1308 N. Patt St. (3)
. TYPE OF PERMIT
Reroof
CITY
l~~f~.t~~::~~i;~\\ . .
{l'~~1\f\t~H ElM.
\\\~l~li~~I>; .
.
BUIlDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUESTLINE:
(714) 765 - 4626
CENSUS CODE: 555
QUARTER SECTION: 81
BU!LD!NG PERMIT NO. BLD2004'03332
DATE: 8/31/20Q4
JOB ADDRESS: 1308 N PATT ST
LEGAL DESCRIPTION: SEC 3 T 4 R 10 POR SE1/4
. APPliCANT:
OWNER INFORMATION: CONTRACTOR INFORMATION:
Packing CBridgford
1308 N PottSt
Anaheim, CA 92801 . .
JOB DESCRIPTION partial reroof wtih tear-off new built-up ro'ofing (south ~~e:.', end of brdg)
ARCHITECT/ENGINEER INFORMATION:
VALUATION: 30,000.00.
.1 OWNER.BUILDE1, DECLARATION
I hereby affirm under penalty of perjury that I'am exempt from the Contrac.t6's License Law for the following. reason (See 7031.5 Business and
Professions Code: any city or county which requires a PE7rmit to construct, ~l::er. fmprove, demolish Of repair any structure, prie{te its issuange. also
requires the applicant for such permit to file a signE;'ld statement that he is licilnsed pursuant to th!3 provisions of the Contractor's License Law (Chapter
9)(commencing with Section 7000 of Division 3 of the Business an~ Profes~.a.n:j> Code) or that he is exempt therefrom and the b~sis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit SJJ~jccts the Cl pplicant to a civil penalty 9f not more fhs n five hundred doflar~
($500). . . . . . . .
o I, as_owner of property, or my emp!,oyees with wages as their Sole comi!9nsation, will do the work, and the sti-uctu~e is not i~tended or offered for
sale (Sec. 7044 Business and Professions Cpde: The Contractor's License 1,aw 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 ""',il employees, provided that ,such improvements are not intended or
offerEld torsale._, If, however. the ,building or improvement !s sold withonE~ Yliai-of wmpletion, the owner-builder will 11ave 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 exduswely contracting with licen:=:.ecwntractors to constflJct the pr'oject (See. ':'044 Business and Professions
Code: The'Contractor's licenSe Law does ni:)t< apply to an owner of propertl'\vho builds or improves thereon,-aricfwho contracts for SL:ch projects with
~ontractor(s) licensed pursuant to the Contractor's License Law). '
LJ 'am exempt under Sec. ' ,B & P .C. for this reason:
Date: Owner:.. . ' ,
r WORKER'S COMPENSATION DECLARATIOG_~J
I hereby ~affirm_ under penalty 'of perjury one ot the fo!lowing declarations: '
o I have and will maintain a certificate of ronsent to self-in.'5ur.e for worker'~ compensation,
as provided for by Section 3700 of tt:le Labor Code, fol' the performance oftl~e work for which
this permit is issued., ", '
D I haye andwill maintain'worker's compensation insurance, as required bj Section 3700 of
the Labor Code, for the perforrnafJce of the work for which this permit is iSSLI~d. Myworker's
COlTlpensation insurance carrier and policy are: ;'
Carrier: . Policy Number. -I: , I NUMBEJ~
This sec~ion need not be completed if the pennit is for one hundred dollars ($10[.) or less. TYPE
D. I certify'that in the,pe!io'rrnance of the work for which this permit is i~.!JEd!.} ;3hall not. . '
employ any person in any manner so as to become 8ubject to the work~(s co:npensation laws
of Califomia,'and agree that if I should become SU bject ,to the worker's~oinP'3n'sQtion
."""~ m ~,~"'OO m'''"~'~' 'ro" bOO . _" ". 'b. _".. ~.~,~ ~'"
VN"
Fire Sprinklered?
