or. Agent : . .
The ~ermit shall expire by limitation and become null and void if the building or
work has not passed final inspection 365 days from the date of permit issualce. A
new Per:'nit is required to commence or continue work.
Fees paid for Permit:
Total:
485.74
INSPECTION RECORD
INSPECTION
Temporary power Pole'
Plumbing (Drain/Waste Pipe)
Electrical Ground Electrode/lifer
SelbacklFormsrrrenches (Footings)
Do not install subfloor or pourtloor slab until the
following applicable items have been signed:
Plumbing (Water Plpe.Sprinkler Valves)
Mechanical (GroundwOrk)
Electrical (Underground Conduit)
Pre-slab (Compaction/Membrane.Rei nt.
Underpinning (Floor Joist/Girders)
Do not cover or conceal the work below unt. the
following applicable items have been signed: '
1st Floor Shear
Firesprinkler (Rough)
2nd Floor Shear
Roof (Sheathing/Diaphragm/Frame
Masonry (ReinfJBond BeamlF're-Grout)
Rough Plumbing (Top Out)
'Rough Mechanical.
ugh E1ectrtcal ( all
Rough Elecl\i"'"
Framing (Only after Plbg~ Elec.. Mech.. and Fire)
Insulation (SoundJEnergy)
po noltape or pla(iter unlilthe following applicable
Ite~s.have been signed: .
Drywall
PenetratiOlis (Fire Rated) Electrical
Penetrations (Fire Rated) Mechanical
Penetrations (Fire Rated) Plumbing
Inlerior Lath
Exterior Lath
DATE
GENERAL ITEMS
Exterior Plaster (Brown Coal)
T -Bar Electrical
T-Bar Mechanical
T -Bar Structural
Sewer
Water Engineering Bacldlow
Water Service
INSPECTOR
-
FINAL INSPECTIONS . Date.. Inspector
Electrical Final
Plumbing Final .'
Mechanical Final'
Gas Test , ,
,
Engineering/Grading Final 765-5126
Fire Dep!. Final 765-4040 , .' "
Water Engineering 765-5268 .
Sub List/Business License 765-519 ,
Zoning 765-5139
Building Final \kaSI Inspection- Only Itlt%r( rr:- ~~
.' fter Above Complete}
PARTIAL INSPECTIONS
Buildina Inspections
Mechanical Inspections..
PlumbinQ, Inspections
Electrical Inspections