PROCESSED BY: DOR
LICENSED CONTRACTORS DECLARATION
I hersby affirm under penalty'of perj1lry that I am
licensed under proviSions of cilapter 9 ( ornmencing
, with Section 7000) nfOivsion 3 of t ' sjne~s and
Professioo,"Eode. .
8131/2004k U
Date: , .
Contractor
EXPIRATlON DATE
Date: 8/31/2004 Applicant" _
WARNING: FAILURE TO SECUR RKER' OMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALT!ES AND CIViL
.FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN APDITIOfJTO THE
CQST. OF COMPENSATION, DAMAGES AS PROVIDED FOR IN S.ECT!On 3706 OF THE
LABOR CODE, INTEREST AND ATTORNEY'S FEES. . :. .
I CONSTRUCTION LENDING AGENCY y
I hereby affirm under penalty of perjury that there, is a construction lending agdj'Cyfor the:
performanCe of the work for which this permit is-issued (Sec.3097 .Civ.C): '
Lender's Information:, ._ __ _,. ~-;"'''~~-
NO
I ceri:i~ th~t I have react this application and state, that the above information is correct. I
agree to comply with all city ordinances a-nd state laws relating to building construction, and
hereby authorize representive of this dty to enter upon the a bove mentioned property for
i~sp~ction purposes.
Date: 8/31/2004
Fees paid for Permit:
Total:
540.00
.8" ature of pplicant or Agent
The permit shall expire by limitation and become null and void if the building or
work has not passed final i1ispection 365 days from the date of permit issuance. A
new permit is required tocommenc"e or continue work.
INSPECTION RECORD
INSPECTION . . DATE. INSPECTOR
Temporary .Power Pole
Plumbing (DrainlWaste Pipe) . .
Electrical Ground Electrode/uter
SetbacklFormslTrencb'" (Footings).
Do not inst"lI subfloor or pour floor slab until the
following applicable items have been signed: . . .
Plumbing (Water Pipe.Sprinkler Valves) .
Mechanical (Groundwork) .
Electrical (Underground Conduit) .'
Pre~lab (Compaction/Membrane.Rllinf.
Underpinning (Floor Joist/Girders) '. .
Do not cover or conceal the work below unt'l the
(ollowing app1itaQle items have been signed: ". . .
1 st Floor Shear
FireSpriilkler (Rough) .
2nd Floor Shear ./..
Roof (Sheathing/Diaphragm/Frame) '(f .1-&1 Iff. .
Masonry (ReinfJBondBeamlPre-GlO\It) , , .
Rough Plumbing (Top Out) .
Rough Mechal)ical . '. '.
Rough BectriCaI (Dry wall) .
Rough Electrical .
Framing (Only after Plbg,. Elec.. r..iech, and Fire)
Insulation (SoundlEnergy) . .' "
00 not tape or plaster untilltle following applicable.
items have been signed:. '. .
Drywall. . . .
Penetrations (Fire Rated) Electri.cal .
Penetrations (Fire Rated) Mechan.ical . .
Penetrations (Fire Rated) P'umbil1!l . .
Interior Lath ..... . . .
Exterior Lath . . .
GENERAL ITEMS
exterior Plaster (Brown Coal) .' .
T'Bar Electrical .
T -Bar Mechanical . . . .
T -Bar Structural . .' .
Sewer . .
Water Engin..,ring Backfl.o,!, . .
Water Service
FINAL INSPECTIONS Date' Inspector.
Electrical Final .
'. ..
Plumbing Final . .'
.
Mechanical F~nal .
. . .
Gas Test . .,
Engineering/Grading Final 765-51.26
Fire Dept. Final 7654040 .
Water E.nginee.~ing 765-5268
Sub List/Business License 765-519
Zoning 765-5139 / /
Building Final ~ast Inspection; Only . B/q/1l5 JA.l)QwS~1
fter Above Complete)
. PARTIAL INSPEcrlol-ls .
Buildina Insoections
Mechanical. hisoections
,Plumbina Insoections
Electricallnsoections
"